How Healthy Are The healthcare Settings for Transgender or Hijra people?

User Rating: / 6
PoorBest 

Thursday, 07 June 2012 20:48

Written by Shobha Shukla – CNS

0 Comments

(CNS): The transgender, 'hijra' or 'kinnar' community is visible as usually its members can be spotted easily by way of their attire and mannerisms. However they are invisible in the sense that society shuns them and does not even want to acknowledge their existence. They face problems in all spheres of life. But, the impediments they face in accessing quality healthcare services at times, cause irreparable physical and mental damage to them and may even be life threatening.

Members of this forsaken community, along with civil society activists, recently met at a National consultation, aptly called Hijra Habba (festival), held in Delhi, to voice their legitimate concerns and seek solutions to their problems from the stakeholders and government officials present there. They had innumerable instances cite about the hardships they face even in getting the minimal amount of medical attention, leave alone any proper counseling worth the name.

According to Ernest Noronha from the United Nations Development Programme (UNDP) India, “The hijras face a two pronged problem within healthcare settings - one is the element of fear and the other is lack of knowledge. Even within the medical fraternity there are a lot of misconceptions/misgivings about them - are they born without some organs; do they have female organs; do they not have sexual organs? The examining doctor may not know what sexual organs the transgender (TG) has and is not prepared for the shock he might get (I am not even talking of the nurses and other staffs at that level because there is still more discrimination at that level). I strongly feel that the medical curriculum should have adequate information on sexual and health issues. Many transgenders suffer from mental health problems like depression and suicidal tendencies. So the doctor must understand what drives them towards such a state of despondency. They do not have anything to fall back upon apart from some community structure.  If you are excluded from your family and are living in a pseudo family, if you do not have children, then what is there for you to look forward to, beyond your earning age of 40 years? So healthcare professionals need to be more sensitized; communities need to be proactive; parents need to understand and the government has to be serious in its efforts.”

Zeenat Pasha, a prominent Hijra guru from Mumbai and a founder member of the Dai Welfare Society, the first community-based organization of Hijras in India, has been working with people living with HIV in the Kamathipura (red light) area of Mumbai for the past 17 years. She is very vocal about the problems faced by transgenders who are HIV positive, and rues that, “The government programs are limited to distribution of condoms and at the best admitting a patient in a hospital in case of serious sickness. When hijras go to a hospital to seek treatment the first dilemma of the doctor is whether to admit them in male ward or female ward. If the hijra is nirvana (they have got themselves emasculated) he is sent to female ward. If he is not emasculated they are put in male ward. Seeing the devastation and death caused by HIV/AIDS hijras are becoming more aware and are counseling each other to save themselves from HIV related death. Earlier they had no knowledge about the benefits of condoms and about clean injection syringes. But now they ensure that the doctor is using clean syringes; else they do not go to him. But only 30-35% hijras have become more aware. So a lot more still needs to be done.”

Billy Stewart, Senior Health and AIDS Adviser at Department For International Development (DFID), UK, also agrees that: “there is clearly a set of challenges about the transgender and hijra community to access  a lot many services, including health services. In India the counseling component is fairly weak across the board in health services, especially regarding mental health issues. This is one of the challenges for the country to develop community based interventions to deal with mental health requirement and counseling requirements of transgenders/hijras. The quality of health care services and Sex Reassignment Surgery (SRS) services also needs to improve and become more responsive. Of course the community will have to be engaged more for this. We need more articulate community members to come forward.”

James Robertson, Country Director of India HIV/AIDS Alliance informs that according to the best estimates available, the number of transgenders in India is 750,000 and the high prevalence of HIV incidence in the community ( it is 30 to 60 times higher than in general population) poses a serious challenge to address their health. He cites the case of a patient who was turned out from a West Bengal hospital even though she was suffering from sepsis after having undergone Sex Reassignment Surgery (SRS). It was after a lot of advocacy at civil society level and community led protests that finally they could find a hospital and doctor who could provide the care that she needed. James laments that, “Such incidences should never happen and yet they are very common. We have a very long way to go.  All of us have to become more sensitive towards them. There should be more sensitization programmes for doctors, health workers, government officials, policy makers. There should not only be sensitization but an understanding of the TG issue must be part of the medical training which doctors, nurses and healthcare professionals undergo.”

Mujra is a Hijra activist from Mumbai who runs a support group for Hijras living with HIV from her home and attends to those in need. She also provides quality peer counseling and yoga training to meet mental health needs of the TG and Hijra community who are also infected with HIV. She is very vocal about the problems which the hijra community faces in accessing treatment and healthcare services: “For them just to get tested for HIV/AIDS is a big issue. They do not get motivated easily to go for testing. They have to be counseled a lot that being HIV positive is not the end of life and that they can still live normally by taking medicines. Even when we convince the person to see a doctor, then we face many problems at the time of registration for which some identification and address proof is required, and in the absence of these documents registration cannot be done. All hijras do not possess such a proof. Similar problems occur at DOTS (Directly Observed Treatment Shortcourse) centre, where residential address of the patient is a compulsory requirement for registration. This is a big problem and I request the government to find a way out, as hijras are also a part of society. Again, even if the doctor at the health centre says yes for admission, when they go to the ward then the nurses and other staff reveal their identity and also wonder where they should keep the hijra. Then, other patients in the ward also start discriminating.”

“There is virtually no counseling worth the while available at government level. The patient is just told when he/she has to eat the medicines, and what nourishing diet is to be taken. But there is no quality counseling to equip the patient to cope with the disease and the mental stress and other psychological problems arising out of it. I try to counsel them on many aspects - mental, medicinal, etc. Here I would like to stress the importance of yoga in the treatment of HIV. I have helped many patients to not start on antiretroviral (ARV) treatment just by making them do yoga regularly. I think more community participation is needed to lessen our misery. Along with proper healthcare facilities we also need some income generation activity for hijras.”

