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The Bacteria Doesn’t Discriminate, But India’s TB Care Isolates Gender Minorities

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Mr X had gone in for a routine check-up when their doctor, who without even physically examining them, pronounced they had TB and must get tested. When Mr X tried to show him their existing reports, the doctor shirked them away, stating he might get TB by touching them or their reports.

Why did Mr X receive such spectacular treatment from their care provider, the person they trusted to heal them? Mx X is a transgender person.

Representative Image. (Source: Wikimedia Commons)

Sadly, this is not just Mr X’s story; it’s the story of many people who identify as LGBTQIA++. Time and again, survivors, the media and public health professionals remind us of the deadly statistics accompanying TB in India. TB kills nearly 1,400 Indians every day.

Yet, we often forget the gendered and social context in which TB exists in India. What does that mean? It’s hard for poor people to fight TB but harder still if you are a woman, transgender or gender non-binary person.

Though the bacteria doesn’t discriminate, people always do. As a result, these groups are often faced with poor quality and discriminatory experiences when fighting TB. Thus, TB becomes harder to fight for them due to stigma, discrimination and denial.

This poor public health response to gender minorities is hardly new. Until recently, India did not recognise the third gender or the rights of gender minorities. Health staff in India, in the public and the private sectors alike, are rarely sensitised to gender diversity. They are often fed with myths and misinformation. The result is stigmatising, poor care for those that need it the most.

The failure is with the medical education and the health system itself, which rarely helps health personnel understand the complexity of gender diversity and sexuality. Instead, it stigmatises and excludes them in medical education and does not discourage discriminatory behaviour. This leads to negative attitudes, misinformation and bad care.

This is evident even in the recent gender-responsive frameworks that the government developed. The framing body itself did not include sufficient trans or other gender minorities. What then can be the outcome of such a framework? It stereotypes trans individuals and reduces them to mere offenders. What’s worse, this framework is being celebrated across the health system.

In the process, we institutionalised stigma, discrimination and poor quality of care for these vulnerable groups.

Representative Image. (Source: flickr)

If we want to provide good care to these groups, there is an urgent need for completely rehauling the approaches to TB and other public health challenges to make the system in our country more gender and sexuality literate and sensitive.

The COVID-19 pandemic provides us with the opportunity to revisit and integrate concepts of gender and sexuality into our medical curricula.

Once a year, medical institutions and all health personnel providing TB care in public and private sectors need to go through sexuality and gender learning programs. They need to understand the challenges of working-class women, transgender individuals and economic, social and other contexts.

The system also needs to understand that treatment is not availability and affordability but rather dignified and sensitive approaches to care that do not isolate or breed fear of violence. Further still, women, transgender and non-binary individuals of lower-income groups are more prone to such discrimination violence. Misinformation, institutional isolation and a lack of political will to combat the same worsen the situation.

For women or gender minorities fighting TB, everything from awareness, diagnosis, treatment, support and nutrition are challenges. In a publication called Nine Lives, nine such Indian women recount their fight against this gendered disease.

India needs to urgently revisit its misguided gender-responsive framework on TB that was published by the Ministry of Health and Family Welfare in 2020 that failed the LGBTQIA+ population. The framework does not recognise and include the specific health needs and challenges of non-normative identities.

Gender-sensitive care needs to go beyond tokenism. Gender diversity needs representation in policy drafting committees and for the government to hold public discussions and listen to the community. The national TB elimination goals cannot be met until the gendered reality of the TB crisis is actively addressed.

This will start by making a change in policy and frameworks, transforming mindsets within the system and earning the community’s trust. The government needs to have an open dialogue with grassroots organisations and work with them for community-led awareness, stigma mitigation and creating policy and programs that address the needs of gender and sexuality minorities.

By Ashna Ashesh and Vashita Madan

Ashna Ashesh is an MDR TB survivor, lawyer and public health advocate. She is a Fellow associated with Survivors Against TB, a collective of survivors, advocates and experts working on TB and related co-morbidities. 

Vashita Madan is a writer and works in public health and communications, also associated with SATB.

Featured image for representational purposes only.
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        An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

        Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

        Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

        The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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        MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

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        As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

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        A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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