{"id":18527,"date":"2021-10-26T11:30:00","date_gmt":"2021-10-26T06:00:00","guid":{"rendered":"https:\/\/idronline.org\/?post_type=article&p=18527"},"modified":"2026-01-15T00:12:29","modified_gmt":"2026-01-14T18:42:29","slug":"indias-health-systems-exclude-lgbtq-people-this-needs-to-change","status":"publish","type":"article","link":"https:\/\/idronline.org\/gu-in\/article\/health\/indias-health-systems-exclude-lgbtq-people-this-needs-to-change\/","title":{"rendered":"India\u2019s health systems exclude LGBTQ+ people. This needs to change."},"content":{"rendered":"

Inequality is one of the most defining characteristics of Indian society and economy. An area that demonstrates this is healthcare—health outcomes in India continue to be closely tied<\/a> to socio-economic status, identity, and community.<\/p>

Combinations of complex barriers are responsible for the exclusion of the most vulnerable communities from access to healthcare. While some barriers, such as poverty or distance to healthcare centres, are simpler to understand, others such as systemic discrimination or policy gaps require a more complex analysis.<\/p>

A key social group that faces systemic exclusion from healthcare in India is the LGBTQ+ community. There is no public data on the exact number of gender and sexual minorities in the country; however, in 2018 it was estimated that 104 million<\/a> Indians (or 8 percent of the total population) belong to the LGBT community.<\/p>

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Despite this sizeable number, the difference in health outcomes for LGBTQ+ citizens indicates the prevalence of exclusion. This article shares insights on that exclusion, as well as the steps health and development organisations can take to make changes.<\/p>

What exclusion looks like<\/h3>

Exclusion of sexual and gender minorities manifests in different ways:<\/p>

1. Mental health<\/h3>

Individuals belonging to sexual and gender minorities typically have higher prevalence rates of mental ill health<\/a> compared to the rest of the population. For example, a qualitative study<\/a> with queer women found that anxiety, high substance use, and suicidal thoughts were a common part of their experiences. Another study<\/a> found that 70 percent of men who have sex with men (MSM) and 91 percent of transgender persons faced depression, frequent alcohol use, and victimisation due to violence. In addition to this is the discrimination<\/a> these individuals face from mental health professionals who pathologise<\/a> their identities, and therefore prevent them from accessing mental healthcare.<\/p>

2. COVID-19 vaccines<\/h3>

In the ongoing COVID-19 vaccination drive, LGBTQ+ people are facing additional barriers to access<\/a>, as many of them do not have an acceptable photo ID. This is especially true for transgender persons whose documentation takes into account the sex assigned to them at birth, instead of their gender<\/a>. Additionally, there are apprehensions in the community regarding the efficacy and side effects of the vaccine, owing to limited research<\/a> on the side effects for those undergoing hormone replacement therapy (HRT). <\/p>

3. Sexual health<\/strong><\/h3>

In India, MSM have a human immunodeficiency virus (HIV) prevalence of 4.3 percent<\/a> while for the general population this number is 0.3 percent. Yet, there are many barriers<\/a> that prevent MSM from getting tested, including stigma and high costs of testing. When it comes to transgender people, almost two-thirds<\/a> have no access to treatment for sexually transmitted diseases (STDs). While 7.2 percent of transgender people are living with HIV, only 59 percent of them had been referred for testing, and 33 percent been given counselling about treatment options. In fact, for anybody living with HIV, accessing general healthcare comes with additional roadblocks<\/a> such as stigma during dental care, excessive personal protective equipment, and unnecessary referral to specialist services.<\/p>

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Dalit transgender and intersex persons face a higher degree of exclusion and discrimination in healthcare than their upper-caste counterparts.<\/p><\/blockquote>

The exclusion from healthcare faced by sexual and gender minorities is exacerbated by the intersection with other identities. If we consider caste, Dalit transgender and intersex persons face a higher degree of exclusion and discrimination in healthcare than their upper-caste counterparts. In a survey<\/a> conducted among a representative sample of Dalit persons from southern Indian states, 24 percent said they were denied treatment; 16 percent said the doctor did not know how to treat their medical condition; and 4 percent experienced physical and sexual assault from their healthcare professionals.<\/p>

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India does not have a strong and exhaustive legal framework that prevents discrimination in health or other aspects of life for gender and sexual minorities. | Picture courtesy: Swasti<\/figcaption><\/figure>

A dedicated effort is required to make a difference<\/h3>

While the issues of discrimination in health access are systemic and require interventions by governments to solve them, there is much that civil society can do. Organisations working in the healthcare space especially can intentionally work to ensure that their programmes are inclusive (which is to say, people are not caused any harm as a result of their programmes, and decisions that affect people are not taken without their representation).<\/p>

To start with, here are eight best practices organisations can follow:<\/p>

1. Introduce inclusivity right at the programme design stage<\/h3>

Inclusivity should be a part of the business case or programme proposal<\/a>. For example, care should be taken to broaden terms such as ‘gender’, ‘women’, and ‘men’ to include transgender and non-binary identities. In addition, normative assumptions about families and relationships should be avoided as people from these communities often leave their birth families and blood relations and have a ‘chosen’ family instead, and the programme should not delegitimise them.<\/p>

2. Analyse the different barriers to inclusion<\/h3>

Barriers to inclusion<\/a> can be broadly categorised into six types, and an evaluation must be carried out to understand how each barrier affects the vulnerable groups identified by the programme. The barriers are:<\/p>