A Trans-Inclusive and Gender Affirmative Healthcare in India

‘Our Healthcare Is Woefully Insensitive To Trans People’

Dr Trinetra Haldar Gummaraju, Karnataka’s first transwoman doctor, rues lack of a trans-inclusive and gender affirmative healthcare in India, which reflects in vaccination drive too

When I was ten years old, my parents took me to a psychiatrist hoping for answers as why my behaviour was gender non-conforming. Instead of being accurately counselled, we were told that I lacked a masculine influence in my life, and that my mother was performing roles that were stereotypically masculine (such as going to work, living a financially independent life and not performing house chores). And that was confusing my sense of gender. The advice was outdated, misogynistic and queerphobic. I stepped out of the clinic thinking I was “crazy”.

In my MBBS years, I found little mention of the healthcare that trans-people require in either my syllabus or in training. The group did find mention in the context of sexual perversions, psychiatric disorders and high-risk groups for HIV/AIDS – all of which are misleading, inaccurate and obsolete perspectives. It is almost as if the medical fraternity doesn’t see trans-people as deserving of access to healthcare.

As has become clear with the case of trans-activist, radio-jockey Anannyah Kumari Alex, there is a significant lacuna with regards to trans-inclusive and gender affirming healthcare in the country.

Transgender people are one of the most marginalised sections of society, an invisible minority. A recent study conducted for the NHRC (National Human Rights Commission) showed that only about 2 per cent of all trans-persons surveyed lived with their natal family; the majority faced social and familial rejection and; 23% were forced into sex work, a profession with exposure to HIV and other sexually transmitted infections.

Dr Haldar says Indian healthcare is queerphobic and outdated both in curriculum and training

Given the pandemic, the risk of exposure to SARS-CoV-2 for Trans sex workers has been enormous. The pandemic added to financial and health-related burdens. Yet, hospitals across the country remain trans-exclusionary, right from the lack of sensitisation and training of medical and para-medical staff, to the lack of infrastructure such as inclusive wards and restrooms. Vaccine outreach has been particularly difficult for this reason.

Any form of healthcare right from the most basic healthcare, such as a sore throat, to specialised healthcare like endocrinology or urology remain blatantly inaccessible and unaffordable. Indian healthcare has a long way to go in creating safe, accessible, affordable healthcare models across the country for queer and trans-persons.

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I always found surgery a very noble and artistic pursuit, one that required finesse, dedication and compassion. Upon witnessing surgery in high school thanks to family friends who were doctors, I was drawn to medicine, and knew I had to pursue it as a career.

The change needs to occur at several levels. First, the medical councils at national and state level need to remove all pathological models of transgender identity from the syllabi. This means that transgender identity must not be seen as an abnormality, but as a variation, which needs support and not correction. This is the model adopted by the World Health Organisation and the American Psychiatric Association. This information and sensitivity thereof must be conveyed to medical and para medical students and staff at an early stage of their careers.

Next, hospitals and colleges must allot wards and washrooms to trans-persons, and train supportive staff in handling trans-patients with sensitivity. All forms of conversion therapy to “correct” LGBTQIA+ persons must be outlawed and made punishable as recently directed by the Madras High Court.

Research and training in gender-affirming healthcare must be encouraged at all levels. Hospitals across the world have created training programs that India may draw inspiration from, and recalibrate learning for its doctors and staff.

Most important, a cultural shift is necessary in making society in general safe for trans-people – starting from conversation at the dinner table, inclusive sex education at schools, representation in the media and all professions, especially in healthcare. “Nothing about us, without us” is a slogan often used in disability activism, and the very same applies to transgender persons in our fight for equality.

As Told To Mamta Sharma

Sexual Identity

'I Will Myself Decide My Sexual Identity'


Today, she works as a street sex worker on Delhi-Noida Highway and is pursuing a bachelor’s degree from Open College.   As the night falls, my day begins. This is also the best part of my daily routine. I take a warm water bath, carefully apply make-up and choose the ethnic wear from my cupboard that suits my mood. There would be matching bangles and danglers to go with the suit.

It may take more than an hour before I am satisfied with my outlook. But I simply love dressing up for the occasion. Like employees in corporate world, I too set daily targets. If I am able to earn Rs 2,000 during one night, I have made it. Anything less is an underachievement, and anything extra is a bonus. A bonus means I can treat myself to new clothes and jewelry.

“Babu chalta hai kya,” is my pick-up line. Trust me, most of my customers are left dumbfounded at the end of our encounters. I often earn extra tips for my oral skills. I feel like a queen with the kind of attention I get from my clients. Most vehicles slow down at my sight. I cruise around Delhi-Noida stretch from late evening till 4 in the morning.

Winters and monsoon are tough, but each job has its hazards. I usually charge Rs 300-500 per client. There are all kind of clients. Some are polite and well behaved. Some are drunk and get abusive and violent. But over the time, I have learnt to deal with them. I have travelled in the most luxurious and modern cars. My services are not limited to the street. I have been to several hotels and luxury apartments too.

I have entertained police officials and bureaucrats who pick me for special services. Yes, safety is another hazard in our dhanda (profession). You always meet clients who do not want to use a condom. But thanks to an NGO workshop, I have learnt the trick to use my mouth to cap a penis with a condom without even a customer knowing about it. I am an educated sex worker.

I am pursuing my graduation from Open College so I know all the risks involved. I cannot compromise on health and hygiene. I take HIV test once a month. Then there are rowdy bikers in groups who harass us. Usually, police patrols ignore us or only seek information from us. I know the stretch well, so whenever I sense trouble, I can jump on the other side of footpath with thick foliage. I have also marked some dark spots that can hide a couple of persons.

My transition from Suraj to Kajal happened the year Salman Khan’s blockbuster movie ‘Tere Naam‘ was released (2003). I would take my sister’s ‘dupatta‘ and dance on its songs. I was young, so nobody paid much attention at home but this is when I realised my true gender identity. I have three elder brothers and two sisters. When my brothers found that I had been wearing my sisters’ clothes, they would beat me up for bringing disrepute to the family.

I was enrolled in a government boy’s school in East Delhi. I was always quite the one in my class. My classmates would often grab me and try to force them on me. I would be bullied into giving some of them oral pleasure. One day, some senior boys grabbed me after school hours and took turns to rape me. I was left crying and bleeding. I even thought of ending my life that day.

My only solace was a classmate of mine who would come to my rescue whenever someone tried to bully me. It could be a perfect love story. But as school got over, we separated. I also separated from my family to own up my sexuality and moved into a locality with other transgenders. Here, we would visit houses of newly wed couples or where a child was born.

We would dance and haggle for monetary rewards. It was a day after the demonetisation was announced (November, 2016), when I was introduced to the life as a sex worker. A transgender friend Bobby asked me to spend an evening with her. She gave me her dress and helped me to apply some make-up. Around 10 pm, we went to the Delhi-Noida border.

I was anxious but also thrilled. That night I entertained 10 clients. This was quick money and since then I have been working during nights only. While working, I decided to study and took admission in B.A. course, opting for open college. I want to continue with my education after graduation too. I want to pursue a master’s degree in counselling. Who knows I would end up as a saviour for many women who have been trapped in another body but silently suffer it all their lives.


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