Discrimination against LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other) people is rampant in health care services in India, a new study has found. Stigma and discrimination against people of different sexual orientations and gender expressions acts as a barrier to accessing healthcare and violates human rights.
the Qualitative study by Lakshya Arora, Dr PM Bhujang and Professor Muthusamy Sivakami was published in Sexual and reproductive health issues.
In-depth interviews were conducted with 15 self-identified LGBTQIA+ individuals who had sought healthcare services at six hospitals in the major cities of Delhi and Mumbai and with 23 cisgender heterosexual employees of those hospitals. In each city, a hospital from the public, private and non-profit sector participated.
Although the small sample size could be a limitation, the researchers made an effort to enroll study participants from a diverse spectrum of the LGBTQIA+ community. About half were gay and lesbian, and the rest identified as bisexual, asexual, queer and other gender diversities. Just under half were not cisgender.
The hospital employees interviewed worked not only in HIV and mental health services (the focus of most previous studies), but also in departments such as venereology, endocrinology, gynecology, proctology, and surgery.
The LGBTQIA+ community is not homogeneous
The researchers found that the majority of hospital employees (especially hospital administrators) viewed the LGBTQIA+ community as a homogeneous entity. The unique health care needs of different people across the broad spectrum of gender and sexual orientation diversity were not addressed. However, the staff in the HIV departments were less discriminatory than others.
Hospital administration and healthcare services are designed and structured around the gender binary, which often leads to the exclusion of gender diverse people. One transgender woman told researchers:
“In hospital settings, everything is gendered in a binary, be it the OPD [outpatient department] lines, medical records, rooms or bathrooms. I felt comfortable in feminine environments, but they kept me isolated from everything.
LGBTQIA+ participants felt that the lack of adequate training of health professionals resulted in discriminatory incidents including humiliation, verbal attacks, and threats to reveal their sexual orientation. A transgender man receiving gender-affirming hormone therapy shared:
“When I went to a doctor for a cough and cold, he was shocked to learn that I have a beard and a vagina… He forced me to show my private parts and even tried to enroll me in a clinical trial. But I asked if cough and cold are treated through the vagina.
Another transgender man said:
“That guard at the entrance gate told me that I don’t look like a normal patient… Other patients will be scared by my appearance… I should go to an NGO for my healthcare needs instead of visiting this hospital; or should I bring a person from the NGO to accompany me to the hospital…”
LGBTQIA+ people who came from different socioeconomic classes, castes, religions, and non-metropolitan areas reported intersectional discrimination. Lesbian and bisexual women shared testimonials exposing discrimination based on sexual orientation and gender, often compounded by other factors.
“We need more open-minded doctors who don’t just make assumptions. They asked me about birth control measures even after I came out. The doctor even made me feel ashamed.”
“She [doctor] I prescribed her a medication without a written prescription which turned out to be a high-dose psychiatric drug… Upon questioning, she said that she assumed that I was facing family pressures (including cases of sexual abuse, abuse and violence).”
Recent legal reforms in India not implemented
India has made significant legal and policy reforms in recent years to decriminalize same-sex behavior and advance the social welfare of transgender people. But the implementation of the existing laws is very unsatisfactory. The study found that most doctors and hospital administrators were unaware of legal and policy protections.
Hospitals lacked policies that included all genders and sexualities. Gender-affirming guidelines in public hospitals were often limited to the creation of sexual harassment committees and medical certification of transgender people.
The nonprofit hospitals in the study did not have any gender diversity or inclusion policies, other than those against sexual harassment of women in the workplace. Nonprofit hospitals with religious affiliations were reluctant to even discuss LGBTQIA+-inclusive policies.
Discrimination against LGBTQIA+ people was explicit in public hospitals (including allegations of sexual harassment) but implicit or subtle in private hospitals. One asexual female person in the study shared:
“Just because I didn’t have any feelings, he (health professional) touched me… And when I wanted to take him to the management, he said that the management is not going to support me, as this is under the treatment plan. to make me sexually active. ”
Private hospitals were hesitant to risk losing their majority cisgender clientele by openly serving the needs of LGBTQIA+ people.
Some evidence-based services, such as gender-affirming surgeries and hormone therapies, were rarely available. A doctor at a public hospital told the researchers:
“Endocrinology as a department itself is mostly available in tertiary care centers as a super specialty. Our hospital’s endocrinology department is limited primarily to thyroidism and diabetes, along with special clinics once a week on podiatry, adrenal disorders, and pituitary and growth disorders. We have never thought of extending our services to LGBT(QIA+) people as well.”
Another doctor shared that no doctor known to him was equipped to perform gender reassignment surgery or related treatment.
“Neither are doctors trained in such treatments and procedures (gender affirmative counselling, hormones, and surgical procedures)…nor does India have a highly trained medical workforce to perform such procedures.”
The study records statements from many LGBTQIA+ people who have undergone gender-affirming surgeries but still face medical complications due to poor care.
The lack of adequate healthcare for LGBTQIA+ people and especially transgender people results in people receiving unscientific “care” in the informal sector. A doctor said:
“The failing public health system and lack of financial independence for LGBTQIA+ people results in… [them] visiting charlatans. The treatments given by quacks are ineffective and are mostly limited to elixirs, creams and inappropriate implants, with silicon content”.
Despite the ban on ‘conversion therapies’ by the National Medical Commission of India, the reality on the ground is very different, with study respondents recounting harrowing experiences of being subjected to such ‘therapies’.
“The social pressure was so great that they (family) took me to a religious healer who charged me 500,000 rupees [over US $6000] for a hawan (fire ritual) and Rudraksh (form of bead)… And when I didn’t become entitlement, they spent another 100,000 rupees [$1220] in a conversion psychotherapy hospital.”
Not just HIV services, but comprehensive health services
Professor Muthusamy Sivakami told aidsmap: “Just like anyone else, people living with HIV also face colds and coughs, diabetes, COPD or may be exposed to other risk factors” that can increase their risk of contracting diseases. not communicable or infectious.
His colleague Lakshya Arora added: “I spoke to one of the gurus of hijra community who told me that ‘all these people from NGOs give us condoms, but they have never tried to give out paracetamol’. So, that was a big mindset shift for me. While it is undeniably important to ensure that HIV services reach everyone, it is equally important to ensure that other health care services also reach everyone, especially LGBTQIA+ people, in a rights-based and non-discriminatory manner.”
Sivakami says this qualitative study provides a deeper understanding of the range of discrimination LGBTQIA+ people face in public, private, and non-profit hospitals. The study findings highlight the need for organizational and systemic changes for non-discriminatory and rights-based access to health services for LGBTQIA+ people.
“We need to reform our public health policies so that all LGBTQIA+ people feel comfortable seeking services at primary or community health care clinics, as well as tertiary care hospitals,” Lakshya said. She also underlined the obligations of Indian public bodies to be gender inclusive. the Judgment section 377 The decriminalization of same-sex behavior calls for greater awareness, while the recent Madras High Court Judgment banning conversion therapy includes the entire spectrum of the LGBTQIA+ population and directs the government to promote far-reaching social changes.