Stigma and ignorance about the diversity of LGBTQIA+ communities in the Indian medical system continue to exact a hefty toll on LGBTQIA+ folks.
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On a sunny morning in May 2023, I was on my way through the narrow streets of Puducherry to a hospital to get tested for sexually transmitted infections (STIs) for the first time. My head was full of questions. "How will I tell them I had had sex with men? Is it a wise choice to visit the hospital?" The anonymity afforded by the mask I’d worn felt insufficient. I was nervous.
As a bisexual man who’s had multiple sexual partners over the years, I’ve been acutely aware of the heightened risk of contracting an STI. Even though I’ve never had any symptoms, getting tested was on my mind for quite a while. But not having enough confidence to disclose my sexuality to a doctor deterred me – until a friend’s encouragement finally helped me muster up the will.
I entered the sprawling campus of the Jawaharlal Institute of Postgraduate Medical Education and Research Institute, colloquially known as JIPMER, a premier public hospital in Puducherry.
Locating the STI clinic was my first challenge. I asked the hospital staff to direct me to one, but they seemed to have no idea what an STI clinic was. I encountered signboards with directions to departments dedicated to all kinds of medical specialisations, but there was no mention of an STI clinic. Later, I discovered that the STI clinic was housed within the dermatology department, something I hadn't even considered.
The afternoon heat had kicked in and I was considering abandoning my quest when I finally managed to find a signboard to a ‘screening centre’. Upon my arrival, the guard stationed outside the centre informed me that the screening centre was not intended for outpatients. Instead, he directed me to the outpatient ward.
In the outpatient ward, the receptionist suggested he’d never heard the term ‘STI’ before. Even after I explicitly mentioned "screening for sexually transmitted diseases," he looked clueless. So, I told him I had to visit a general physician (GP). As I waited in the queue to see the GP, I considered, again, leaving without getting tested.
Men who have sex with men (MSM), a terminology that some groups find problematic, and transgender persons are considered to be at high risk of acquiring HIV/AIDS and other sexually transmitted infections and diseases according to the National AIDS Control Organization (NACO), which recommends that they visit STI clinics four times a year for testing and treatment. However, as I was finding out, accessing these clinics can be an uphill task.
While I was in the queue outside the GP's office, I asked a doctor who was passing by, whether I was in the right place to get an STI test. He told me to go to the screening centre – the same place I had been turned away from. But the GP redirected me to the right place within his building. This time, I found the 'STI testing room' with a signboard outside.
But my anxiety spiked suddenly when I spotted a student from my university outside the adjoining skin speciality room. I worried about the possibility of him wrongly assuming I had an STI and telling other people on campus about it. I avoided being seen by him, but he did. Thankfully, he didn’t react in any way. But my anxiety, like many queer individuals’, wasn’t baseless.
A 2019 New York Times story outlines the shame and stigma surrounding sexually transmitted infections among both heterosexual and homosexual persons. But for queer persons, this stigma can do more than psychological damage. A 2016 UN report cited stigma being one of the reasons why 1 in 8 HIV positive persons have been denied medical care.
I entered the screening room and took a seat across the table from the counsellor. What followed made me regret considering the STI testing.
The counsellor loudly asked me the reason for my visit. I mumbled a response. I was already scared, seeing that only a thin plastic partition separated this room from the skin clinic my acquaintance was visiting. This violates the Ministry of Health’s guidelines on STI-related healthcare, which mandates that a counselling room must have a door in order to ensure patient privacy.
But the counsellor continued at the same volume as he probed about my sexual experiences: “How many people have you had sex with?” “From what age have you been having sex?” “Do your parents know that you have sex with men?” “Do you think your parents will ‘accept’ you if they know that you have had sex with men?”
I faked some responses to what felt like aggressive and intimidating questions beyond the scope of medical care. The need to protect my privacy in a space that seemed non-confidential outweighed by my duty to be honest to a medical professional. But for the most part, I couldn’t say anything and stayed quiet.
Even as his questions made me feel uncomfortable, his advice made me feel downright helpless. “Considering your sexual experiences, your chances of testing negative are very low,” he informed me. “But if you test positive, you won’t be able to lead a normal life. Even your parents won’t support you.”
He added, “There is no cure for HIV. You will have to take so many medicines. It is going to cost you a lot. Do you think you can afford them as a student? Even your friends will abandon you if you test positive. Are your parents rich, will they support you?”
At the end of his moral tirade, he had offered little information on safe sex practices or on the STIs for which I was to be tested. At that time, I didn’t even think about raising a complaint. I just wanted to face it and get the test done.
