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Woke, But Not Yet Awake—Discrimination Faced by the LGBTQ+ Community in Healthcare

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The post-90s was an era of dramatic societal change, building an environment seemingly quick to accept, understand and socialise. Advocacy for marginalised communities reached an all-time high. However, it appears to be a surface phenomenon in many ways. It is simple to hide behind a screen and type out a plea for justice for a community without believing and being faithful to the cause and exercising it in actuality. Equal access to healthcare is a fundamental right. The picture today’s society paints, however, is anything but peaceful. This has marked the onset of the so-called Woke Phenomenon.

As human beings, we resist change. We are opposed to any sort of dissimilarity, unable to accept the differences between people and their personal choices, and feeling the uncontrollable urge to infiltrate personal lives and pass commentary on impersonal issues. In this scenario, one finds it difficult to go through life in the absence of proper help. The average teaching imparted to the youth simply perpetuates the opposite sex attraction over same or no sexual attraction. The community is often treated as an added accessory to society: a society which is divided into two human-made factions—the “normals” and the “aberrations”.

Innumerable mental health issues for the community [Image Credits: istock]

The LGBTQIA+ community faces many barriers in their everyday life regarding acceptance and equality from friends, family and society. One would think trained medical professionals with implicit knowledge of biology and the human mind would not be a part of the problem however, the attitude of the medical sector only makes the wall infinitely higher for them to climb.

The Fear Factor

Medical professionals, in many cases, are not equipped to handle the issues and needs of the community as healthcare training is often done on the basis of heteronormativity and gender stereotypes. Patient-doctor confidentiality rules are violated, and their problems are treated as taboos or salacious gossip. Purposefully misgendering individuals and stereotyping them only furthers the innate fear of visiting medical professionals in times of need. More often than not, members of the community are not recognised as equal receivers of treatment and healthcare. Other times they might be heckled, harassed and humiliated for their gender identity or sexual orientation.

Consequentially, the community becomes averse to approaching the healthcare system and getting their medical needs addressed, in constant fear of ridicule, moral policing or even macro-aggressions such as foul, abusive language and assault.

The Increasingly Horrifying Reality

The experiences recorded in the results of a study on the experiences of discrimination against the LGBTQ+ community show that interpersonal discrimination was highly common, including a majority being subjected to slurs. The atrocities faced by the community only seem to escalate drastically as macroaggressions such as sexual harassment, violence and harassment regarding bathrooms were recorded at a shocking rate. Consequently, the community chooses to hide crucial details about certain conditions, which results in doctors not being able to identify the issue, brushing it under the carpet or leading to wrong treatment, which may be fatal.

Statistics show that the community faces mental health burdens at a higher proportion than others as a consequence of constant harassment and the tussle for acceptance as an equal shareholder of society. For queer women and transpeople, unfortunately, the family is often a site of abuse. Policing and suppression of their identities by their family members is highly prevalent. Transpeople are consistently ridiculed and systemically shunned for their gender expression. This takes a severe toll on one’s mental state of being. Life becomes difficult to traverse in the absence of proper help.

The pandemic added to their problems [Image Credits: The Trevor Project Design by Ruth Basagoitia]

Mental health and treatments related to prior experiences depend on how transparent the communications between the doctor or counsellor and the receiver are. If someone is scared to reveal the bigger chunk of their identity in fear of abuse from the people in power, their vulnerabilities can only amplify drastically with time.

The severe lack of medical knowledge about LGBTQ+ issues in terms of health promotion poses a grave disparity in access to proper healthcare. Given that there is no dearth of funding in biomedical, pharmaceutical and physiological research, the lack of concrete information can only be traced to the perpetual innate homophobia, lack of acceptance of opposite sex attraction or transpeople and viewing the members of the community as “add-ins” or “outliers”. The lack of recognition of the community as individuals with equal rights is simply perpetrated by the medical society and shamefully so, as educated and trained professionals should be bridging the gap instead of widening it.

Bridging The Gap

On the grounds of pre-existing research, there exists a massive health equity potential which is not inclusive of data populated from the studies conducted on cisgender, heterosexual individuals. At the very outset, gender identity might seem irrelevant to predominantly respiratory and viral illnesses, but knowing this information can have a significant bearing on a better understanding of quarantine and isolation behaviours. The ability to perform routine health care maintenance, mental health needs, and support networksare all critical to disease transmission and the severity of the clinical course.

Growing evidence clearly illustrates that LGBTQ+ adults have an increased risk of cardiovascular disease such as angina, coronary artery disease, and myocardial infarction compared to cisgender, heterosexual adults due to higher rates of substance abuse induced due to greater exposure to discrimination and violence among many other psychosocial factors.

