Dr. Deepak KG and Renny Jopol Johnson
Covid-19 is having its catastrophic effects on human psyche by wreaking havoc on industry, civil society, state machinery and sundry other spheres. Many of these issues have already been discussed extensively through media, both traditional and modern. But, one section within the civil society is yet to receive the discourse and attention they deserve the transgender community. Even after a legal deliverance from oppression, albeit with limitations, the unique social, economic, political and physiological challenges faced by transgenders are still existing and it got exacerbated during this pandemic propelled lockdown. All these together are causing immense psychological challenges among the 4.8 lakh transgenders living in the country.
The mental hardships of getting daily bread, housing and other essentials
Financial insecurity due to loss of livelihood can cause severe mental stress in any person. For the transgenders, there is negligible social security to handle crisis situations as most of them do not have any ID to get government benefits, for they either are migrants or runaways. Poverty, hunger and deprivation was bound to follow.
This economic predicament is aggravated by the pervasive social stigma leading to worsened psychological trauma. They become unfairly excluded from the supply of essential items like food, water, fuel and most relief packages. States like Kerala and Uttar Pradesh had announced financial aid in addition to bulk rations for the next six months. The PM Garib Kalyan Yojana also brought in a slew of measures. These steps are laudable. However, there is no separate mention of transgenders as beneficiaries in any of these propositions. Categorising them along with the BPL (Below Poverty Line) population in welfare schemes may fail to recognise the specific needs of the community and deprive them of actual welfare.
The menstruating transgenders face an additional period poverty, as they go deprived of sanitary pads. To worsen all this, they are also suffering from blaming, shaming and verbal stoning during their lockdown-compelled dependence on nearby common shops for these essential goods, unlike in the past where they could buy from trans-friendly shops elsewhere.
Shocking, but true that posters that read talking to a transgender will get you infected of COVID had appeared in Hyderabad. This stigma and their inability to pay rent due to loss of livelihood had led to eviction of many by their landlords. For the ones who continued to stay in their cramped spaces in proximity, the risk of virus spread was high. This in turn increased their ostracization of being labelled as COVID-19 carriers as said by Mumbai-based hijra activist Urmi Jadhav.
Waves of Transphobia are pushing from all around as fear and hopelessness are mounting. We cannot measure the mental health impacts of this pandemic on transgender community, with our customary scale. They lack social capital, and their challenges are totally a different ball game.
Overhanging impacts of inaccessibility to medical care
India is home to a large number of HIV infected transgenders. Their compromised immune system is highly vulnerable to COVID-19 and hence are living daily in anxiety. As the healthcare system has prioritized the pandemic, retroviral therapy is facing delays and postponements which has worsened their fear, making them prone to depression. Small, but not a trivial share of transgenders are currently under Hormone Replacement Therapy (HRT) and face challenges in continuing their treatment during this lockdown. Sudden stoppage of Estradiol and Progesterone can lead to depression, mood swings and anxiety. Irrespective of the hormone, sudden stoppage of HRT would cause Gender Dysphoria where the individual will suffer from mental conflict between two genders.
According to a study published last year in American Journal of Psychiatry, individuals with gender incongruency are six times more likely to have mood swings and suicidal tendency compared to the normal population. A work published by Herbs et al in 2008 showed that the suicidal ideation and attempts are highest among transgender women in the world. Also, Clements-Nolle et al (2006) says that the discrimination and marginalization has resulted in minimal mental health seeking behavior among Trans Gender Non-Gender Conforming (TGNC) groups.
Indian health system already lags in mental health surveillance and accessibility. The already negligible TGNC-specific paths available to seek mental healthcare has shrunk for worse during this lockdown. This is leading to an alarming situation of mental health breakdown among the community.
The loss of community
The Indian Psychiatry Society points out through their survey that the number of reported cases of mental illness rose by 20% within one week of the national lockdown in India. The sections of the population with no family or state support are the ones at the worst receiving end. Transgenders fall in this list. So, where do their support come from?
