Easing the Way for Transgender Care

Mitr Clinics employ doctors, counselors and outreach workers from the transgender community. (Photograph courtesy USAID)

In January 2021, the USAID-supported ACCELERATE program, which is funded under the United States President’s Emergency Response for AIDS Relief (PEPFAR), and implemented in partnership with Johns Hopkins University (JHU), launched India’s first transgender clinic in Hyderabad. Mitr means “friend” in Hindi and the Mitr Clinics help meet the needs of the transgender community through conversations and activities built on empathy and friendship.

The clinic is supported by USAID in conjunction with Telangana State AIDS Prevention and Control Society and the Government of India’s National AIDS Control Organisation (NACO).

The clinics, which employ doctors, counselors and outreach workers from the transgender community, are now operational in Thane and Pune as well. So far, Mitr Clinics have assisted over 3,000 members of the transgender community by providing an accessible and smooth service. For example, Tanya Khan, a 25-year-old transgender woman who visited a Mitr Clinic seeking HIV care services, says her experience at the clinic was hassle-free and the services provided were inexpensive. “Everything was so easy and smooth,” she says.

Another similar initiative, the Transgender Health and Wellness Centre in Imphal, at the Jawaharlal Nehru Institute of Medical Sciences, was launched in March 2021, this time with support from the United States Centers for Disease Control and Prevention (CDC). The establishment of the Center and the Mitr Clinics were both funded under the PEPFAR.

Comprehensive care

The ACCELERATE team has also made PrEP available for free at the clinics, with contributions from donors like the John C. Martin Foundation. PrEP is considered one of the most effective tools to prevent the spread of HIV and can be administered as an injection or a pill.

“USAID recognizes that the transgender community in India faces significant barriers in accessing quality health care and suffers from disproportionately high rates of HIV/AIDS and other health problems,” says Deepika Joshi, USAID’s HIV Division Chief in India.

In addition to increasing access to preventive medications, the clinic also offers HIV-prevention services like counseling on the need and use of PrEP, HIV and risk reduction education, provision of prophylactics, supportive services for survivors of gender-based violence, and harm reduction interventions.

Overcoming challenges

Running the Mitr Clinics comes with unique challenges, given the diversity of culture and identities within the transgender community. “One of the most significant challenges we face is navigating the interpersonal community dynamics between the various subsets of the transgender community,” says Simran Bharucha, director of transgender health at ACCELERATE/JHU School of Medicine. “It is important for us to remain impartial and prioritize the well-being of all individuals to deliver the highest quality of care to our patients.”

Another challenge is managing community expectations. To ensure maximum reach and continuity, the ACCELERATE team has established referral mechanisms that direct patients to subsidized private providers and government-funded service providers, says Aditya Singh, executive director and deputy chief of party at ACCELERATE/JHU School of Medicine. These referral institutions provide clients with greater access to the government’s social support schemes as well as additional health care services provided in a patient-centered and holistic way that is sensitive to the patient’s gender identity.

Future plans

The teams at the Mitr Clinics maintain open communication with the community and network with other platforms and programs to support their beneficiaries. Singh says the clinics want to provide comprehensive health care services beyond HIV-related services, collaborate with other health care providers and community-based organizations, raise awareness, and advocate for the rights of the transgender community.

“The clinics also aim to sensitize and garner support from the government, civil society, and private sector to establish a fair and just society for the transgender community,” he adds.

The model behind the Mitr Clinics has inspired other initiatives in the country. For example, the All India Institute of Medical Sciences (AIIMS), New Delhi, has incorporated elements of the Mitr Clinic model in the design of its Centre of Excellence for Transgender Health. The center will help expand transgender-related comprehensive care across the country and build capacity among the medical and paramedical staff.

“The Mitr Clinic model has influenced the establishment of ‘one-stop-centers’ for transgender individuals, under the collaboration of NACO and the Global Fund to Fight AIDS, Tuberculosis and Malaria,” adds Singh. “Through our project, we are also exploring government integrated help desk models, private sector collaboration models, and community-led models across different settings.”

The White House Proclamation in honor of Pride Month has reminded us that “we still have generational work to do to ensure that everyone enjoys the full promise of equity, dignity, protection, and freedom.” The same proclamation re-emphasizes the need to end the HIV/AIDS epidemic and PEPFAR continues to support this endeavor. This year marks PEPFAR’s 20th year of active collaboration, in which the U.S. government has invested over $100 billion in the global HIV/AIDS response in more than 50 countries. Initiatives like the Mitr Clinics are a crucial component of this global response to strengthen basic human rights for the transgender community and end HIV/AIDS as a public health threat by 2030.

Paromita Pain is an assistant professor of Global Media Studies at the University of Nevada, Reno.