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

indiaaidsalliance 15 April, 2013

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!

 ___________________________

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.