Building Health Infrastructure and Social Support

U.S. government-supported clinics in Hyderabad and Imphal are providing health services and support to the medically underserved transgender community. In January 2021, India’s first transgender clinic was launched in Hyderabad (above). Photograph courtesy ACCELERATE

The United States is working with partners across the world to build a more inclusive society for LGBTQI+ persons and address the challenges faced by them. As part of this effort, the U.S. government recently supported the establishment of two clinics for the transgender community, which is medically underserved and frequently encounters bias and discrimination. On January 29, 2021, India’s first transgender clinic was launched in Hyderabad. Funded through the ACCELERATE program, under the President’s Emergency Plan For AIDS Relief (PEPFAR), the clinic is supported by the United States Agency for International Development (USAID), in conjunction with Telangana State AIDS Prevention and Control Society and the Government of India’s National AIDS Control Organisation (NACO).

Simran Bharucha, director of transgender health, ACCELERATE, describes the clinic as a one-stop center providing comprehensive services for the transgender community in a stigma-free environment. “The clinic provides general health services; guidance and medication on hormone therapy and gender affirmation procedures; mental health counseling; HIV/STI counseling; prevention and treatment services; legal aid and social protection services,” says Bharucha. “Referral linkages are being explored with private clinics for gender affirmation surgeries at a subsidized cost.”

A diverse range of stakeholders was engaged in the process of designing and establishing the clinic’s service delivery model. Transgender community members and activists were involved in assessing the current gaps in the transgender community program, their expectations and recommendations, based on which the clinic structure and services were designed. Building on community feedback, the timings of the clinic were altered to align with the availability of the target population.

The clinic is being promoted through outreach activities, social networking sites and apps and community collaborations. “The Hyderabad clinic is completely led by transgender representatives, which helps spread a positive message about the friendly environment, staff and the services,” adds Bharucha.

In March 2021, the U.S. Centers for Disease Control and Prevention (CDC), under PEPFAR, helped launch the Transgender Health and Wellness Centre in Imphal, at the Jawaharlal Nehru Institute of Medical Sciences. The center brings improved access to health care, and specifically HIV/AIDS medical care, for the transgender community in Northeast India.

In coordination with the U.S. Consulate in Kolkata, the CDC worked with International Training and Education Centre for Health (I-TECH) India, the implementing partner, local communities, the Manipur State AIDS Control Society and NACO to launch the clinic.

“The United States is committed to working with like-minded governments and civil society organizations to support and advance the human rights of LGBTQI+ persons,” U.S. Consul General Patti Hoffman said at the opening of the clinic. “This successful inauguration demonstrates the strong partnership and health cooperation between the United States and India.”

I-TECH India, which has roots within the University of Washington’s Department of Global Health, collaborated with the community-based Maruploi Foundation, as well as national and state AIDS control societies to build a two-pronged approach in serving Manipur’s transgender community. “Situated next to the Transgender Health and Wellness Center,” says G.S. Shreenivas, director of prevention at I-TECH India, “the health desk at the Jawaharlal Nehru Institute of Medical Services offers our clients HIV/STI screening and testing as well as antiretroviral therapy referrals to public hospitals and general hospital services.”

Dr. Anwar Parvez Sayed, country director at I-TECH India says that in the first phase of the project, the support from the U.S. government through the CDC was focused on people who inject drugs. “After successfully demonstrating various innovations for HIV prevention among people who inject drugs, CDC, through its implementation partner I-TECH India, moved toward providing HIV prevention and treatment services for other vulnerable populations including transgender persons,” says Dr. Parvez. “The move received further encouragement from emerging evidence and demand from the transgender communities in Manipur for a comprehensive approach addressing their broader health and social needs.” This prompted the clinic to go beyond clinical services and provide wellness, gender affirmation support and welfare services along with capacity building and skills building for the empowerment of Manipur’s transgender community.

“The Transgender Health and Wellness Centre is not focusing only on trans women but also on trans men, to bring all the vulnerable and marginalized genders into the private and public set-up,” says Abhina Aher, technical expert for key populations at I-TECH India. “This will open up newer avenues for transgender centers to integrate the gender affirmation surgery in different set-ups in the future. The learnings from this comprehensive approach will also help the team in devising strategies for other vulnerable populations.”

For both clinics, recruiting transgender staff has been a crucial step in gaining the trust and confidence of the community. Ganga Bhawani, who completed training to be a nurse as a male and now identifies as a transgender woman, illustrates this vital component. “In spite of being qualified, I used to beg for my survival since there were no jobs available with my desired gender,” says Bhawani. On learning about the ACCELERATE transgender clinic opening in Telangana she applied as a professional nurse. “As the first trans staff to be hired by the Hyderabad clinic, I was skeptical about the remaining staff,” she says. “All my doubts were gone when the clinic committed to hiring only transgender-identified staff to provide services to trans people.”

Dr. Parvez shares the experience of Sur (name changed), a trans woman who stopped taking medicines for more than 10 years due to myths and stigma surrounding people who are living with HIV. “She was highly motivated after visiting the Transgender Health and Wellness Centre, on finding many transgender community persons working here along with a transgender person living with HIV working at the same premises.” This inspired Sur to initiate her treatment along with peer counseling.

The success of the clinics in Hyderabad and Imphal is already inspiring similar initiatives across India. “Under the ACCELERATE project, work is in progress to initiate transgender clinics in the Pune and Thane districts of Maharashtra,” says Bharucha. “Based on the Hyderabad model, many community leaders from other states such as Gujarat, Andhra Pradesh, Delhi, Punjab and Odisha are reaching out to initiate clinics in their respective cities.”

Hillary Hoppock is a freelance writer, former newspaper publisher and reporter based in Orinda, California.