With all the context around queer people like me being stigmatised in healthcare, this treatment was neither unexpected, nor new. The United Nations Programme on HIV/AIDS, found in a 2022 study that in India, 29.3 percent of MSM avoid health care because of stigma and discrimination. Another 2018 study, which surveyed 4179 MSM, found that about 47% of them never took the HIV test, partly because of stigma.
Systemic accountability is crucial for policymakers, government officials, executives, and healthcare administrators to enforce laws, design inclusive public health policies, reform medical curricula, and create non-discriminatory environments for LGBTQIA+ patients, studies show.
So, I contacted Malathi Munisamy, the head of the Department of Dermatology and Sexually Transmitted Diseases at JIPMER. Dr. Malathi apologised and offered a detailed response, in which she wrote that this is the first time the department has received a complaint about discriminatory approach toward gender and sexual minorities but that my allegations are “taken very seriously and that a thorough investigation will be conducted” as the attitudes that I encountered from the counsellor “do not align with JIPMER’s policies.”
Munisamy’s statement acknowledged that although both medical and non-medical staff at the hospital are expected to follow the “guidelines for responding to special groups” specified by the Ministry of Health and Family Welfare, they are not given any specific training on working with the LGBTQIA+ community.
On a sunny morning in May 2023, I was on my way through the narrow streets of Puducherry to a hospital to get tested for sexually transmitted infections (STIs) for the first time. My head was full of questions. "How will I tell them I had had sex with men? Is it a wise choice to visit the hospital?" The anonymity afforded by the mask I’d worn felt insufficient. I was nervous.
As a bisexual man who’s had multiple sexual partners over the years, I’ve been acutely aware of the heightened risk of contracting an STI. Even though I’ve never had any symptoms, getting tested was on my mind for quite a while. But not having enough confidence to disclose my sexuality to a doctor deterred me – until a friend’s encouragement finally helped me muster up the will.
I entered the sprawling campus of the Jawaharlal Institute of Postgraduate Medical Education and Research Institute, colloquially known as JIPMER, a premier public hospital in Puducherry.
Locating the STI clinic was my first challenge. I asked the hospital staff to direct me to one, but they seemed to have no idea what an STI clinic was. I encountered signboards with directions to departments dedicated to all kinds of medical specialisations, but there was no mention of an STI clinic. Later, I discovered that the STI clinic was housed within the dermatology department, something I hadn't even considered.
The afternoon heat had kicked in and I was considering abandoning my quest when I finally managed to find a signboard to a ‘screening centre’. Upon my arrival, the guard stationed outside the centre informed me that the screening centre was not intended for outpatients. Instead, he directed me to the outpatient ward.
In the outpatient ward, the receptionist suggested he’d never heard the term ‘STI’ before. Even after I explicitly mentioned "screening for sexually transmitted diseases," he looked clueless. So, I told him I had to visit a general physician (GP). As I waited in the queue to see the GP, I considered, again, leaving without getting tested.
Men who have sex with men (MSM), a terminology that some groups find problematic, and transgender persons are considered to be at high risk of acquiring HIV/AIDS and other sexually transmitted infections and diseases according to the National AIDS Control Organization (NACO), which recommends that they visit STI clinics four times a year for testing and treatment. However, as I was finding out, accessing these clinics can be an uphill task.
While I was in the queue outside the GP's office, I asked a doctor who was passing by, whether I was in the right place to get an STI test. He told me to go to the screening centre – the same place I had been turned away from. But the GP redirected me to the right place within his building. This time, I found the 'STI testing room' with a signboard outside.
But my anxiety spiked suddenly when I spotted a student from my university outside the adjoining skin speciality room. I worried about the possibility of him wrongly assuming I had an STI and telling other people on campus about it. I avoided being seen by him, but he did. Thankfully, he didn’t react in any way. But my anxiety, like many queer individuals’, wasn’t baseless.
A 2019 New York Times story outlines the shame and stigma surrounding sexually transmitted infections among both heterosexual and homosexual persons. But for queer persons, this stigma can do more than psychological damage. A 2016 UN report cited stigma being one of the reasons why 1 in 8 HIV positive persons have been denied medical care.
I entered the screening room and took a seat across the table from the counsellor. What followed made me regret considering the STI testing.
The counsellor loudly asked me the reason for my visit. I mumbled a response. I was already scared, seeing that only a thin plastic partition separated this room from the skin clinic my acquaintance was visiting. This violates the Ministry of Health’s guidelines on STI-related healthcare, which mandates that a counselling room must have a door in order to ensure patient privacy.
