International Human Rights Day 2013: Reflections on Rights Situation of PLHIV and Key Populations in India

Since the United Nations adopted the Universal Declaration of Human Rights in 1948, there has been a slow but steady expansion of international agreements that promote and protect the rights and dignity of all people everywhere. But even today, people living with HIV (PLHIV) and members of key population groups, such as men who have sex with men, transgenders, hijras, people who inject drugs and sex workers, continue to face violations to their basic rights. They are denied recognition in society, face barriers in accessing basic services like healthcare and education, and are often victims of violence and other forms of discrimination and marginalization.

Protection and fulfilment of the human rights of vulnerable communities are at the core of India HIV/AIDS Alliance’s work. Although the full enjoyment of their rights remains a dream for too many people, there are stories of hope and courage. This Human Rights Day take a look at some of the challenges facing India and how we’re responding:

The Other Epidemic: Gender-based Violence in India

Gender-based violence is an epidemic facing India and the world, and like AIDS, it will require a sustained and committed effort to overcome. Attitudes must change. We must never tolerate violence against women and girls. We must never be blind to gender’s diversity. Read more.

Fighting for the Right to Health for Women Living with HIV: A Success in Gujarat

Stigma and discrimination remain among the primary barriers to achieving universal access to HIV treatment, care, and prevention. As HIV treatment programmes become increasingly available, access to these lifesaving services depends on the degree to which all health facilities welcome PLHIV and respect their rights. Read more.

Confronting Quackery, Demanding Care: India’s Hijras Seek Access to Sex Reassignment Surgery Services

India’s hijra community routinely experiences mistreatment at the hands of doctors and the health system. Progress is slow and often only as a result of significant advocacy by community organisations. Hijras and transgenders have the same right to health as any other citizen, and the government must act to protect their lives. Read more.

Confidentiality: A Health and Human Rights Issue for PLHIV

There is nothing more angering than the thought of stigma faced by people living with HIV (PLHIV). Take, for example, the situation where numerous PLHIV had their HIV status published on the front page of their medical history records, making confidential information available to anyone who glanced at their files. Read more.  

The Pain of Being ‘the Other’: How Stigma Fuels HIV/AIDS among People Who Inject Drugs in India

The vulnerability of people who inject drugs (PWID) is further fuelled by the fact that society perceives drug users as criminals and a threat to society. This makes it difficult for people who want to reach out to them to build rapport and trust. This demonization further fuels the HIV epidemic in the country. Read more.

Shedding Light on Abuse: Alliance India study shows that almost 50% of women who inject drugs in Manipur report harassment and abuse from community members

A study conducted by Alliance India sheds light on the extent of the social discrimination and isolation experienced by women who inject drugs in Manipur. The lack of a support system in the lives of women who inject drugs significantly increases their isolation and likelihood of engaging in sex work as a means of earning a living. Read more.

A Beacon of Hope in the Fight Against Child Marriage: One Girl’s Story

The issue of child marriage is a very common problem in Allahabad in the conservative Indian state of Uttar Pradesh. Here, girls are married early and are expected to bear children soon after.  Issues such as contraception, sexually transmitted infections, and reproductive rights of young people are met with a wall of silence. Read more.

My Trans Reality: An Interview with Tista Das, Founder, SRS Solutions

(Photo courtesy of Tista Das)

An important step in the process of self-affirmation for many transgender people is to adapt their physical appearance to align with their gender identity. Many transgenders face significant challenges in accessing transition-related services in India. Government hospitals seldom offer services like Sex Reassignment Surgery (SRS) and the private ones are too costly for many community members to afford. Without other options, many turn to quacks and other unlicensed practitioners for help.

SRS Solutions is a community-led and self-funded initiative that provides SRS-related information, counselling, and referral services to trans people in Kolkata. It was founded by Tista Das, a self-identified trans woman. In an interview with Alliance India’s Ankita Bhalla, Tista opened up on the tough times she has faced as a trans woman and what motivated her to found SRS Solutions.

Q: When did you acknowledge your gender identity? What was the response from friends and family?

