A year before homosexuality was decriminalized in India in 2018, the Supreme Court defined privacy as a fundamental human right. The court’s verdict concluded that a person’s sexual orientation was “an essential attribute of privacy.” Discrimination based on sexual orientation was therefore regarded as both illegal and “deeply offensive to the dignity and self-worth of the individual.”
While advocacy in the form of decriminalization provided a platform for a landmark legal victory, de facto systems of oppression against LGBTQ+ communities continue to persist. The denial of civil and human rights, the need for increased social empathy and awareness, the absence of adequate familial support – these are all inequities that create barriers to accessible, informed healthcare.
There are gaps in the availability and scope of academic research about LGBTQ+ health in India. Many of the issues faced have been documented by community members themselves following negative clinical encounters. Additionally, the use of indigenous self-identification labels (ex: hijra, kothi, panthi) indicates the importance of understanding how these identities are lived in specific cultural contexts. Even with these demographic challenges, existing studies demonstrate significant health disparities when comparing LGBTQ+ individuals with their cis-gendered, heterosexual counterparts. LGBTQ+ people are more likely to be denied medical care due to their gender identity and consequently avoid treatment for fear of discrimination. A 2014 report by India’s National AIDS Control Organization found that the prevalence of HIV among transgender populations was about 26% higher than the country’s overall HIV prevalence level. Given more frequent instances of bullying, harassment, and structural and interpersonal violence that are often not quantified by the law, LGBTQ+ individuals are more vulnerable to experiencing mental health conditions, including depression and substance use.
Currently, there appears to be no formal LGTBQ + training in medical schools, either in India or the United States. The lack of official sensitization trainings is significant because education on non-discriminatory practices and standardization of certain history-taking and counseling procedures can help create a safer clinical space. On a societal level, while certain states, including Tamil Nadu, have attempted to address some of these issues by providing free sex reassignment surgery (SRS) at few governmental hospitals, long waiting lists, difficulty in scheduling appointments, and bureaucratic delays with obtaining medical/legal documents make these procedures inaccessible for many people. More recently, in December 2019, India’s Parliament passed the Transgender Persons (Protection of Rights) Bill. The legislation requires trans people to apply for a “transgender certificate” and “change in gender certificate,” the latter of which asks for medical proof of gender-affirming surgery (SRS), to be legally recognized as transgender. It’s a law that backtracks the progress made in securing civil rights of the country’s sexual and gender minorities, disregarding people’s “right to dignity and bodily autonomy.”