This meet was organized by Pehchan project in association with India HIV/AIDS Alliance. (CNS)


The Third Gender Does Not Deserve A Third Grade Treatment
Shobha Shukla – CNS

(CNS): Raveena Bariha, the fire brand graduate tribal hijra activist from Chhattisgarh (a relatively backward state of India) is lovingly called the chhota bomb and chhota rocket.  At the recently concluded National Hijra Habba Consultation and Cultural Event, which was organized by Pehchān project, in association with India HIV/AIDS Alliance in Delhi, her diminutive frame dressed in a cotton salwar kurta without any jewellery stood apart from the other ornately dressed participants of her community. Raveena spoke to CNS about the hopes and aspirations, the trials and tribulations of the transgender and hijra/kinnar community.

This is what she had to say:

“As I am a kinnar, I have personally faced the problems affecting them. I have suffered a lot of taunts, jeers, disrespect, and discrimination even as a student and completed my graduation in very difficult circumstances. I know that the people of my community have a lot of ability to do well in life. What they really need is an enabling environment and some encouragement. It is for this reason that I started working full time for the broader good of my community in 2008, after resigning from a government teaching job. It was a hard decision as I was earning Rs 9000 per month. I then worked for some time as assistant editor for a Hindi press Hari bhoomi, and then with the National AIDS Control Organization (NACO) for targeted interventions in men who have sex with men (MSM) and hijra community. Then I formed my organization ‘Chhattisgarh Mitwa Sankalp Samiti’. Today 2000 hijra members are registered under it. Chhattisgarh is a relatively new state of India and the government is very proactive. We had recently given an application to the Chief Minister for formation of Welfare Board for Transgenders and the administration has already worked out the Board’s structure. I think that Chhattisgarh will be the second state after Tamilnadu, where such a board will become functional within the next few months. So it has been a fast process as compared to other states. We are collectively working on other issues too- like education, tree plantation, Anna Hazare’s anticorruption movement - just to help make the kinnars stay in the mainstream of society.

The main problem is the stigma and rejection the transgenders/hijras face in society. As soon as people come to know about their status the process of discrimination begins. This partly stems from ignorance of the people who only know about the male and female sex and are not even aware of the existence of a third sex. I am sure that if people are more informed about gender then 80% of the discrimination will vanish. So it would be helpful if information about the third sex is made part of the educational syllabus so that students are sensitized about this issue. We also need more legal awareness and sensitivity in law enforcers.

Also the community members should not fight amongst themselves but work together for their own betterment and rise above petty matters of colour, caste, creed, dress, etc. We have to remain united to get our rights. Our traditional behavior which makes us conspicuous and stand out in a crowd, stems from the natural human tendency to identify ones gender and sexuality through different means—dress, manner of talking, gesturing etc. Perhaps the gesture of clapping and dressing gaudily started to fulfill this urge. The community will have to move out of its traditional stereotype image and change its behavioral pattern to join the mainstream of society, so that others do not feel uncomfortable in their presence. It is the duty of the community leaders to mould existing perceptions and bring about positive changes in the existing traditions of the community which are detrimental to their growth. This is not just a social issue but a psychological issue as well. In our society mental hardships and problems still take a back bench and are not addressed properly. If we can address the problem of discrimination then all other problems will be taken care of.

I think that the enormous potential of the young transgender (TG) and Hijra is going untapped and unutilized owing to the high degree of multi-level stigma and discrimination against the community which is rampant in society. This is one of the reasons for the anger and frustration brewing within the young generation of the community who hardly have any other option than begging, singing badhais, and indulging in sex work. So it is very important to keep them in a healthy and positive atmosphere. I belong to an adivasi community where even the bride is forced by her own parents to drink liquor. But when I lived in a hostel all these conditioned attitudes vanished. Recently UNDP had conducted a month long leadership development program and within that period there was an unbelievable change in behavior patterns. If 30 days mentoring can do such wonders one can imagine the positive results we can achieve if we can have just one hostel for the young hijras where they can live and study for 3, 4 years. So my request is that the government should build hostels for young TGs and hijras as has been done for the tribal youth in every block of Chhattisgarh. This will not only give them educational opportunities but also have a profound effect on their social development. Presently the hijras have to live a life of shame and indignity as there is too much negativity in society. I know of a medical student who left his studies in between as he just could not bear the insults, taunts and jeers he had to face daily in the hostel where they had nicknamed him ‘chhakka mama’. Another 15 year old was raped 4 times but the family did not report the matter to police for fear of spoiling their so called reputation in society. Still another was forcibly married by his family which resulted in divorce within two months. There are innumerable such cases.

One can imagine the mental state of a person who has to face so many indignities in life from such a young age. It kills all the sensitivity of the person and hardens his attitude. So proper counseling at every stage is a must. As soon as this gender is discovered in a child, parents should become more caring and protective; schools should have trained personnel to counsel such children; there should be hostels for them where they can live and breathe freely. Discrimination can end by doing two things—they should be kept in a healthy atmosphere and secondly create awareness in society that there is also a third gender who have their own specific problems and their own life. It is criminal and cruel to try to make a boy or a girl out of them. Jawaharlal Nehru had once lamented that why is it treated to be a crime to be born a hijra. The community leaders will have to see that their ego does not come in the way of community empowerment.” (CNS)

Shobha Shukla - CNS

(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it , website: http://www.citizen-news.org)