Experiences of MSM and transgender women in accessing healthcare services from public hospitals: a qualitative study from India

Title

Experiences of MSM and transgender women in accessing healthcare services from public hospitals: a qualitative study from India

Presenter

Biji Mohan

Authors

B. Mohan * (1,2), K. Ranade (3), S. S (4), S. Nair (3), U. Das (5), A. Nuken (6), R. Gaikwad (7), S. Rawat (1), M. Shunmugam (2), R. Nelson (2), V. Verma (5), C. Das (5), V. Chakrapani (2)

Institutions

(1) The Humsafar Trust, Research, Mumbai, India, (2) C-SHaRP, Research, Chennai, India, (3) Tata Institute of Social Sciences, School of Social Work, Mumbai, India, (4) Madras Medical College, Chennai, India, (5) National AIDS Control Organisation, New Delhi, India, (6) International Centre for Research on Women, New Delhi, India, (7) AiM Institute, Mumbai, India

BACKGROUND: Stigma and discrimination have been shown to reduce access to health services for sexual and gender minorities. This study was aimed to explore the experiences of MSM and TGW in accessing healthcare, including HIV services, in public healthcare facilities in two metros in India.
METHODS: This qualitative study was conducted in January-June, 2021 among a purposive sample of MSM and TGW accessing healthcare services from public hospitalsin Chennai and Mumbai in India. We conducted a total of 12 focus group discussions (FGDs) with MSM and TGW, including two FGDs with MSM living with HIV. Key informant interviews with 3 health care providers and 4 community leaders were also conducted. Data were explored using a combination of framework analysis and grounded theory analytic techniques to identify key themes.
RESULTS: A total of 37 MSM (median age 31) and 38 TGW (median age 29) participated in the FGDs. Among them, 40.5% MSM and 10.5% TGW were PLHIV, and 35.1% MSM and 63.2% TGW engaged in sex work. Some facilitators of healthcare access identified were the availability of free antiretroviral treatment and quality counselling by some community-friendly counsellors. However, several layers of stigma/ discrimination were identified as well: odd stares at TGW, verbal abuse, body shaming, and sexual harassments from the hospital staff and co-patients. These incidents were more commonly reported by TGW andKothi- identified MSM (feminine/receptive role). TGW expected free or affordable gender-affirmative hormone therapy and gender-affirmative surgeries to be provided with minimal waiting time, which are currently considerably delayed due to bureaucracy/paper work in the hospital.
CONCLUSIONS: Stigma experiences could delay or prevent access to healthcare services, or reduce the perception of service quality in public hopsitals. The findings from this study will be used to inform designing theory-driven multi-level stigma reduction interventions to reduce stigma/discrimination faced by MSM and TGW in public health care settings.

Download the e-Poster (PDF)

Download the e-Poster (Movie)