Lets get this Straight. Indian Healthcare needs to get LGBT-friendly

Traditionally, Indian healthcare has pretty much ignored the health concerns of lesbian, gay, bisexual and transgender communities. Here’s why not much has changed and what might actually work in Indian hospitals.

As he made his way from his home, near Anna Nagar to Nungambakkam, *Karthik, a queer student felt his courage slowly crumble. He had to meet an endocrinologist at one of the top tertiary hospitals in Chennai. But by, the time he reached the hospital, he lost his nerve. “I might be embarrassed by questions regarding my gender identity,” says *Karthik, anxious about sharing his case history with his doctor. “Most doctors accuse me of promiscuity and won’t care if I have actually come for treatment for fever or cold,” he says.

*Deepanjana, another resident of the South Indian city, formerly known as Madras, seconds his views. “I have always struggled with my orientation. To a point where I thought that it was a mistake to be the way I am. It took a really long time for me to come to terms with it,” says the thirty something anesthesiologist.

What’s it like to be a Sexual Minority in an Indian Hospital

Over the years *Deepanjana ,the young doctor has noticed homosexuality being written in black and white as a psychiatric illness in routine psych evaluation questionnaires.

When she and a friend went for blood donation, she had to fill in a declaration questionnaire which included homosexuality as a disease right next to HIV.It drove her crazy, but she had to curb her irritation. “Once in medical school, a gay couple walked into a psychiatrist’s outpatient service for some other issue and the learned colleague went on to counsel them for the next 2 hours about how homosexuality is a disease, a deviation from nature”, she recalls”

Controversies related to transphobia and homophobia regularly pop up in Indian hospitals. In fact, in the case of Anirban Kundu, a trans-woman, her condition became critical, only because the maternity hospital in Kolkata refused to admit her.

Bathrooms, Wards and Pronouns

For many researchers and activists like *Deepanjana the widespread apathy and stigma is frustrating, because there are effective methods of making a healthcare setting more gender inclusive. In the past, several news agencies have reported how many LGBT avoid healthcare facilities due to the fear of being ostracized. In hospitals, gender segregated wards, bathrooms can be of particular concern to gender minorities.

“I know trans-men and women struggle to get the receptionist’s attention in hospitals just to be seen by a doctor. These things don’t usually happen to cis-men and women. Imagine the emotional trauma they must go through when hospital authorities insist on using their old names and genders and LGBT struggle because they don’t have a legal document in their preferred name gender and pronoun. And how about lesbian/bi women been asked questions in OB-GYN centers about being sexually active. When they ask about protected sex sometimes I don’t know whether to laugh or cry,” says *Deepanjana, who has been in the business of saving lives for the past ten years.

Interestingly, many Indians often use sex and gender interchangeably. But in fact, these are two separate characteristics. At birth, a child is assigned with a sex, based on their body parts. Gender is a broader term which includes a person’s internal sense of who they are.

When a person’s gender aligns with its sex assigned at birth, he/she is called cis-gender, which is the common case. When a person’s gender does not align with sex assigned at birth, he/she is called transgender. Cis-gender comes from a term called cis-molecule in organic chemistry, where a cis molecule is a molecule with two functional groups, oriented in the same direction. In a trans-molecule, the functional groups are oriented in the opposite direction.

What Indian Doctors don’t know about LGBT Health

Sadly, the accurate size of India’s LGBT population is hard to come by, but 2.5 million could be labeled LGBT. http://www.bbc.com/news/world-asia-india-17363200 .Yet, despite the increasing awareness among the healthcare providers about the gender spectrum, some doctors say that they feel awkward with transgender patients, because they don’t feel equipped with the right language or knowledge about gender identity. According to a 2006 study to assess attitudes, knowledge and skills of medical students in India with respect to LGBT population, a significant 55.43 per cent thought homosexuality was a psychological disorder and required therapy. In the book, Nothing to Fix, Dr Bharath Reddy, points out that “several students said that they made eye contact (42.39%), did not conduct procedures that avoided physical contact (46.73%) and did not spend more time discussing their sexual behavior (29.34%).”

