Centre for Internet and Society

Raina Roy and Abhiraj Bag - Kolkata’s trans community has been locked out of healthcare and livelihood

Raina Roy and Abhiraj Bag — 2020-08-01T14:54:16Z

Over six months into the outbreak of Covid-19 in India, it has become clear that the pandemic does not affect everybody equally. It has amplified the sufferings of the already-marginalised trans community. Raina Roy spoke to 10 trans persons and trans rights activists in Kolkata over the course of the past few months to better understand the situation. The piece was transcribed by Abhiraj Bag and edited by Kaarika Das and Srravya C, researchers at the Centre for Internet and Society, India. This work is part of a project at CIS on gender, welfare and surveillance, supported by Privacy International, United Kingdom.

Originally published by Scroll on July 28, 2020.

Raina is a founder of Samabhabona (Baishamya Durikaran Samiti), a trans-led organisation in Kolkata working with trans rights since 2013. Abhiraj is a trans rights activist based in Kolkata.

Several members of our community have lost their livelihoods due to the lockdown and remain unemployed for over three months now. Those engaged in sex work and begging have no respite in sight for the foreseeable future. As a community, we are more likely to be unemployed as traditional employment opportunities are inaccessible to us. Our health concerns are also diverse, as we grapple with gender dysphoria alongside other psychosocial issues. Covid-19 has exacerbated these inequalities and effectively locked us out of livelihood as well as healthcare.

An alienating system

When it comes to accessing institutional healthcare, visiting hospitals can be a daunting ordeal for trans men and trans women, as we frequently encounter discrimination and stigmatisation from healthcare providers.

Even in emergency cases such as accidents, medical attention is delayed due to confusion whether the patient should be admitted to the male or female ward. Finding compassionate healthcare providers is difficult, especially in government hospitals. Most often, they are not sensitised to trans-health issues.

Such experiences have alienated us from the healthcare system and left several members of the trans community reluctant to seek medical help.

Access to general healthcare has further worsened with Covid-19, as many are unable to seek emergency medical assistance. With no sustainable source of income and deteriorating health condition, elderly trans persons are hit with a double whammy. Despite their failing health, there is presently no provision for routine health check-up which they can avail. The reluctance to consult a healthcare service provider has increased due to the added risk of infection.

SRS services are city-centric

Many in the community had scheduled their sex reassignment surgery or SRS and started taking the necessary hormonal medication. However, because of Covid-19, they have now had to postpone their surgery indefinitely. This uncertainty further aggravated distress together with issues of hormonal imbalance. Due to loss of income, many are resorting to alternative cheap hormonal medication and without proper medical supervision, its consequence could be harmful.

Those who have undergone SRS or are currently on hormone replacement therapy often experience side effects such as rise in blood pressure and blood sugar levels, urinary tract infection, and other immunity-compromising problems. To treat these side-effects, a patient may need to consult an endocrinologist, gynaecologist or urologist. However, such specialists are only available at district hospitals. At the sub-district level, we may be able to consult a gynaecologist at best. An endocrinologist or urologist would be available only if we travelled to the district hospitals or medical college hospitals.

A lockdown spanning over three months, restrictions on travel and closure of public transport have made the city-centric, SRS-related healthcare systems inaccessible to the transgender persons in smaller towns and villages. Pre-Covid-19, a few NGOs and community-based organisations provided sexual health services. However, they were unable to continue their services during the lockdown. This has adversely impacted the trans community’s access to sexual health services.

So far, two trans women have been tested positive for Covid-19 in Kolkata. Thanks to the intervention from activists and other allies, they were quarantined in the female ward when they tested positive. Both were asymptomatic and are presently self-isolating at home. Within the trans community, there is inadequate awareness about Covid-19 testing protocols and procedures. The saving grace has been the dedicated provisioning of ten beds at the MR Bangur Hospital, specifically reserved for transgender persons.

