Vinay Chandran, Counselor and Executive Director of Swabhava is studying LGBT (Lesbian, Gay, Bisexual and Transgender) community and its access to healthcare in South India: the states of Kerala, Tamil Nadu, Karnataka, Telangana and Andhra Pradesh. This study is a part of a study by TATA Institute of Social Sciences in an attempt to understand the discriminations faced by the LGBT community in different domains – education, housing sector, healthcare and public spaces across India.
Started in 1999, Swabhava works to provide access to support services and counselling to members of the LGBT community. Swabhava has a helpline called Sahaya and an in-person counseling service. The organisation provides support information about coming out of the closet about one’s sexuality, family, relationships, and workplace, among others. It also provides referrals to doctors, counselors, access to support groups, be it for LGBT or queer adults. Hidden Pockets caught up with Vinay Chandran to know more about this study on LGBT community and their access to healthcare and share some of the findings of this study with our readers.
About the study
Hidden Pockets: What is the expected outcome of this national study on health related problems faced by the LGBT community?
Vinay Chandran: The overall project on LGBT discrimination is an exploratory study. It is about trying to find out the experiences of discrimination that the community faces in the country. It is important to record these experiences simply because the Supreme Court talked about LGBT community being a miniscule minority during the Supreme Court hearing against Section 377. This was cited as the reason to read down Section 377. This resonates with why we need to collect this data.
Hidden Pockets: What do you think would be the number that will make them (Supreme Court) recognise the LGBT community as an entity?
Chandran: It is not about that. The point is that the affidavits and other reports haven’t used the existing statistics and data properly. So we want to be able (at least in my case), to flood the market with this information about the discriminations faced. The conversation around discrimination right now is heavily focused on the LGBTQ sector and their legal rights. But this can also be seen as a systemic discrimination in the society and its functioning. Therefore there is more to it than just being abused by the law. It is a systemic thing and this adds to that questioning (of the system).
Hidden Pockets: What is this healthcare project focused on?
Chandran: Be it generic healthcare, seeking mental health services for LGBT people in terms of counseling and so on or accessing surgery without having prejudice thrown at them, we are looking at how the different mental health and medical health services interact with LGBT people and how we can improve that interaction and improve the experiences of LGBT people in that context.
Challenges faced by the LGBT community
Hidden Pockets: From your experience, what would you say are some of the challenges that the community faces with respect to accessing healthcare?
Chandran: See healthcare itself is not a priority for LGBT people simply because of the fear of what it might entail. The context where medicine and LGBT meet could be in terms of sex reassignment, gender reassignment surgeries, sexually transmitted infections and mental health.
We have heard enough stories of the issues that transwomen face. I don’t know about transmen experiences but a lot of transwomen refuse to go to medical colleges for treatment. They say we don’t want to go to medical colleges even if they have a chest cold or a cough because the immediate response from the doctor is – ‘Take off your clothes, call the students and say this is what a trans woman looks like.’ They do this to their bodies without even asking their permissions. This is problematic because government medical colleges are the cheaper medical places for them to go to. Most of the people if you’re LGB (Lesbian, Gay and Bisexul) for instance can pass (without being questioned about their sexuality) if it is a cough or cold but not transwomen.
You can be a gay man asking help from a doctor and your sexuality wouldn’t matter but if it is a Sexually Transmitted Infection (STI), which is another contact point, then you’re talking about doctors’ attitudes. One person we spoke to, went to a doctor with a STI and the doctor asked him if he was married and when he said no, the next question was if he had gone to a sex worker. The doctor asked nothing about other sexualities. When the client actually said that he’s gay, the doctor replied, ‘agh that’s why you’ve got it (STI). You stop that you’ll stop getting this.’ The sense is that if you are gay then it is automatic for you to get STIs. It proves whatever prejudice they already have in their minds.
Hidden Pockets: What problems do women face and trans men face with respect to accessing healthcare or sexual health services?
Chandran: I don’t have a lot of data about that. Bina Fernandez has done some work on the issues faced by women. She talks about lesbian and bisexual women accessing mental health and the kind of prejudices that doctors have more so because they are biologically female. Therefore the idea of reproduction and the need to reproduce also comes into the picture. Ketki Ranade has another paper in which she also talks about the same issues that lesbian, bisexual women and some among trans men face. In one particular context, a gynaecologist obstetrician who has otherwise good records of supporting trans women and trans issues refused to do hysterectomy on a biological woman who is trans man because he doesn’t believe in removing the uterus of a woman who has not enjoyed motherhood. The fact is that the transman has no desire for that body. But that is irrelevant to the doctor. He understands removing penis and testicles for a trans woman and recognizes the need to provide that surgery. But with a transman, he refuses to do the same.
LGBT community and access of the healthcare
Hidden Pockets: How does section 377 affect the LGBT community with respect to accessing health care?
