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Innovating for equitable, integrated and comprehensive care for transgender people: the transgender health and wellness centre in Manipur, India

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BACKGROUND: In 2020, HIV prevalence amongtransgender (TG) people in India was estimated at 7.5%.In Manipur, 700 TG people were identified through mapping exercises, although this number may underestimate the true population size due to misclassification with other groups like men who have sex with men (MSM). I-TECH India, supported by CDC India under the President's Emergency Fund for AIDS Relief (PEPFAR), in collaboration with Manipur State AIDS Control Society and Maruploi Foundation (a community-based organization), launched the first 'Transgender Health and Wellness Centre' (TGHWC) in North-eastern India, to strengthen a comprehensive, integrated HIV and health response for TG people in March 2021.
DESCRIPTION: The objective of the TGHWC is to provide overall health, wellness, and gender affirmation services (GAS), along with capacity and skill-building to empower TG communities using a community-led model. The TGHWC has a wellness community-based clinic and a community-led health desk situated in the public hospital setting.
LESSONS LEARNED: Over 750 TG people have registered in the first six months of operation, which is higher than previous TG size estimates. Thirty-seven percent (n= 277) received HIV testing and 8% (n =22) were HIV positive and linked to ART through the community-led health desk.Additionally, 35% (n=262) agreed for first-time syphilis screening and 10% (n= 26) were diagnosed and linked to treatment services. Community system strengthening was especially critical during the COVID-19 pandemic and included young TG leadership opportunities through webinars, gender-based violence support groups, skill-building, and income generation through an on-site beauty parlour.
CONCLUSIONS: The TGHWC, a community-led model for comprehensive health for TG people, provided point-of-care diagnostic and treatment services to TG people while offering a wider spectrum of services for integrated care including gender-affirmation services and economic empowerment options. Key lessons for the early success of the centre included strong political will, public sector engagement, and community-led response to fully stand up the health service integration. This community-led model is a sustainable model due to its integration into the public sector and is being recognized as a 'game-changing model' in the HIV response for TG people in India.