However, such proclamations are not new. A report by the Observer Research Foundation found that such efforts have a long legal history rooted in social movements and public interest litigations. As recently as September 2019, a High-Level Group on the health sector constituted under the 15th Finance Commission not only recommended that the Right to Health be declared a Fundamental Right, but that Health be also shifted from the State List to the Concurrent List. While the latter recommendation may posit its own constitutional and administrative challenges, swift and progressive actions must be taken soon because India’s expenditure on public health is still abysmally low (it was just 1.29% of the GDP in 2019-20) and accessibly remains a dream for many. A study found that while only 3% of all major illnesses in Indian metro areas remain untreated, 12% of the same were untreated in less developed villages. Moreover, one-fifth of all diagnosed major illnesses among the scheduled tribes were also untreated. These data point to unaddressed inequalities along the lines of geography, class, caste, and tribal status.

While much has been written and said about the rural/urban divide, unequal access to hospital spaces for people with disabilities, and caste/class-based exclusions, etc., very rarely are queer people’s exclusions from the healthcare sector discussed or addressed, especially outside of the context of HIV/AIDS. And this problem becomes more complicated when one factors in the many intersections that undergird queer people’s experiences. Thus, one could be queer and disabled, or queer and working class, and thereby face additional forms of marginalisation which are rarely (if ever) acknowledged.

A 2021 article in the Swaddle accurately points out that within the healthcare sector, most HIV/AIDS interventions targeting queer and transgender people viewed their issues as primarily biologically determined. The social and cultural dimensions were rarely factored in. And the NGOization of HIV/AIDS prevention programmes in India has increasingly reduced complex problems like HIV/AIDS infectability and care to a numbers game. The social, cultural, and economic determinants that either deter people from accessing HIV/AIDS care (such as social stigma, a lack of awareness, etc.) or those that make medical spaces structurally inaccessible are rarely addressed in such corporatised interventions. Mental health care for queer communities, while noble in their endeavour, also typically fail to engage with these wider socio-cultural issues. The very epistemology of psychological practice in both India and the West is cis-heteronormative and rooted in queer oppression. As illustrated in a Psychology Today article, the time has come to “queer ”psychology in order to effectively engage with queer populations in more inclusive and affirming ways. While the APA (American Psychology Association) released an important book in 2017 to do exactly this (called “Teaching LGBTQ Psychology: Queering Innovative Pedagogy and Practice) it is unsure whether the Indian counterpart has plans to do anything similar.

As is well known, The World Health Organization (WHO) defines health as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Thus, health is to be viewed holistically and must include physical health (such as the issue of HIV/AIDS care addressed above), mental health (such as the issue of ‘queering’ psychology), and social health (the issue of inclusion and equity).

Some ways to achieve greater health equity for the queer community in India are as follows:

• ‘Queering’ Indian Psychology: Following the heels of the APA, the Indian Psychiatric Society (IPS), which is the oldest & largest organization of psychiatrists and allied mental health professionals of India needs to come together to put forth an Indianized version of ‘queer’ psychology that takes into account the unique cultural and political dimensions of the Indian queer identity. Such an initiative needs to ask complex questions like: what are the mental health implications of casteism in India and how does it affect DBA (Dalit Bahujan and Adivasi) queer people? In what ways do police militarization in places like Kashmir and the North East affect the mental health of residents, and what is its impact on queer populations in those regions? To answer these questions, Indian psychologists, sociologists, anthropologists, gender specialists, and social psychologists (to name a few) must come together. Other issues that come to mind are religious persecution, the rise of right-wing nationalism, and the impact of increasing authoritarianism on queer people’s mental health.

• Creating healthcare systems that are welcoming and inclusive: A lot has been said about the unwelcoming nature of hospital settings. People with disabilities, for instance, have routinely called out Indian hospitals, doctors, and insurance providers for their blatant ableism. Gender discrimination in healthcare access for cis women in India has also been well documented. The time has come to reimagine and challenge the way these health systems are conceptualised. And even small changes can make huge differences. For example, having gender-neutral bathrooms, and offering medical insurance policies for same-sex couples are a few ways in which healthcare systems can be more inclusive.

