Vulnerable communities are guaranteed certain rights and entitlements that they are often unaware of or face barriers to access. Community collectives with solid leadership and support structures can serve as a vital force for advocacy and the attainment of rights. When trans women were excluded from financial aid, community institutions rallied the power of the people, and CAC and partners provided the framework to make a case for the community and won. Such victories amplify community voices that carry to the future attaining the attainment of rights.
The COVID-19 health crisis was deemed “the great equaliser,” affecting everyone without discrimination. However, in reality, this was not quite so! The pandemic unearthed deep-set inequities in accessing primary healthcare facilities, pronounced in the Transgender and Non-Binary (TGNB) community. The trans community remains estranged from mainstream society. Transphobia leads to extreme forms of physical and mental abuse from every corner, including public and private healthcare systems, alienation from the family, and deadnaming. A strained relationship with the healthcare system, caused by a lack of gender-sensitive treatment protocols, low health literacy among transgender women and hijra persons, poor healthcare-seeking behaviours, socio-economic barriers, lack of health insurance, and exclusion from social protection schemes, has driven them away from availing essential healthcare services, such as vaccines, hormonal treatments, and HIV medication during the pandemic.
Jeevika, a 27-year-old “Mangalamuki” or trans-woman based in Chikkaballapur, Karnataka, has faced such indignations multiple times. Facing social aversion and lack of support from her own family, she had to beg at traffic signals and solicited sex work; the transphobia, appallingly, has prevented her from actively seeking a decent livelihood. So, when the city came under strict lockdown, she found herself helpless with no transportation facilities to the vaccination centres; discriminatory glances and rude remarks were thrown at her, making her very uncomfortable. On the other hand, despite the general awareness about vaccination and information received through mobile, rumours spread in her community like wildfire: “some people said that they lost their family members after taking the vaccination; others got fever and body pain. Even though I don't have a family to take care of, I am fearful if I take the vaccine and get the fever; who will care for me then?”
This fear and mistrust about COVID-19 vaccines are not entirely unfounded. For one, the TGNB community is highly at risk of contracting HIV. At 3.14% of affected people, trans and hijras have the second-highest HIV prevalence rates across all most-at-risk population groups (i.e., people injecting drugs, female sex workers, and MSM). They remain higher than all adults in India (0.22%) as per data from the National AIDS Control Organization and ICMR-National Institute of Medical Statistics. It is unclear how vaccines affect people undergoing hormone therapy or antiretroviral treatment for HIV. Thus, it becomes an essential factor for vaccine hesitancy in the TGNB community.
Even as the country rolls out large vaccination camps, the TGNB community has been isolated in a sea of information deficits or misinformation. Jeevika says, “We are engaged in sex work, and we didn’t know what the situation was like about vaccination for us. For information on HIV, I would go to the doctors and directly ask them because they are the only right person to clarify our doubts. If doctors told us it was safe and would not cause any trouble, we would be willing to take the vaccination. But in the pandemic, doctors and counsellors did not reach out to us.”
Past experiences in her community have made her bitter against approaching hospitals for vaccines: “In hospitals they make us stand in the line to get the vaccine. Sometimes after seeing us, they tell us that vaccination is not available”. Swasti and Samara, an NGO working with trans communities for decades, also recognised that trans people need a safe space within their comfort zone. They are treated with respect and dignity and have their concerns addressed by trusted healthcare providers. In 2020, they collaboratively organised webinars for the community to discuss their concerns with the doctors. Other organisations in Bengaluru collectivised trans women to facilitate vaccination campaigns and counselling that were explicitly targeted at the TGNB community. More than 200 trans people were served in this camp.
Given the economic transgressions of the pandemic and subsequent nationwide lockdown, the Government of India declared financial aid packages for all vulnerable groups, including daily wage workers, construction workers, garment workers, and migrant workers. The transgender community, which constitutes a 4.88 lakh population (Census 2011), was left out. This exclusion came as a shock considering that in 2014, the Supreme Court of India recognised the transgender as “third gender” entitled to reservation in education and jobs and eligible for many social security programs at the central and state levels. However, the fact remains that their gender is neither recognised nor accepted in various formal registrations. Many State governments have constituted Transgender Welfare Boards (TWB). Still, these have not yet yielded concrete actions in addressing the social protection needs of transgender people, including health care, housing, education, and employment in the State. Moreover, TWB’s work during the time of the pandemic remains unknown.
Most TGNB members like Jeevika subsist by begging on the streets or as sex workers. Thus the exclusion of the community from centrally-sanctioned monetary support was devastating. Swasti realised this need and approached the National Institute of Social Defence (NISD), Delhi, to provide financial relief to the transgender community in Karnataka, Maharashtra, and Tamil Nadu. Through the collaborative efforts of Swasti and district CBOs, vulnerable groups eligible for receiving financial aid were identified. Factors like comorbidities, homelessness, old age, and people living with HIV were considered for determining the vulnerability of transgender people. The number of beneficiaries of the relief fund was set at roughly 10% to 15% of the total transgender population residing in that district.
Each selected transgender person received a direct bank transfer of Rs under this intervention—1,500, expected to last for around a month. While vulnerable groups were supplied with basics such as cereals, pulses, and oil under government or NGO relief programs, this financial contribution could be used to buy groceries that provide essential nutrients significantly since the cost of food had increased because of the pandemic. A beneficiary of the intervention expressed her gratitude, “We have been earning a livelihood by begging in shops. Due to the outbreak, we stayed at home for days together. It was difficult for us to live our lives. During this time, Rs. 1,500 was deposited into our account. It was quite helpful, and we are happy with the money provided. We are thankful for all of them involved in helping us get these funds”. Jeevika’s story and that of other trans people who found support during the pandemic represent the title of this collection of stories - they found an ear willing to listen to their difficulties, with the help, they were able to voice these at the correct forums, leading to steps towards its redressal.