The transgender community live and thrive in the fifth space. It is the space where they develop a psycho-social world view of themselves a view devoid of stigma and prejudices propagated by the mainstream gender-binary heterosexual society. Here, there is dignity and collective solidarity.
The lockdown has struck hard on this fifth space for the community and has confined them within the four corners of their dwelling. The solidarity and constant mutual support emanating from their collective conscience, has come under severe strain. A community which lived majorly on social interaction like begging, badhais and sex work, is suddenly under an ontological insecurity an existential term which denotes a condition where a person is facing sudden changes in the environment which is threatening his/her very essence. This loss of community their sole emotional support and source of power, is creating significant mental stress among them.
Domestic abuse
The lockdown has made many transmen and transwomen go back to their villages and families of blood or conjugal relations. Domestic abuse from family members increase due to the current proximity and lack of community support unlike in the pre-lockdown period. Abusive partners in LGBTQ relationships can use the patriarchal power differential to blackmail them about revealing their identity out to the public. This is called outing of a partners gender identity or sexual orientation. Many at times, the abusive partner cuts off any resource for the victim by conniving with other friends and family members. Often, violence is portrayed as mutual and even consensual, or as an expression of masculinity or some other desirable trait.
In a recent study (2020) Published by De Jesus, Gopal Krishna Kaza et al on mental health issues of transgenders, they found out that 96% of their participants from Hyderabad had experienced physical or mental abuse from their intimate partner. The paper had also shed light to some shocking facts. All the participants have either been denied or lost a space to live and 48% have been denied a job due to their sexual orientation. As the pandemic is accelerating the rate of joblessness in the country, more transgenders are likely to be thrown out of their livelihood. This would increase the chances of domestic abuse within the household due to their economic disempowerment.
Need for change
Highlighting the plight of the transgender community, Amnesty International said: As the world comes together, Indias transgender community fights COVID-19 alone. The immediate need is to provide ration through PDS (Public Distribution System) and cash transfer to their Jan Dhan bank accounts. This should be done on a war footing by the state machinery by aggressive provisioning and enrolment into Aadhaar, PDS and creation of bank accounts. The long-term aim of the government should be their proper enumeration for targeted interventions and the Legislative should amend the law to let them self-identify their gender. This would also be consistent in letter and spirit with the judgment of the Honorable Supreme Court of India in the NALSA vs Union of India and obligations of the state under Articles 14, 15 (Equality) and 21 (Liberty and Right to life) of the Constitution of India.
The government should financially support organisations like TWEET, Essar Foundation, Kineer services etc. in taking care of the communitys dietary requirements, rescuing stranded trans people after the lockdown announcement, mobilising resources to ensure the supply of medical essentials, as well as providing entrepreneurship platforms. Many NGOs are helping transgenders to cope up with mental health problems through digital means. They are using platforms like Facebook, YouTube and Instagram to hold regular live chats to address issues such as anxiety, depression among others arising due to improper hormonal balance (due to disruption in hormonal therapy). Strong state-civil society partnerships are imperative to ensure that Indias transgender community doesnt fight COVID-19 and lockdown associated mental insecurities alone.
Dr. Deepak KG, Student, Masters in Public Health Administration, TISS, Mumbai
Renny Jopol Johnson, Student, Masters in Hospital Administration, TISS, Mumbai
Views are personal
References
Jaqueline Gomes de Jesus, C. Micha Belden, Hy V. Huynh, Monica Malta,Sara LeGrand, Venkata Gopala Krishna Kaza & Kathryn Whetten (2020): Mental health and challenges of transgender women: a qualitative study in Brazil and India, International Journal of Transgender Health, DOI: 10.1080/26895269.2020.1761923
Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons. Journal of Homosexuality, 51(3), 5369
Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., & Crepaz, N. (2008). Estimating HIV prevalence and risk behaviours of transgender persons in the United States: A systematic review. AIDS and Behaviour, 12(1), 117.