Tista Das (TD): My parents always insisted that I was a boy, but I always felt like a girl. All my childhood playmates were girls. I used to behave and dress like them. I felt discomfort among the boys, and I was always forced to use the boy’s toilet. When one of my closest schoolmates was undergoing menstrual changes, I had an inner desire to be able to do so too. I missed the same changes in my body.

I came face to face with my trans reality when I saw a photo of female genitals when I was in Class 8th. I was perplexed. The question ‘why was I different from girls?’ kept playing in my mind. I was desperately searching for a way out of this anatomical cage. I wanted to align my body with my psyche. Then I came upon an article of postoperative trans women in a leading Bengali fashion magazine. I jumped in joy, but my entire family and most of my friends were strongly against my desire. In my first medical intervention, I was taken to a psycho-therapy clinic. The clinician there was understanding, and she requested my parents to let me live my way. My parents were against this and searched for a new psychiatrist, who gave me six electric shocks to cure my ‘disorder.’

I was lucky to have some supportive friends. Every day I changed from male to female at my friend Nupur’s house. My friends never refused me, even after they became subject to ridicule by neighbors because of me. Most people only consider two genders in life: male and female. They are seldom think beyond this conventional gender frame.

Q: What prompted you to start SRS Solutions?

TD: While my peers were going to college and checking out career options, I was denied admission to university because of my gender identity. While my friends where enjoying gully cricket, I dealt with insults from neighbors who took it upon themselves to make my family’s life and mine miserable. I was scared, upset and totally at a loss.

There was a strong urge in me for surgical intervention, but I had no money. I was introduced to the eminent author and professor Nabanita Debsen who told me about an executive opening at a sister concern of Indian Oil Corporation for a trans woman. I successfully made it through. Now I had a job and an income, but no place to undergo my physical transformation. Government hospitals were just playing with my emotions and wasting my time. Private care was not what I could afford. I underwent the same agony each day.

I underwent psychometric testing—a primary diagnostic procedure to conform whether a person is really suffering from gender dysphoria and is eligible for SRS—and was recommended for hormone replacement therapy. But again my resources were limited. I approached government hospitals in vain for genital reconstruction. I lost all hope. Then my parents came to my support. My mom sold her jewelry and my father took some loans. I got donations from school teachers. Still it was not enough. Finally, a miracle happened. I got an opportunity to act in an English short film as a protagonist girl. This income helped my desire come true.

The hardships I had faced seeded within me the idea of an organization where people in gender distress can get proper solutions. My desire was made stronger by the suicide of one of my transgender classmates. I finally established the SRS Solutions in Kolkata in 2012.

Q: How do you feel post transformation?

TD: I have chosen to be a woman neither to get any socio-legal and political advantages nor to get a sex partner. It was unbearable for me to live in an unwanted body, and every day I desperately hunted for a way out. I always loved to see myself as a girl physically in front of the mirror. I always felt trapped in a male body. I felt incomplete and wanted to align my body with my psyche. I only wanted to be a beautiful, decent girl, nothing else.

Q: What are the common problems faced by trans people in India related to SRS?

TD: Trans people in India who want SRS face problems in arranging the finances needed, identifying qualified facilities for surgeries, and gaining social acceptance for their transformation. A large number of us are oppressed because of the alarmingly low level of awareness at all levels of society. Few doctors are skilled in SRS, and most don’t understand gender identity issues. The pressure of having to fight society at every step, along with our own discomfort of being stuck in bodies we wish to change, is highly traumatic.

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Readers can learn more about the challenges faced by transgenders and hijras in accessing gender transition services in India in our recent publication,Transforming Identity, which presents findings of our recent research on this topic.

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The author of this post, Ankita Bhalla, is Communications Associate at India HIV/AIDS Alliance.

With support from the Global Fund, Pehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust,  PNRO,  SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

Transforming Identity: New Pehchan Issue Brief on Gender Transition Services in India

Sex Reassignment Surgery (SRS) and cross-sex hormonal therapy are two essential health services required for Male-to-Female (MtF) transgender people to help them align their bodies with their gender identity. Available evidence indicates a near lack of gender identity-related services in even tertiary-level government hospitals, and the offerings in private hospitals are typically unaffordable. This gap persuades many MtF transgender people to seek surgical services from unqualified medical practitioners and face a dangerously high level of complications and inadequate counselling and care.