LGBT Health Disparities

There are numerous health disparities which affect members of this population. These stem from legal factors (section 377), stigma, and a lack of gender inclusive health care.

One challenge that many researchers face in studying LGBT health is the sheer lack of data. Further, individuals and their partners in same-sex relationships are less likely to have health insurance and are more likely to report unmet health needs. Sexually transmitted infections, including human immunodeficiency virus (HIV), are major concerns in some LGBT groups. The Centers for Disease Control and Prevention (CDC) reports that in 2009, gay and bisexual men accounted for 61 percent of all HIV infections in the United States, and 78 percent of all new infections among men . In India, the prevalence of HIV is estimated to be 12 times higher among MSM than among men overall. Even though, there is no comprehensive data available for entire India, it is safe to assume that the numbers would be similar or higher in the traditional Indian society. In addition to tobacco abuse, alcohol and other drug abuse may be more common among LGBT. Several studies have also suggested higher rates of depression, anxiety and suicidesamong the community . For instance, according to Indian Journal of Psychological Medicine, thirty-one percent of transgender persons in India end their life by committing suicide, and 50% of them have attempted suicide at least once before their twentieth birthday. Research on depression among MSM in India from Chennai, Kumbakonam, Mumbai, Kolkata and Ahmadabad indicates that MSM are at risk for depression, with estimates ranging from 29 to 55 %.

In the past several years, India has started to grapple with these problems, or at least to quantify them. In 2014, the Supreme Court of India recognized that people who identify themselves as transgender can identify themselves as a “Third Gender” legally. Following the judgment, several Indian states announced schemes for the community. The numbers were not good; neither were the quality of services provided at the hospitals.

Pathologizing Non-procreating Sexual Desire

And then there are public utterances that reveal what leading men in policymaking think of the LGBT community and their healthcare needs. In 2011, Ghulam Nabi Azad, the health minister described homosexuality as ‘unnatural disease’ from the west at a HIV/AIDS conference in New Delhi. “Unfortunately this disease has come to our country too … where a man has sex with another man, which is completely unnatural and should not happen but does,” Azad said.

Time to De-Pathologize

Still there is hope. Several non-profit organizations and consultants have sprung up to provide solutions for the community.

“Identifying and training exceptional staff members who can effectively communicate respect for all patients, regardless of their gender identity, is a key component of a welcoming, gender expansive clinic environment. If the staff members themselves can be representative of the diversity that the clinic wishes to welcome, that’s even better,” explains Biswa Bhusan Pattanayak, a social worker, who has been working with the LGBT community in Orissa and North-East for more than ten years.

Pattanayak says gender bias is a big problem in Indian government hospitals, where doctors try to cure deviant sexual behaviour. “There is a long history of anti-LGBT bias in healthcare which continues to shape access to care for LGBT individuals . Until 1973, homosexuality was listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Due to the pathologic understanding of homosexuality and transgender identity, many LGBT individuals were subjected to treatments such as cognitive behavior therapy, aversion therapy, hormone therapy or castration in the past. Many LGBT patients often don’t reveal their sexual orientation to doctors or their providers, as many providers perceive it as a deviant sexual behavior,” he adds.

Perhaps most encouraging is that, as new organizations come along, some of them are preemptively adopting the lessons that other non-profit organizations have already learnt-training grass root level organizations to empower the community.

Shubha Chacko, Executive Director at Solidarity Foundation tells that the requirement of each section of LGBT is different. “We partner with local organizations, to help LGBT community. Members often go with patients during doctor visitors. We also make a list of allies in the healthcare space and circulate it among the community .”


Author : Team HE

Healthcare Executive

Written by

Healthcare Executive is an exclusive online Healthcare Business magazine based in India .

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