What Is India’s Medical Community Doing to End the Apathy and Abuse Trans* People Face in Healthcare?

I haven’t fallen ill for some time now, but when I do, I try my best to self-medicate. When that doesn’t work, and I need to go to the doctor, I am struck with panic. Worsening symptoms alone do not trigger this panic—it’s the fear of discrimination at clinics and hospitals. Healthcare avoidance is not just my problem. Unfortunately, many trans* folks are in the same boat. We suffer because of institutional bias in the medical community. And so, we continue with self-treatment, knowing well that it’s dangerous, all the while imagining the worst it could do to us.

The anxiety of medical encounters kept me from booking my COVID vaccine slot for months. This hesitation can be dangerous and adds a tremendous amount of distress to every small or big health crisis we face. Every time I have to go to a clinic, the anxiety is extreme—the misgendering, the stares, the unsolicited questions, not to mention the lack of confidence in the system. In short—healthcare is a nightmare for most trans* people.

The pandemic’s impact on trans* people is still not understood by most. According to the Co-WIN dashboard, only 35,000 trans* people (out of 4 lakhs approximately that live in India) have received vaccinations at the time I am writing this. That means a whopping 3 lakh 65 thousand weren’t vaccinated, even though it was seen as the only shield for possible survival. It’s as if our lives don’t count as much as those of cis-folks.

Not only do trans* people evade routine medical checks to avoid stress, we dread interacting with medical staff even during emergencies. Rina (name changed), a trans* woman, told me she had to go to a hospital in Kolkata after she was in an accident. The auto-rickshaw she was in collided with a bike causing serious injury to the back of her head and her arm.  She was made to wait for hours only because the hospital was confused about which ward they should place her in—men’s or women’s. Eventually, to get the necessary treatment, she had to book a private cabin beyond her budget. Zahir (name changed), a non-binary person I know, recently experienced emotional and mental distress during a visit to a clinic in Mumbai where they had gone for a blood test. Information about their genitals was demanded even though it wasn’t required for the test. These invasive questions and discriminatory behaviours add up—we are forced to live with this collective trauma.

Gender affirming medical intervention is often considered a mere cosmetic procedure. But for some trans* folks, it is much-needed to find relief from the very real dysphoria that hinders their everyday functioning. This mental, emotional, and physical upheaval is something the cishet world has no imagination for. Therefore, it isn’t viewed as something that requires urgent medical intervention. The cis-centeredness of medicine also distorts the knowledge related to hormone replacement therapy and procedures like vaginoplasty and phalloplasty. This deepens the existing stigma and shame around the procedures, creating barriers for many trans* people. It's no surprise that medical insurances—whether individual or those offered by organisations for their employees—do not, in most cases, include gender-affirming intervention in their schemes. Besides, some of us may want to transition medically, but that's not the end of our story. We obviously need other medical care as all humans do. But clinical encounters are violent for us. And this rampant human rights violation is routinely ignored by a cishet dominated world.

The constant fetishisation and hypersexualisation of trans* women and fem-representing individuals is so extreme that it completely strips us of our humanity even during healthcare access. Stigma and disgust make our interactions with doctors and healthcare experts dangerous. We are not received in clinics as worthy of care. It’s one of the worst kinds of ostracisation a human being can face. If we ever contract a sexually transmitted infection (STI), we are told it’s because of our “lifestyle”. Neglect by healthcare providers is common.  According to a report published in The Wire on India’s healthcare system and its inaccessibility to queer and trans* people, out of 7.2% of transgender people who are living with HIV, only 59% had been referred for testing, and just 33% had received counselling about treatment options.

Sexual and reproductive health for transgender people is not limited to STIs and HIV. At the TAG Transgender Rights Conference (2021), Dr Aqsa Shaikh, a transgender woman and doctor, said both medical professionals and the law reduce transgender persons to their body parts and stigmatise them. “Medical professionals completely ignore reproduction in discussions around transgender persons’ bodies, believing them to be asexual or hypersexual perverts incapable of having children.”  At the same conference, Vihaan Peethambar, a trans* man and activist, spoke about the need to include transmasculine folks in conversations around reproduction and reproductive health. As recently as in 2021, the Medical Termination of Pregnancy Act, 1971 was amended to expand the scope of access to safe abortion, yet it failed to include trans* folks within its scope.

Even though the Transgender Persons (Protection of Rights) Act, 2019  asks for the enforcement of sensitisation programmes for trans* healthcare, there is no implementation. There are numerous cases of trans* people blatantly being refused hospital beds, yet these do not ever make it to mainstream news reporting. The barriers to healthcare are rooted in generalised transphobia ^[1] and the systemic failure to address the needs of trans* folks. What makes it worse is that there is rarely any documentation of the violations of our rights, the mistreatment, and the discrimination.

Any mental or emotional health crisis queer/trans* folks face is seen as their fault, directly or indirectly caused by their queerness or transness. This is the cishet gaze, and mental health practitioners have only started learning about queer- trans* affirmative therapy practices. We are losing time and the opportunity to live whole lives. Gender affirming care—medical and psychosocial healthcare designed to affirm people’s gender identities—is known to be life-saving. It can greatly improve the overall well-being of gender diverse, trans* and non-binary people, including children and adolescents. In India, there is no push towards this kind of care. There is an urgent need for those in the medical field in India to understand how unethical and transphobic this silence is. Under the Indian Medical Association Code of Conduct, doctors pledge to respect the human dignity and fundamental freedom of all their patients and to “protect individuals & groups of special vulnerability & respect the personal integrity of such individuals and groups.” Perhaps, they need to explain what happens to this pledge when trans* patients are being treated. The burden lies on the Indian medical community to educate themselves and understand that their biases push trans* people into fatal situations.

Cishet people must vacate space in the medical community for trans* professionals to occupy. That is the only way policies can shift to grant us what we deserve—our right to health care without hesitation or fear. What a relief it would be to be treated by queer or trans* doctors whom we can trust our bodies with!

[1] *We acknowledge that the etymology of the word “transphobia” is problematic. “Phobia” could be interpreted as “biological fear” absolving people of their responsibility for the prejudice they hold against transsexual or transgender people. Such prejudice leads to violence, oppression, and discrimination.