By Manogni T:
The right to health is one of the Fundamental Rights guaranteed under Article 21 of the Indian Constitution. The historic ruling of the Supreme Court in 2018, which read down a colonial-era law (Section 377 of the Indian Penal Code) effectively decriminalizing homosexuality in India, was a magnificent direction for the country as a democracy with an incredibly gender-diverse population to follow. But for LGBTQAI+ citizens, healthcare has been an inaccessible and problematic sphere for the longest period of time. Multiple instances of LGBTQAI+ individuals stating their discomfort around healthcare professionals (and their discriminatory reactions) has been the norm in the community for a long time.
On The Stigma Induced Practices
A recent article by NPR on Anti-Gay law history in India featured the harrowing account of Shivam Sharma who rushed to a hospital in Mumbai because he had spent the night earlier with a man who was HIV positive. The account sprawls through how the nurses and other hospital staff treated Sharma with indecency and outright harassing him. This is similar to how most LGBTQ+ Indians describe their encounters with healthcare professionals.
A study conducted by M. V. Lee Badgett, professor of economics at the University of Massachusetts, in 2014, titled “The Economic Cost of Stigma and the Exclusion of LGBT people” in India (also a part of a World Bank project) showcased how 64% of Indians believed that homosexuality could never be justified. It also reflected how public health studies found evidence of health disparities for LGBTQ+ persons which could be linked to environments of stigma and exclusion. Higher rates of depression, suicidal thoughts, and levels of HIV among LGBTQ+ people are worth significant mention as compared to the general population.
On Health And Sexual Concerns
The landmark judgment of Section 377 does intend to recognize and sensitize medical practitioners and the overall medical community. One of the main concerns is the susceptibility to health problems among the LGBTQ+ community, coupled with stigma and discrimination.
The prevalence of HIV in men who have sex with men (MSM) ranges between 7% to 16.5%, according to the Indian Journal of Medical Research. The National AIDS control programme (NACP) is currently providing preventative measures such as HIV education, voluntary HIV counseling, and treatment of sexually transmitted infections (STIs). Yet, there is a high disproportion of sexual risk among MSMs because of the social pressure to marry women and have children. This is followed by engaging in unprotected sex with both male and female partners, and thus creating a bridge between other high-risk MSM and transgender people and female partners or spouses according to various studies. A high number of MSMs also are seen engaging in unsafe commercial sex work which adds to this risk.
A study in Chennai assessed the concerns among perceptions of sexual risk using significant predictors of unprotected sex and it was clear that not being a part of HIV prevention programmes, or being less educated, being unaware, only adds to the complications around sexual risk perceptions in India, where LGBTQ+ communities are concerned.
There are no widespread triangulated studies with women who have sex with other women. Qualitative research and knowledge building about sexual and reproductive healthcare among various subgroups of the LGBTQ+ community is urgently required for a better implementation of public health programmes.
Systemically tackling problems such as stigma, sensitization, and education, which are all interlinked issues is the call of the day.
Providing support to non-governmental organizations to tackle and evaluate situations such as these with research and informed programmes, for action and aid, help move the discourse towards minorities in the community as well as the general population, which is extremely crucial.
Making It A Reality
Initiating conversations and destigmatising reproductive health-related topics are the only ways to ensure and build a more conducive environment for positive and effective healthcare outreach. Sexual and reproductive health topics in schools and colleges are glossed over, all thanks to the ‘taboo’ around them. Many individuals suffer at the hands of poor sex education. Gender minorities are burdened with the ill-treatment and inefficiency of public and private health officials.
Karthik, a queer student, narrates his experience, “I might be embarrassed by questions regarding my gender identity […] most doctors accuse me of promiscuity and won’t care if I have actually come for treatment for fever or cold.”
Vyjayanti Vasanta Mogli, an LGBTQ+ activist and public policy scholar, told Livemint, “Village medics and babas often prescribe rape to cure lesbians of homosexuality. Refusal to marry brings on more physical abuse. Stories of family acceptance that you see on TV and other media platforms are more often than not an urban phenomenon.”
Open ended conversations—co-learning, co-sharing and co-understanding—is incredibly necessary to solve the health and reproductive concerns of the LGBTQ+ community. We need systems enriched to cater to citizens from all walks of life irrespective of gender and class.
The hour is now. There never will be a more perfect time to spark action and shift societal perceptions.
Manogni T. is an Editorial Intern at One Future Collective.