• Training and sensitization programmes: The medical curricula in Indian medical colleges need to be re-engineered to factor in topics around diversity and inclusion. Medical staff also need to be sensitized about the vulnerabilities that marginalized people such as gay, lesbian, transgender, bisexual, and non-binary patients (to name a few) might face while entering hospital settings. For instance, it is a fact that incidents of HIV/AIDS infection are higher among MSM (men who have sex with men) in India, yet these people are afraid of disclosing their sexual history for fear of judgment, ridicule, and shame. Thus, hospital settings need to be very vocal about their non-discrimination policies and communicating this is the hospital’s responsibility.

• The Role of Mass Media: Mass media plays an important role in shaping perception. For far too long, the Indian media has shied away from addressing the complex cultural, social, economic, and emotional deprivations faced by the queer community. Given that queerness was- until recently- perceived as a criminal offense and mental illness, it is important for the media to re-mold people’s perceptions by positively addressing the needs and aspirations of queer people. For instance, one major challenge that queer people face is accepting one’s own identity. And even today, many queer people and their family members seek medical interventions to “cure” what they believe is a pathological illness. Thus, it is incumbent upon the media to debunk these myths for the public once and for all.

Various other interventions also exist. Civil society organizations can be strengthened, collaborative government interventions are possible, and medical oversight bodies can be established across the country that could acts as watchdogs for medical malpractices such as ‘conversion therapy’ and ‘corrective rape’.

Indeed, the challenges are many and the solutions complex, but with collective action and iron-clad willpower, change is possible.

Further reading

C-SHaRP: Readings on stigma and discrimination faced by hijra and kothi persons in HIV/AIDS-related contexts: [link]

Narrain, Arvind and Vinay Chandran (2016). Nothing to Fix: Medicalisation of Sexual Orientation and Gender Identity, Sage Publications [link]

Dutta, Sayantan (2021) Trans and Queer People in India Should Demand Better Health Care.
Scientific American [link]

The findings of her study are available here. The abstract of her study is presented below, from genderdiversityandschools.in/research-design/

“I present the results of a first of its kind qualitative study to understand the experiences of queer students during their K-12 education in India. “Queer” signifies various counter-heteronormative identities apart only from lesbian, bisexual, gay and transgender (Narrain and Bhan, 2005; Menon, 2008). Using semi-structured interviews with self- identified queer persons of <=25 years of age, focus group discussions and expert interviews, I develop a coding scheme based in grounded theory and guided by Olweus’ (1993) definition of bullying.

I find that: 1. Gender non-conforming students are labelled as gay, lesbian or transgender and are bullied verbally, physically, sexually and relationally by students, teachers and administrators, regardless of their actual sexual orientation. 2. Perhaps, due to the androcentricism and invisibility of female sexuality, gender non-conforming PAGFB are subjected to less bullying than gender non-conforming PAGMB, up to a certain point. 3. Schools are sex negative with little or no sexuality education, and no policies prohibiting bullying. Complaints are either trivialized or bullied students are blamed for bringing this upon themselves by being gender non-conforming. Bullied participants report isolation, depression, fall in grades and educational aspiration, suicidal ideation and increased absenteeism but many also excel academically and in co-curriculars. Some love school as it is the only place that they can be themselves. Participants and experts suggest that comprehensive sexuality education and inculcating equal respect through effective school and state based policies may create more inclusive school climates.”

I attempt a model “Anti-Discrimination and Sexual Rights” policy based on my findings, legal decisions and suggestions from participants and experts.

Click here, or on the image below to go to the website:

Editors’ note: This post has been added to Orinam’s compilation of resources for educational institutions in India, at https://new2.orinam.net/resources-for/educational-institutions/

This talk was part of ‘TransForm: Transgender Rights and Law‘ conference, organized by the Centre for Law and Policy Research (CLPR),  on December 14-15, 2016, and held at the Indian Institute for Human Settlements, Bengaluru.

Orinam thanks Gee for consent to share this on Orinam, and CLPR for making this available in the public domain (see TransForm site for links to other talks).

Indira has been out as a queer person since she was 20. However, she was not out to herself as a transwoman back then, identifying as a gay man for a long time. She began her professional career with the India operations of a Wall Street giant ‘X’. During her six years at X, Indira was open and out as a gay man with her employer. She did not have the need to inform them that she was dyslexic, as the role leveraged her strengths and didn’t put her inadequacies to test.