Disproportionate Occurrences for Major Diseases

According to the National LGBT Cancer Network, gay and bisexual men have been proven to have had a significantly higher incidence of anal cancer, while lesbian and bisexual women have an elevated risk of breast cancer. Respiratory health disparities are also common among the communities, including higher rates of sinus infection, asthma, bronchitis, and chronic pulmonary obstructive disease (COPD), which also has an influence on COVID-19 prognosis.

Social constructs like a person’s gender individuality and its effect on health have been taboo topics. There has to be a new beginning, and that is the proper acceptance of how relevant the interconnection between sexual minorities and their need for categorised health data analysis actually is.

Effect of the Pandemic on Healthcare for Marginalized Communities

The pandemic made healthcare for marginalized communities hit a new low. Sexual activities are already considered a social stigma. The community faces much higher discrimination in this regard. Studies by The Indian Journal of Medical Research show that the HIV virus is 4% more prevalent in the case of homosexuals than in the general population. Yet the barriers are far more daunting for the community as the cost of testing is high, and the prevalence of social phobias makes it even more inaccessible as a viable resource. Of the transgender population, more than half are unable to access proper healthcare for the treatment of STDs, rendering the entire community at risk.

 HIV-positive transgender health workers at a counselling programme [Image Credits: Thomson Reuters Foundation/Annie Banerji]

The lockdown had restrictions on livelihood and access to health care, especially for the trans community. It impacted the proper communication of medicines like Anti-Retroviral Treatment (ART) for people living with the Human Immuno Virus (HIV)/Acquired Immuno Deficiency Syndrome (AIDS) and those going through Hormone Replacement Therapy (HRT) for gender transitioning. India is home to the world’s third largest population living with HIV. Given their damaged immunity, the HIV+ transgender community is even more vulnerable to COVID-19.

Till today transpersons are dependent on conventional and interactive forms of livelihood, which came to a halt due to the lockdown. Transgender people staying with unsupportive family members during the pandemic have had to deal with stress leading to anxiety and depression.

Poor mental health has been linked with behaviour that is detrimental to their overall health, including extended use of substance abuse, smoking, drinking, self-harm, eating disorders and suicidal tendencies.

Health Insurance—Spending the Big Bucks

The Insurance Regulatory and Development Authority of India (IRDAI) has stated rules for insurance companies around the country to be loud and clear about underwritten rules, specifically for transgender applicants. The decision is hugely admired for ensuring transparency and making such social security benefits inclusive and accessible for the community. Under the IRDAI directive, the insurers must not conceal any details of the health insurance offered. They said, “All the insurers are now instructed to publish on their respective websites the aspects of underwriting philosophy and approach about offering health insurance coverage to transgender persons so that they have the complete information on the philosophy adopted by the company.”

Reputed companies like IBM, Godrej Group, Accenture, IT services providers Cognizant and Tech Mahindra and HR services firm ADP offer medical insurance to same-sex partners of their LGBTQ employees. However, many companies still do not extend this benefit to live-in or unmarried partners, even though they can. This is perhaps due to a lack of clear definitions of laws for such couples. A major setback is that gender-reassignment surgery is still considered an essential medical procedure and not covered under insurance by most companies.

Slow and Steady Wins the Race

For a matter as sensitive as this, changes should start off fundamentallyby changing the inherent mentalities of power-rich entities and hence the society in general. One can only define non-abstract shoulds and shouldn’ts by setting rules and regulations such that the marginalized communities aren’t violated. In bigger chain hospital units, funding must be properly used to impart proper knowledge and training to the staff regarding making patients from the community feel comfortable. As for corporates, equality in all literal genders should be carried on. There should be boards to make sure these employees aren’t singled out for their complaints and are given proper healthcare benefits. As citizens, we must encourage all individuals from the communities to seek proper medical help.

Judiciary justice for the LGBTQ community [Image Credits: AFP]

While individuality is attacked and put to the stand very often, what makes the average human population feel threatened, is the existence of unabashed personalities. When we talk about identity from the constitutional spectrum, it must not be a non-customisable binary spectrum.

In the NALSA vs Government of NCT in Delhi case, the petitioners have stated that the rights of the lesbian, gay, bisexual and transgender(LGBT) community, comprising 7-8% of the total Indian population, need to be recognized and protected, for sexual orientation is an integral and innate facet of every individual‘s identity.

It no doubt is clear how abuse and inequity in accessing rights have a domino effect on the holistic progress of the LGBTQ+ community. A person belonging to the said community does not become an alien to the concept of the individual, and their individualism cannot be viewed with a stigma. The impact of sexual orientation on an individual‘s life is not limited to their intimate lives but also impacts their family, professional, social and educational life. Ultimately, the human species over the years have flourished and thrived best with the ‘live and let live’ ideology.

Featured Image Credits: Firstpost

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