Healthcare Services for LGBT People in India

If we take a close look at the world’s map and categorise the countries on the basis of the legal, administrative and healthcare laws supporting the LGBT people, India’s position would not look so good. While eradicating violence and discrimination against the LGBT community has a lot to do with social participation and not only stated laws, they still form the basic skeleton based on which positive steps can be taken.

While India does not penalise LGBT people by death or life sentence, they are still “criminals” in the eyes of law since Section 377 is yet to be struck down. And although the open community of the gays, lesbians, bisexuals of India are expanding every passing year and the third gender community (transgender, transvestite, transsexual) are getting more rights than before, there are big holes in the overall system that rob the LGBT people off their very basic rights.

ILGA_WorldMap_ENGLISH_Overview_2017

One of the major issues is healthcare. To put it mildy, Indian hospitals are not LGBT-friendly. There are layers of discrimination that the LGBT people face in Indian hospitals, starting from being judged right at the entrance to straightaway denial of treatment. There is already a lack of mass awareness about many sex or gender related diseases or psychological disorders in India. Throw in homosexuality or third gender in the mix, and it is nothing less than a horror show.

Some of the very common problems that LGBT people face in Indian hospitals are:

1) For majority of the third gender people whose orientations are visible, it starts right at the entrance where they have to face questions like “What are you doing here?” or even threatening of physical violence.

2) Lack of proper addressing of gender or sexuality in admission forms.

3) Refusal to use the proper pronouns because of lack of legal document (which, by the way, the State refuses to provide).

4) Stalling the process of admission and treatment, even in case of emergency, while deciding which ward to provide to a transgender person.

5) Emphasizing more on their gender identity or sexuality instead of addressing the issue for which they are seeking treatment.

6) In case of psychiatrists or psychotherapists, many tend to try and convince their clients how homosexuality is a disorder and it can be cured with counselling, instead of focussing on the main issue.

7) People with same-sex partners have difficulty explaining their sexual life to the doctors, because of taboo or ignorance or both.

8) Doctors are not trained or equipped to understand and treat the LGBT community and their problems properly. As a result, there is misdirection, mistreatment and misguidance. Certain physiological diseases like HIV, HPV, hepatitis mostly in MSM (men who have sex with men) and OB-GYN issues in trans-women, lesbian or bisexual women needs acknowledging their gender and sexuality. But 90% of the doctors lack the knowledge or ability to communicate on the matter without breaching their personal boundaries.

9) There is not enough study or survey done on the healthcare issues of the LGBT community, which means practitioners have basically zero information as a background.

10) An overall sense of being ostracized, separated, being treated differently, passing comments, making mocking and demeaning jokes at their cost – all these stop the LGBT individual to reach out for professional help in the first place.

Difference with developed countries like Germany

The European countries have always been more or less ahead of Asia when it comes to LGBT rights, as is clear by the map in the first section. Germany is one of the countries with the safest space for LGBT people in the world as well is Europe, and they have laws in place to make sure that the rights are practised.

Historically, they have had ups and downs with the law as well. It was almost decriminalised under Napoleonic code before being re-criminalized by the German Empire in 1871. Once again the restrictions got down during the early 20th century even though the law was never struck out. The Nazi regime made things worse. However, things started to change in the later part of the 20th century. Legal partnership between same-sex couple had been legalised in 2001. Recently since October 1, 2017, legal rights for marriage and child adoption have also been declared. At present, Germany has the highest percentage of LGBT people living in Europe.

chartoftheday_6466_europe_s_lgbt_population_mapped_n.jpg

When it comes to physical and sexual health issues, Germany has the following rights for LGBT people:

1) Sex reassignment surgery has been legal since 1980. At first, it was a necessary process to get documents changed but it has been declared unconstitutional since 2011.

2) Age of consent for heterosexual and homosexual activities is 14 years.

3) In March, 2017, the German government passed a law to pardon more than 50,000 people who were convicted during Nazi Germany and afterwards for their sexuality. The bill was signed by the President in July.

4) The Equal Treatment Act passed in 2006 explicitly bans any discrimination which includes sexual orientation, characteristics and gender identity. Along with education and employment, healthcare is included in it as well.

5) The Federal Constitutional Court of Germany had ruled in November 2017 to allow a third gender option for intersex people.

6) There is an on-going petition to ban Conversion Therapy from Germany, and it has 60,000 signatures as of August, 2018.

7) Gay people are allowed to donate bone marrow and blood as well (with one year deferral period), since 2014 and 2016 respectively.

These are the legal laws that are in place in Germany to provide rights to the LGBT community. One of the main problems in India, apart from the basic fact that the law criminalises homosexuality, is people’s mind set. An American organisation called Pew Research Centre took a poll in 2013 that indicated 87% Germans voted for acceptance of LGBT people. This was only second highest in their poll, which was lead by Spain at 88%.

coupleofmen.comSource: coupleofmen.com

This shows that over and above the laws written in the constitution, there needs to be understanding and acceptance among the society for things to get better.

What reforms does India need?

Since the current Indian youth were exposed to even lesser normalisation of homosexuality and third gender than it is today, it is only obvious that not only physical problems, but many of their mental issues might have roots in the non-binary nature of their gender and sexuality. It can be psychological problems like suicidal tendencies, substance abuse, depression and anxiety. And because of circumstances, LGBT people, especially young ones, are more prone to these than cisgender and heterosexual people.

reparativeinfographic

Source: http://www.hrc.org

Most of the times the therapists or psychiatrists are not trained to address such situations since it is not covered in the educational curriculum. So even if someone wants to help, they do not have the proper, scientific tools to do so.

As per a survey by BBC, Indian LGBT population came to 2.5 million approximately. But this is not a perfectly accurate figure and certainly does not include all those who are still closeted or unsure, thanks to the environment. In India, we do not have any proper study or survey regarding the LGBT population or their health issues, which hinders any medicinal or scientific research on the matter that might help the doctors. Thus it becomes a vicious circle.

Urmi-Jadhav-QAM-Pride-2018

Indian medical student and to-be doctors in support of the LGBT community (Source: Youth ki Awaz)

There are not many sources to know about Indian LGBT health, research and legal policies. But Indian LGBT Health Research Information Centre has a collection of articles, links and other details that might help.

As for medical practitioners being well-equipped with handling the issue of gender and sexuality, an organisation called Health Professionals for Queer Indians (HPFQI) has been formed by Prasad Raj Dandekar, a Mumbai-based radiation oncologist, to train doctors and nurses and spread awareness about the issue.

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Dr. Prasad Raj Dandekar (Source: http://www.medium.com)

So in very short, the things we need the most to make India a safe space for LGBT individuals are:

1) Repealing of Section 377.

2) Implementation of laws to protect the rights and dignity of the LGBT people in healthcare and everywhere else.

3) Laws that explicitly mention that people falling under the LGBT umbrella will be treated equally in case of sexual violence, rape, genital or reproductive operations and childbirth.

4) Ethical researches, studies, facts and information to be available for educational and practical purposes.

5) An overall mass awareness about homosexuality, bisexuality and non-binary genders. After all, we learn what we are taught.

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