Indira was recognized with awards for high performance every year of her time at X.

She then moved to company Y. During the next six years, Indira was open and out as a gay man to her employer at Y as well. It was over these years that Indira began questioning her gender and gender identity, and came to terms with her disability. In June 2014, Indira was rehired by company X. Over the next six months Indira would be at the receiving end of the company’s violation of the mandate of the NALSA vs. Union of India judgement (hereafter, NALSA judgement) where the Supreme Court laid down that SRS should not be a prerequisite for gender change as gender transcends the body and cannot be reduced to the presence of an organ or the absence of it. The company also violated its own disability policy that mandates that differently-abled people be offered roles in consonance with their skills and strengths. This essay documents the challenges faced by Indira since her coming out as trans and dyslexic.

The First Week
Late in March 2014, Indira received a call that informed her of a role in her former employer X. The job description (JD) emailed to Indira detailed that the role she was being considered for was a ‘high logic’ role in need of a person with ‘investigative problem solving’ skills and ‘out-of-the-box’ thinking. The JD laid down the need for very strong logical and analytical skills in the candidate and Indira was an excellent fit. She was immediately hired after a battery of aptitude and psychometric tests. Almost immediately, Indira received an offer, and in less than a week she had landed the job. It is widely believed that a corporate does not rehire an ex-employee unless it is very clear and convinced about the value proposition that he/she would bring to the table.

Indira joined X in the first week of June. Her on-boarding was rushed and was completed in just 1.5 hours. She was made to board a flight to Mumbai on an assignment the very same day. Consequently, Indira’s full-fledged three–day long induction was deferred for 6 months. And, no bank account was set up.

Indira did not come out to her employer as a transwoman during hiring, for fear of an adverse hiring bias that may have no bearing whatsoever on her competence or merit. No law or organizational policy mandates that candidates reveal either their gender identity or sexuality at the time of hiring. Candidates may choose to disclose it if they wish to. Also, during the time of hiring, Indira had applied for gender- and name-change documents through an affidavit. Within a week of her joining work at X, she obtained her papers formalising these changes. Immediately, Indira came out to her manager and the functional head as a transgender woman. She submitted the papers and stated that she wanted her new name and gender to be reflected in all her records, emails, business cards and HR and business databases. She also sought access to either a women’s restroom or a gender-neutral restroom. Indira also informed her manager that her induction was pending and hence all other joining formalities were undone too. He listened and assured her that it would be done and that she will be nominated for it in some time. He did not specify a timeline, and instead put her on to the HR person. Indira also came out to the HR as a transgender woman. In a follow-up email to the HR and her functional head, Indira flagged four key concerns:

1. The training on prevention of sexual harassment at X is obsolete as it does not take transgender people and the NALSA 2014 judgement into cognizance. This is a grave concern: inaction makes the organization strategically complicit in the invisibilization of transgenders, in allowing practices deleterious to their wellbeing at the workplace. It is also violative of the NALSA judgement.

2. Her discomfort in accessing the men’s restroom and need to access either the ladies restroom or at least a gender-neutral restroom in line with the NALSA judgment. She felt sexually harassed on being forced to used the men’s restroom.

3. Her complete discomfort with being addressed Inder or the use of male personal pronouns, such as ‘he’ or ‘his’. She stated that mis-gendering when read  with NALSA the judgement clearly constitutes sexual harassment. She also told them that as per both the statute and X’s policies all sexual harassment complaints need to take impact as stated by the complainant into immediate cognizance. She reminded them of the thumb rule of impact vs. intention applied in the Vishakha guidelines of the Supreme Court and the new law Prevention, Prohibition and Redressal of Sexual Harassment of Women at Workplace Act, 2013.

4. Her non-induction till date and consequent incompletion of all induction formalities.
Indira attached her non-SRS gender- and name-change papers with this email. The HR questioned her as to why she didn’t reveal her trans identity at the time of hiring. Indira explained that her coming out was legally unwarranted. He addressed her as Inder despite her telling him that she is not Inder but Indira. Since he was clearly unaware of the NALSA judgement, the HR person was not able to advise Indira. He asked for some time and told her that as she was in a critical stage of a high priority project, she would need to wait to get released to get inducted. This email and this week in June was the first in a seven-month long fight against employment discrimination and organizational opacity.