As part of its advocacy efforts, our Global Fund-supported Pehchan programme documented the current situation for MtF transgender people in India with respect to their access to and use of health services related to gender transition. Based on this study, Pehchan has published a new issue brief, Transforming Identity: Access to Gender Transition Services for Male-to-Female Transgender People in India, which summarizes the research findings, describes barriers, and offers suggestions to improve access to these necessary health services.

Read the complete brief here.

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The author of this post, Yadavendra Singh, is Senior Programme Officer: Capacity Building for Alliance India’s Pehchan Programme.

With support from the Global Fund, Pehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, PNRO, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

Confronting Quackery, Demanding Care: India’s Hijras Seek Access to Sex Reassignment Surgery Services

Friendly attitudes and responsive services by hospitals can help transgender patients be comfortable and speak about their health concerns. (Photo by Peter Caton for India HIV/AIDS Alliance)

Malika (her name changed) remembers feeling helpless when a government hospital refused to treat her for a painful and dangerous infection that had resulted from her sex reassignment surgery (SRS). Malika is a hijra and her story is not unique. Many others in her community sadly face similar problems.

In India, hijras have a long and remarkable history, spanning 4,500 years. They are mentioned in ancient religious texts as symbols of dignity and courage. Yet modern Indian society fails to offer them respect or treat them with even basic human dignity. With limited livelihood options, most hijras turn to sex work, begging or other professions that offer them a meagre salary.

With limited resources, many hijras turn to quacks for SRS services since most of them are unable to afford the high rates charged by private clinics. Without national standards for SRS, most of these surgeries are legally ambiguous and performed in miserable conditions by ill-trained surgeons. In Malika’s case, the ‘clinic’ turned out to be a house without proper lighting, surgical facilities or even a recovery bed. If Malika had known and understood the risks, she would not have travelled some 600 kilometres from her hometown Kolkata in West Bengal to the state of Bihar for the operation.

Whether hijras are operated on by quacks or in more expensive private clinics, they tend to experience the same lack of physical and psychological care that is essential after SRS. Happy to accept fees for the surgery itself, doctors fail to provide their patients with appropriate pre- and post-operative counselling or checkups following surgery.

When Malika felt the intense pain that racked her body and realised that she was suffering from a severe urological infection caused by the surgery, she sought help at a government hospital. Both transgender and HIV-positive status, she was refused a hospital bed and any of the care she urgently needed.

On hearing about Malika’s situation, team members from the Global Fund-supported Pehchan programme organised meetings with the project director of the West Bengal State AIDS Programme & Control Society (WBSACS) and with doctors at two hospitals, including the one that had turned Malika away. They also met with members of the press to raise awareness about Malika’s story. The WBSACS project director wrote Malika a support letter, as did the West Bengal health minister. Armed with these letters, Malika underwent treatment at the hospital that had initially turned her away.

After two months recuperating, Malika was discharged from the hospital. Seeing Malika’s resilience and the bold way she handled her situation, the Gokhale Road Bandhan, a community-based organisation that is a sub-sub-recipient partner of Pehchan, offered Malika a job as an outreach worker. “The job has not only helped me deal with my financial instability but has also instilled a sense of self-confidence and self-esteem especially since many of my peers abandoned me because of my HIV-positive status,” says Malika.

Malika’s story reveals the mistreatment that our country’s hijra community experiences at the hands of doctors and the health system. Progress is slow and often only as a result of significant advocacy by community organisations. While we have our own health priorities such as SRS, India’s hijras and transgenders have the same right to health as any other citizen, and the government must act to protect our lives, provide access to care, and ensure the fulfilment of our full rights. Our community cannot be silent!

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The author of this post, Simran Shaikh, is Programme Officer: Pehchan.

With support from the Global Fund, Pehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.