But the counsellor continued at the same volume as he probed about my sexual experiences: “How many people have you had sex with?” “From what age have you been having sex?” “Do your parents know that you have sex with men?” “Do you think your parents will ‘accept’ you if they know that you have had sex with men?”
I faked some responses to what felt like aggressive and intimidating questions beyond the scope of medical care. The need to protect my privacy in a space that seemed non-confidential outweighed by my duty to be honest to a medical professional. But for the most part, I couldn’t say anything and stayed quiet.
Even as his questions made me feel uncomfortable, his advice made me feel downright helpless. “Considering your sexual experiences, your chances of testing negative are very low,” he informed me. “But if you test positive, you won’t be able to lead a normal life. Even your parents won’t support you.”
He added, “There is no cure for HIV. You will have to take so many medicines. It is going to cost you a lot. Do you think you can afford them as a student? Even your friends will abandon you if you test positive. Are your parents rich, will they support you?”
At the end of his moral tirade, he had offered little information on safe sex practices or on the STIs for which I was to be tested. At that time, I didn’t even think about raising a complaint. I just wanted to face it and get the test done.
With all the context around queer people like me being stigmatised in healthcare, this treatment was neither unexpected, nor new. The United Nations Programme on HIV/AIDS, found in a 2022 study that in India, 29.3 percent of MSM avoid health care because of stigma and discrimination. Another 2018 study, which surveyed 4179 MSM, found that about 47% of them never took the HIV test, partly because of stigma.
Systemic accountability is crucial for policymakers, government officials, executives, and healthcare administrators to enforce laws, design inclusive public health policies, reform medical curricula, and create non-discriminatory environments for LGBTQIA+ patients, studies show.
So, I contacted Malathi Munisamy, the head of the Department of Dermatology and Sexually Transmitted Diseases at JIPMER. Dr. Malathi apologised and offered a detailed response, in which she wrote that this is the first time the department has received a complaint about discriminatory approach toward gender and sexual minorities but that my allegations are “taken very seriously and that a thorough investigation will be conducted” as the attitudes that I encountered from the counsellor “do not align with JIPMER’s policies.”
Munisamy’s statement acknowledged that although both medical and non-medical staff at the hospital are expected to follow the “guidelines for responding to special groups” specified by the Ministry of Health and Family Welfare, they are not given any specific training on working with the LGBTQIA+ community.
Aqsa Shaikh, professor of community medicine at the Hamdard Institute of Medical Science and Research in New Delhi, said that part of the problem is that the STI and AIDS related trainings given by NACO to medical systems have largely focused on trans people, MSM community and sex workers as high risk groups. "What gets lost in this is other queer identities including bisexual people, trans man and lesbian women, who then bear the brunt of the ignorance of the medical establishment." Agreeing with Shaikh, L. Ramakrishnan, a public health expert with SAATHI, a Chennai-based non-profit, added that he reviewed about a dozen MBBS textbooks on topics such as STIs, psychiatry, and gynaecology, but found that none provided a nuanced understanding of the LGBTQIA+ community and its needs.
Even as recently as 2021, the Madras High Court observed that medical textbooks contain ‘vast amounts of transphobic and homophobic literature’. The Court directed the National Medical Commission, which is responsible for determining the curriculum for medical education across India, and the Tamil Nadu Medical Council to update the textbooks. “Following this, subjects in psychiatry and forensic medicine have been updated. However, the texts on STIs have still not changed,” added Ramakrishnan.
Like mine, Aishwarya’s experience (name changed on her request to protect her privacy) iterates this need for the medical fraternity to understand diverse queer identities. The 24-year-old writer and filmmaker based in Delhi, who identifies as a bisexual woman, had approached YRG Care in Delhi. YRG Care is an NGO focused on AIDS-related healthcare and STI testing across India.
At the clinic, according to Aishwarya, she was forthcoming about her sexual history with different partners. But instead of being met with medical advice, she said she was probed about her sexuality. She said, “The doctor and nurse struggled to comprehend bisexuality. They asked me whom I prefer more - men or women? And when I explained that it varies, they said they couldn’t understand how one person can like both men and women."
Furthermore, Aishwarya stated that the doctors themselves made remarks like ‘You seem well-educated, why are you here?' and even questioned if she was a sex worker.
When I reached out to YRG Care they said they were unable to locate any records of a woman visiting the centre on the specified date. AK Sri Krishnan, Chief Operating Officer, and Subash, Project Lead, at YRG Care clarified that while they do not dispute Aishwaya’s claim, they can neither validate nor negate it due to the absence of records. They expressed regret and committed to preventing any such incidents in the future by retraining staff and reinforcing sensitivity awareness throughout their premises.