The First Month
Indira began her assignment—a training and immersion programme with the client in Mumbai—that was meant to go on for 1–1.5 months. Near the last week of June, Indira reminded her managers and the HR, both verbally and on email, of her non-induction and of her trans identity for change of name and gender formalities.

In the meanwhile, another issue had popped up at work. The job-on-the-floor was completely different from what was communicated to her during hiring in the JD. It was, instead, a high precision job, demanding critical business decision-making in one reading, and within a timeline of 15–20 minutes; a dyslexic’s nightmare. Indira informed her manager, the functional head and the HR person of her dyslexia and the wrong fitment into this role. She explained at length that dyslexia is a statutory learning disability covered in X’s own disability policy. She followed this up on email by attaching her dyslexia certificates from two leading private hospitals, viz. Apollo and Medanta, and two leading government hospitals, viz. Institute of Behaviour and Allied Sciences and Vidyasagar Institute of Mental Health and Neurosciences, Delhi.

Indira was asked by the HR as to why she did not reveal her condition of dyslexia at the time of hiring. She responded that she was never asked if she was dyslexic either verbally or in writing. She highlighted that the JD sent to her showed no bearing that her dyslexia could possibly have on the role that she was being hired for. She also highlighted that the key information on the role was misrepresented and withheld by the employer who shared a flawed JD and skewed her understanding of the role. There was a clear and total JD vs. job-on-the-floor mismatch; this was not an L&D (Learning and Development) job, but an operational training role. Indira received a standard response on email from the HR person that her concerns were being considered, while he continued to address her as Inder.

Three Months, Two Reminders and One Escalation
In July, Indira requested her functional head and the HR for a resolution to all the above issues she had raised. She received no response to her email other than an out-dated Out of Office reply. Indira received an email from the HR in the end of July that she needs to submit her Sexual Reassignment Surgery (SRS) certificate for gender change. Indira immediately responded that insisting on SRS as a prerequisite for gender change is violative of the NALSA judgement. She did not receive a response. One month later, in September, Indira writes again to all highlighting that insistence on SRS as a prerequisite for gender change is violative of the NALSA judgement. She reminded her manager and the HR of her request for a resolution to all the issues raised. Four months down, Indira was still in Mumbai, hadn’t been inducted yet, bank account formalities were not done and salary unpaid.

By the last week of September, Indira escalated the issue to the General Manager (HR). However, that did not yield any results either. Her HR personnel responded instead, informing Indira that that there were no provisions in X’s India policies to change her name and gender. She wrote back explaining that it was not in line with the NALSA judgement and sends her the gender- and name-change documents again. She also drew attention to his email that it didn’t address the other issues she had raised, viz. statutory protection for dyslexics at work under the company’s policy, JD vs. job-on-the-floor mismatch, non-induction and incompletion of induction formalities.

Reaching the Ombudsperson
The ensuing reply from the HR personnel still addressed Indira as Inder and simply repeated that there were no such policies at X in India. Indira reminded him of X’s global policy, explaining that the global policies on ‘Respecting the individual and Diversity and Inclusion’ have a provision for it. The HR dismissed it as not being applicable in India. It was the end of October and the GM (HR) intervened for the first time, adding a one-liner that Indira should submit her sex re-assignment surgery (SRS) certificate. Indira was still in Mumbai after her first assignment of 1–1.5 months gets extended to 6 months.

In the first week of December, Indira received her confirmation letter. Now, she raised the same issues in the confirmation meeting with her manager and the HR and followed it up with an email. Indira was coaxed and cajoled verbally to stay calm as she is doing very well for herself and shouldn’t insist on a role change. They skirted the issue of her trans identity, name and gender change, access to gender neutral restroom, role change and other issues. Her subsequent escalation of this concern to the GM (HR) did not yield any result. Instead, she received an email from her functional head and the HR person complimenting her work in the project. The mail explained she was a strong resource, greatly needed, and that she could not have a role change. Her manager had also written in reiterating that she should submit an SRS certificate. This email had an undeleted comment in email exchanges between her manager and the HR personnel casting aspersions on her trans identity and questioning the veracity of her dyslexia. It must be remembered that she had submitted, well in time, all gender- and name-change documents as evidence and her dyslexia certificates from leading private and government hospitals.

