We need an entire ecosystem of transgender healthcare providers: Dr Aqsa Shaikh, Hamdard Institute Of Medical Sciences and Research

ETHealthworld, spoke to Dr Aqsa Shaikh, Associate Professor, Community Medicine, Hamdard Institute Of Medical Sciences and Research, New Delhi, to figure out the existing challenges despite the Act of 2019 and the promise of the TG Plus card.

Shahid Akhter, editor,

Transgender Healthcare: Trends

I think when we speak about the healthcare of any human being, irrespective of their identity or level of marginalisation, it is the same for everyone. Like all others, trans people also need healthcare services like immunisation and treatment for common

ailments like fever, diarrhoea, etc. At the same time, because of their specific needs, because of their marginalisation, and because of their lack of access to healthcare, they have special healthcare needs. For example, trans folks do need gender-affirming surgeries that they may want to undergo, to affirm the gender that they identify with rather than the sex to which they are assigned at birth. At the same time, we also know that because of the many stressors trans people have from their family, their workplace, and society in general, they face a lot of mental stress.

Trans people are at a higher risk of mental illness, including suicide ideation and deemed suicides. In such cases, the mental health needs of trans people also increase. We also know that trans people often lack access to simple healthcare services for menstrual disorders, immunisation against COVID-19, preventive checkups for cancer, etc.

Because when these policies were made or when the healthcare delivery system was made, it was not taken into consideration that the recipient of this healthcare service could also be a trans or intersex person. So, to give you an example, if I speak about breast cancer screening through mammography, I only imagine women coming for it, though we know that men also have breast cancer, but you hardly see any awareness or Advt inclusion in the healthcare services for men to seek breast cancer screening. Similarly, when we think of breast cancer screening, do we also consider trans people going and taking those services? Can we have trans men seeking those services? Or, for example, when we speak about cervical cancer screening, which we generally think only women will have, we forget that trans men can have cervixes and they also need that screening.

But unfortunately, that’s not part of the imagination or design of the programmes. So, trans people have health needs just like anyone else, but at the same time, they also have specific health needs. And we also need to take into account their marginalization and the lack of access to the healthcare system.

Transgender healthcare: Challenges

Fortunately, India is one of the countries that has specific legislation for transgender people. We have the ‘Transgender Persons Protection of Rights Act 2019’, which protects trans people against discrimination in the healthcare system and also guarantees the provision of healthcare to trans people, not just in terms of general healthcare but also in terms of gender-affirming services, what is called as gender reassignment surgeries. It says that every district should have a hospital providing these services, and every state should have a hospital providing these services. Last year, in September 2022, the government of India included trans people in the Ayushman Bharat scheme by providing them with a card called the Ayushman Bharat TG Plus card.

This card entitles them to avail of healthcare services up to five lakh rupees per annum, including gender-affirming services. Now, while that’s a very welcome move, the devil lies in the details, and the problem is: how many trans people really have access to the card? Only those who have trans IDs, which are very few, so maybe less than 10% of trans people can have access to the insurance card, and even when I have access to the insurance card, the next question is: where do I avail myself of those services? So, for example, in a state like Delhi, we do not have a single government hospital providing these surgeries, and the private hospitals that do provide surgeries are not interested in partnering with the Ayushman Bharat scheme because they are already in high demand.

Therefore, the important aspect to consider while making policies is not just to have the intent right but to also ensure that the beneficiaries of these healthcare services receive the benefits. And therefore, it’s very important that public health institutions and government hospitals start providing not just general healthcare services but also genderaffirming services to trans people. And we also ensure that these health insurance schemes are actually workable and have more private hospitals impanelling and providing services under them.

Transgender healthcare: Way forward

I think it’s also important now that we think of solutions for trans healthcare; we should think of trans people not just as people who receive services but also as people who provide services. To really bring about access to services, we have to ask, Where are trans doctors? Where are trans nurses? Where are trans-friendly hospitals or transfriendly health insurance schemes? Because unless you have an entire ecosystem where you have transgender healthcare providers, from doctors, nurses, and technicians, to hospitals that are trans-friendly and include them, and healthcare policies and insurance policies that include them, only then can we really have inclusive and accessible health care services for transgender people.

One of the nations with unique laws for transgender individuals is India. The Ayushman Bharat TG Plus card, which was issued by the Indian government in September 2022, allowed trans persons to participate in the Ayushman Bharat programme. The “Transgender Persons Protection of Rights Act 2019” guarantees that trans individuals will receive healthcare and protects them from discrimination within the healthcare system. Where are these district and state hospitals, is the question.

Courtesy : ET Health World

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