While JIPMER and YRG Care’s statement reflects a willingness for accountability, stigmatising behaviour towards queer individuals can not only restrict access, but also cause lasting damage.
Vignesh Dhananjayan, a final-year medical student at Dhanalakshmi Srinivasan Medical College, Perambalur, Tamil Nadu uses social media to raise awareness and assist queer individuals in accessing HIV-related healthcare like Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). PrEP and PEP are anti-HIV medications that can reduce the chances of getting HIV when exposed to the virus. PrEP should be taken 2 to 24 hours before possible exposure to HIV and PEP can be taken within 72 hours post-exposure.
Vignesh told me that in March 2023, Kishore (name changed to protect his identity), a gay man, reached out to him for help after being allegedly sexually assaulted on a date. According to Vignesh, Kishore tested positive for HIV, so he directed him to the government-run Antiretroviral Therapy (ART) centre in Coimbatore, Tamil Nadu. Vignesh said, “Instead of treating him, the counselors at the ART centre pushed Kishore to the brink of suicide.”
I was unable to speak directly with Kishore, as Vignesh mentioned that he is reluctant to engage with journalists. Vignesh said, “Kishore told me that a counsellor at the centre said he deserved the rape and questioned his manhood because he ‘wasn’t able to stop it [the assault]’,” Vignesh continued. “Within one week of this ordeal, Kishore was searching the internet for methods to die [by suicide]. It was a real struggle for me to walk him off the ledge.”
When I contacted Sundaresan, a medical officer at the ART centre, they denied the incident, stating that it could not have occurred within their facility. According to Vignesh, Kishore remembers the name of the employee who allegedly made discriminatory remarks as Senthil Kumar, although he is uncertain of his position at the centre. Sundaresan stated that no one named Senthil Kumar was employed there, and suggested that such an event might have occurred at the STI clinic within the same hospital. However, Vignesh responded, “It is the ART centre and not the STI clinic, as confirmed by the victim.”
Vignesh eventually registered a complaint about this incident via email to the director of the Tamil Nadu AIDS Control Society (TANSACS) through email (which queerbeat has received a copy of), but didn't receive any response.
Like Vignesh, queer individuals in India advocate for and await industrial reforms within the healthcare system that paves the way for rightful access to safe healthcare for sexually transmitted infections and diseases. Shaikh believes that the larger accountability lies with the Ministry of Health and the National Medical Commission if we want to ensure that queer people don't face queerphobic behaviour from the medical fraternity and to create systems level queer inclusivity in the medical establishment in India.
Ramakrishnan emphasised on the need for collaborative system overhaul with participation from the queer community to help create safer systems. He said, “While many NGOs provide training and sensitivity programs for healthcare workers, reaching every individual is almost impossible. Comprehensive change requires updating textbooks and educational materials across the board. Without these systemic changes, it's difficult to shift the current situation significantly.”
“HIV-related training in the health centres has been happening since the mid-1990s and more intensively from 2002-2003. But LGBTQIA+ rights movements are very recent, so many doctors who have learned about HIV and STIs don’t make a connection between MSM, transgenders, and the LGBTQIA+ community. Additionally, the issue of heightened vulnerability to STIs has often operated separately from the broader LGBTQIA+ activism,” added Ramakrishnan. “Along with the textbook updation, people from the LGBTQIA+ community should also participate during the training programs for healthcare workers.”
But even while the queer community makes moves towards greater awareness of sexual health in India, a tacit question lingers in queer bodies—who will heal the wounds created in the process of trying to heal from diseases?
Gangadharan (he/him) is an aspiring journalist, deeply passionate about writing and multimedia storytelling. He recently completed his Masters in Mass Communication from Pondicherry University and is particularly interested in uncovering and sharing the lives and experiences of marginalised communities.
Jose (she/they) is a non-binary illustrator from Kerala whose work highlights personal stories marked by gender, body experiences and their south-Indian heritage. While not lost in their sketchbook, they can be found devouring all things camp and horror.
Visvak (he/him) is a writer, editor, and teacher based in Goa.
Shruti Sunderraman (she/her) is a journalist, writer, editor and strategist who splits her time between Bombay and Bangalore. She has edits and bylines in culture, health, gender and science across several publications over the last 10 years.
Ankur Paliwal (he/they) is a queer journalist, and founder and managing editor of queerbeat.
