An HIV-positive MSM commented during a Pehchan-supported study on discrimination and stigma in healthcare settings: “I went to a government hospital. The doctor did not treat me well when he learned about my HIV status. He looked at me like I had committed a crime. I don’t want to be treated like a criminal!”
According to a PLOS Medicine report in 2007, HIV prevalence among men who have sex with men (MSM) is more than 19 times the prevalence of the general population in low and middle income countries. The Lancet reports that HIV prevalence among transgenders is even higher: nearly 49 times. According to Pehchan’s own baseline survey, there also exists a gap between awareness of healthcare services in this population and actual access.
While many MSM, transgenders, and hijras (collectively, MTH) are aware of services, they stay away because of the behaviour of staff, mistreatment by other patients, and other instances of discrimination. It’s simply too difficult to disclose their identities and that can directly affect their health. Another MSM in the study reported, “I am an MSM and HIV-positive, but I don’t go to hospital for treatment, because I don’t want to disclose my identity.”
Despite having high HIV prevalence, MTH populations in India are not availing mainstream services. Preliminary data from this Pehchan operational research study reveals that they face routine social stigma and discrimination. The main barrier appears to be a reluctance to disclose their sexual identities for fear of discrimination at the clinic, in their families and with the community at large.
Over the last four years, Alliance India’s Pehchan programme has registered more than 400,000 MTH community members in 18 Indian states. Nearly 70% of the registered population have been referred to HIV testing and counselling in the government’s Integrated Counselling and Testing Centres (ICTCs). A full 88% of clients detected HIV-positive have been linked to antiretroviral treatment (ART) at government ART Centres, and 90% of them have been provided regular ART adherence support.
Pehchan has worked to build capacity of 200 community-based partner organizations, including efforts to address homophobia and transphobia in healthcare settings. Regular sensitization sessions on MTH health have been conducted for ICTC counsellors and ART Centre staff to create an enabling environment to improve healthcare access for sexual minority clients. Accompanied referrals with Pehchan Field Workers are provided to district health centres for clients with symptomatic Sexual Transmitted Infections.
While progress is being made, MTH communities still remain largely outside India’s health system. We need to work together to prevent HIV and ensure healthy lives for all. While there has been enormous demand on ground for services like those provided by Pehchan, most healthcare institutions across the country still have much to do to create sensitive and caring environments for MTH. Simple solutions like community-friendly opening times and the placement of targeted services near hotspots, along with routine training of staff, can help ensure and sustain health-seeking behaviour and contribute to quality healthcare for all sexual and gender minorities in India.
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