Community care

The most hard-hitting impact of Covid-19 is undoubtedly on the mental health of our community. Often faced with social stigma and physical abuse, we take refuge in the comfort of each other’s support. In the absence of familial ties, community support is vital for our well-being. However, Covid-19 and the consequent lockdown measures, has distanced us from our only source of support and solace – community interaction and meet-ups.

Although digitally mediated communication has somewhat helped in coping, it is not as effective or cathartic as an in-person conversation. This has increased the susceptibility of substance abuse in the community. Parallelly, there has been a considerable rise in domestic violence cases too. Even under normal circumstances, we are more likely to encounter intimate partner violence, but are skeptical to seek redressal as the law-enforcing institutions – both judiciary and the police – are biased against us.

At hospitals, the constant misgendering that we face at the hands of healthcare professionals can be traumatising. Aparna Banerjee, a trans-person in Kolkata, said that this trauma has only worsened during Covid-19, when frontline healthcare workers are not sensitised about trans health. To escape this trauma, some trans women have resorted to unscientific castration, leading to urinary tract infection and kidney-related problems. Gender dysphoria also puts the trans community at a higher risk of anxiety, depression, self-harm and suicidal tendencies.

The political milieu

Such strains on our mental and physical health come at a time when we are already distressed by the thought of being disenfranchised. The latest National Register of Citizens list in Assam had excluded many trans persons, as they couldn’t establish family ties, for being disowned by their families. And if they were included, their gender was incorrectly stated.

With the 2019 Transgender Person Act coming into force, a District Magistrate is given the authority to recognise a person as trans. This defies the right to self-identify, as upheld in the 2014 NALSA judgement. The current provision also necessitates providing proof of surgery and has no consideration for gender incongruence. The burden of providing proof of surgery is unnerving, especially for someone who has just transitioned.

As such, the cumulative impact of the 2019 Transgender Person Act and the Citizenship Amendment Act-National Register of Citizen mandate could lead to a significant part of the community being disenfranchised. In resisting this coercive pronouncement, we staged a protest in Kolkata earlier this year.

What can be done

The health and well-being of the trans community has suffered decades of institutional neglect and the Covid-19 pandemic has intensified this suffering. Remedial policy measures have been long due and cannot be delayed any further. Shelter homes have been one of our long-standing demands, to ensure safety and care for the transgender community, particularly the elderly. It is important that such shelter homes are democratic spaces, and not religious centres, that are welcoming of trans persons from different walks of life.

Secondly, healthcare systems, both public and private, need to be more trans-friendly – doctors, nurses and other staff in hospitals and healthcare centres need to be sensitised and trained to identify and understand the healthcare needs of transmen and transwomen. Recruitment of more transgender people as health workers would go a long way in treating transgender patients more humanely, with support and care.

Measures to contain the spread of the pandemic should include increased testing of transgender persons, and tracking the testing and infection rates among trans persons. Relief measures aimed at addressing the economic crisis need to acknowledge the loss of livelihood in the trans community and provide adequate financial support and compensation. Finally, it is important that governments, both at the centre- and state-level, pay heed to our demands and include representatives from the trans community while formulating policies that impact our lives in significant ways.

For more details visit https://cis-india.org/raw/raina-roy-abhiraj-bag-transgender-community-kolkata-covid19-healthcare-livelihood

Comments to the United Nations Human Rights Commission Report on Gender and Privacy

Aayush Rathi, Ambika Tandon and Pallavi Bedi — 2019-12-30T17:40:20Z

This submission to UNHRC presents a response by researchers at the CIS to ‘gender issues arising in the digital era and their impacts on women, men and individuals of diverse sexual orientations gender identities, gender expressions and sex characteristics’. It was prepared by Aayush Rathi, Ambika Tandon, and Pallavi Bedi in response to a report of consultation by a thematic taskforce established by the Special Rapporteur on the Right to Privacy on ‘Privacy and Personality’ (hereafter, HRC Gender Report).