Chandran: There are doctors who say that ‘if there is a law, you have to worry about the law’. There are doctors saying that I don’t want to become an abettor to a crime. But by and large doctors understand their ethical duties. Even if they provide fake treatments (to treat homosexuality), they keep quiet about it. If they publish it in a paper, they mention that treatment was provided and the patient successfully got married.
Hidden Pockets: Is it legal for a doctor to refuse treatment because someone is LGBT?
Chandran: There are doctors who can do that to anything, not just LGBT. There is no policy in India that addresses discrimination of LGBTQ people. NALSA judgement in 2014 (on transgender rights) is the first place where they’ve actually spoken about transgender people. They’ve tried to add sexual orientation but I don’t think the government is going to address it. However it’s the first time that kind of discrimination has been spoken about and the HIV AIDS bill addresses it in the context of HIV. There’s no other context where specifically someone says you cannot be discriminated against on the basis of sexual orientation or gender identity. We can start that conversation because of NALSA judgement.
Hidden Pockets: What is the cost of accessing SRS services for trans women? Which are the states where SRS services are available?
Chandran: Each state is very different. It depends on the kind of services that are available. Some hospitals offer subsidized services and some hospitals offer full services. In terms of government SRS services, it is only available in Tamil Nadu, among the Southern states. There is no recognized service center anywhere else that I have seen (in Southern India). NALSA judgment hasn’t been implemented right across the country so we still struggle with implementation of basic policies for trans men and women.
LGBT community and mental health services
Hidden Pockets: How do you work around the clinical diagnosis of homosexuality as a disease or condition by several mental health practitioners in the country?
Chandran: This is changing. There are a lot of practitioners who have caught up with the fact that it is no longer right to prescribe treatment for being LGBT. In fact, we’re getting stories where we actually hear people say that the psychiatrists are now catching onto the game because they can actually make more money by supporting the LGBT community as opposed to prescribing treatment. But as expected, the prejudice against the LGBT community remains. However there is a lot of improvement. What we want to do is improve the experiences of the community members. So when we present the study, we are also talking about creating outputs like booklets (for all) with the kind of questions you might encounter and how to respond to them. On the other hand booklets for doctors and counselors would give information about the kind of problems that clients might come to them with, clients responses and what would be the ideal (responses).
Hidden Pockets: The Mental Health Bill of 2017 mentions that no one shall be discriminated on the basis of sexual orientation with respect to access to mental health care. How does this conflict with Section 377?
Chandran: This is not a new problem. Government of India has always had policies on the left and punishments on the right so it is really not a conflict as far as we are concerned. If you consider the National AIDS Control Programme (NACP), they have always had MSM (Men who have sex with men) friendly programmes and they also have section 377.
The conflict between the law and the policies
Hidden Pockets: How then can you also have section 377 when you have MSM friendly AIDS programs? How will people come out and say I have AIDS?
Chandran: You’re seeing it as a conflict. The government is not seeing it as a conflict. For them, on one side, the law will continue to do what it wants to do and on the other side, it wants to help. So it will continue to do so until it meets a block. During the UPA (United Progressive Alliance) government, the Department of Health, Department of Law and the State Department had no objection to removing Section 377 and that’s how the Delhi High Court passed its judgement in 2009. Despite that, we had a bad response from the Supreme Court because the Supreme Court judges were fairly homophobic. Now in the current argument, it has become a cultural issue with morality and value systems. Now they (government) don’t see having Section 377 and MSM friendly programmes as a conflict. Healthcare can do whatever it wants but the law will do what the law has to do.
Hidden Pockets: How open are MSMs as they call, to actually coming out and accessing these sexual health services? Is there no breach of privacy?
Chandran: There’s been a lot of work over the last 14-16 years with NGOs and all these Community Based Organisations (CBOs) that are especially working around HIV. The conflict is not there. The conflict is when it comes to law. There is no intentional breach of privacy. Let’s put it that way. People are not going out of their way to say I’m serving homosexuals, come and arrest me so the programmes are going on and they maintain confidentiality because its HIV. I’m assuming that most other departments will keep their hands off. I haven’t seen this in any policy so I’m just assuming that that’s how it is.
Hidden Pockets: Does that mean that they will not breach anyone’s privacy or ask for data?
Chandran: We don’t know. There’s not a written policy that says that they will not approach HIV organizations or that they will not touch them or go and infiltrate them.
Hidden Pockets: What kind of changes have you observed over the years with respect to looking at LGBT issues?
Chandran: As far as urban scenarios are concerned, there is a sense that a lot more people are familiar with LGBT rights narratives now and therefore are more cautious of providing that kind of (homosexuality curing) treatment facilities in urban scenarios. We don’t have full knowledge on what it is in rural areas. There are still people who offer treatment for homosexuality but they don’t do it openly. They don’t announce except if there is a religious backing to them. By and large in urban spaces, there is now some sense of awareness about the LGBT communities. So if a client comes to them and is LGBT then they are referred to us. This happens a lot more than it used to 15 or 20 years ago.