Following this Indira raised a complaint with the office of the Ombudsperson and the Global Diversity and Inclusion Head. She mentioned in her email that the escalation to the GM (HR) did not yield any results and that she had engaged enough and more with the business and HR leadership and that she had exhausted all options of redress in India. She reported the deliberate mis-gendering, wanton sexual harassment, persistent disability discrimination, employment discrimination and protracted non-payment of wages.

She attached all supporting documents, emails, follow up emails, incomplete responses from her manager and the HR personnel that showed the inherent discrimination, and flagged these as violative of X’s policy and the laws of the land. She explained that her case had a very high risk of litigation if not addressed internally and adequately within X.

Hearings and the Deliverance of Justice
The offices of the Ombudsperson, Global Diversity and Inclusion took cognizance of this complaint and scheduled the first hearing—with Indira and the defendents, her manager and the HR personnel—on 11th December 2014. On the day of the first hearing, Indira presented and defended her case with evidence before the joint committee of the Ombudsperson, Global Diversity and Inclusion. After the 2-hour sitting her manager and the HR personnel seek time to build their defence and show evidence. The case was adjourned for second hearing on 17th December 2014.

On 18th December 2014, the second hearing was summoned. Indira defended her case with all the above evidence, supporting emails, notarised affidavits and certificates. The defendants failed to present any evidence other that their own verbal submissions. They sought more time. The joint committee made oral and written observations and gave time up to 5th January 2015.

On 5th January 2015, the third hearing was summoned. The defendants yet again failed to present any evidence in the form of emails or their responses to Indira’s emails. Making oral submissions, they sought more time to gather evidence. The joint committee made scathing verbal and written remarks on file against the defendants and gave a final timeline not exceeding beyond 13th January 2015 for submission of evidence. The committee mandated that the decision would be announced on the 13th of January regardless of whether the defendants submit evidence or not.

On 13th January, the fourth hearing was summoned. The defendants failed to present any evidence other their own verbal submissions. The committee awarded a verdict. The committee held the defendants complicit in violating X’s policies on the following counts:

1. Disability discrimination under X’s Global Disability Policy. The committee upheld Indira’s right to a role change in line with her skills and the JD that was emailed to her at the time of hiring.

2. Deliberate mis-gendering both verbally and on email as Inder instead of Indira by company X’s India business leadership and India HR despite submission of all relevant and necessary supporting documents by her. The committee declared that such treatment of Indira by X India was violative of X’s HR policies and the NALSA judgement.

3. Sexual harassment of Indira by undermining her integrity on email with disparaging remarks; denial of access to a restroom of her chosen gender and coercing her to only use the men’s restroom; and, wantonly addressing her by the name and pronouns assigned to her at the time of her birth.

4. Insistence of SRS for gender change as violative of the NALSA judgement.

5. Discrimination and severe harassment for denial of pay, non-induction and for not setting up her bank account even after six and a half months of joining.

The committee awarded immediate release of Indira from the current role and instructed a role change within a timeline not exceeding 10 business days to a role in accordance with X’s JD and Indira’s skills, resume and her dyslexic condition. The committee ordered that Indira shall henceforth only be addressed as Indira and that she shall have access to restrooms of her chosen gender and that all records both online and otherwise should reflect Indira’s credentials by her chosen gender and name and that all the above changes need to completed within 10 business days ending on 27 January 2015.

This essay tries to bring to light the undercurrent of bias and stigma that operate invisibly against a certain disenfranchised and marginalised constituencies, in this case a dyslexic transgender person at the workplace. Besides, it reveals how disability, diversity and anti-sexual harassment policies that are meant to offer an equitable workplace and cover of protection are observed more in the breach than in compliance in the case of the differently-abled and the transgenders. Consequently, X tested Indira not on her skills, strengths or inadequacies but on her disability. It also underscores how the same person with the same set of skills and the same level of performance is treated very differently before and after gender change by the same employer.

P.S.: For confidentiality, names of all people—including Indira’s—have been changed, places have been changed and the name of her employer withheld.