HRC Gender Report - Consultation version: Read (PDF)

Submitted comments: Read (PDF)

The Centre for Internet and Society (CIS), India, is an 11-year old non-profit organisation that undertakes interdisciplinary research on internet and digital technologies from policy and academic perspectives. Through its diverse initiatives, CIS explores, intervenes in, and advances contemporary discourse and regulatory practices around internet, technology, and society in India,and elsewhere. Current focus areas include cybersecurity, privacy, freedom of speech, labour and artificial intelligence. CIS has been taking efforts to mainstream gender across its programmes, as well as develop specifically gender-focused research using a feminist approach.

CIS appreciates the efforts of Dr. Elizabeth Coombs, Chair, Thematic Action Stream Taskforce on “A better understanding of privacy”, and those of Professor Joseph Cannataci, Special Rapporteur on the Right to Privacy. We are also grateful for the opportunity to put forth our views and comment on the HRC Gender Report.

For more details visit https://cis-india.org/internet-governance/blog/comments-to-the-unhrc-report-on-gender-and-privacy

Announcing Selected Researchers: Welfare, Gender, and Surveillance

sumandro — 2020-02-13T15:04:24Z

We published a Call for Researchers on January 10, 2020, to invite applications from researchers interested in writing a narrative essay that interrogates the modes of surveillance that people of LGBTHIAQ+ and gender non-conforming identities and sexual orientations are put under as they seek sexual and reproductive health (SRH) services in India. We received 29 applications from over 10 locations in India in response to the call, and are truly overwhelmed by and grateful for this interest and support. We eventually selected applications by 3 researchers that we felt aligned best with the specific objectives of the project. Please find below brief profile notes of the selected researchers.

Call for Researchers: URL

Kaushal Bodwal

Kaushal is persuing his MPhil in Sociology at Delhi School of Economics, University of Delhi. He completed his Master's in Sociology at Centre for the Study of Social Systems, Jawaharlal Nehru University after getting a BSc honors degree in Biomedical Sciences from Delhi University. He is one of the founding members of Hasratein: a queer collective, New Delhi. He has been an active spokesperson for Queer and Trans Rights in India and have been on a number of panel discussion on Trans Act 2019 in various campuses. He has also delivered a lecture series on Colonialism and Medicine in Ambedkar University, Kashmiri Gate, Delhi. His areas of interest are Sociology of medicine, gender and medicine, sexuality, religion and biomedical science, intersex studies.

Queerness as disease – a continuing narrative in 21st century India, Kafila, 27 August 2019

What it means to be queer under a regime bent on remaking India on its own ideological terms, Firstpost, 17 January 2020

Rosamma Thomas

Rosamma has worked both as a reporter and as an editor of news reports with newspapers. She currently writes reports for NGOs while also undertaking freelance reporting assignments. She is based in Pune.

India's mining state steps up fight to rein in killer silicosis, The Times of India, 29 June 2016

Doctor may have found early marker for silicosis, but who will fund him?, Newsclick, 18 July 2019

Asbestos poisoning: Raghunath Manwar’s fight for safer work conditions, Newsclick, 9 January 2020

Shreya Ila Anasuya

Shreya is a writer, editor, journalist and performance artist currently based in Calcutta. Her fiction explores the places where myth, memory, history and the performing arts meet. As a journalist, her work explores gender, sexuality, politics, culture and history. She has been published in The Wire, Caravan, Scroll, Mint Lounge, Deep Dives, GenderIT, Helter Skelter, and many more. She is the editor of the digital publication Skin Stories, housed at the non-profit Point of View. She is the writer and narrator of ‘Gul - a story in text, song and dance’ which has been performed in several cities in India. She was a Felix Scholar at SOAS, University of London, from where she has an MA in Anthropology. For a full portfolio, please click here or visit her website.

This project is led by Ambika Tandon, Aayush Rathi, and Sumandro Chattapadhyay at the Centre for Internet and Society, and is supported by a grant from Privacy International.

For more details visit https://cis-india.org/raw/announcing-selected-researchers-welfare-gender-and-surveillance