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Glad to be gay in India

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3885 (Published 11 September 2018) Cite this as: BMJ 2018;362:k3885
  1. Jeetha D’Silva
  1. Mumbai

A member of India’s lesbian, gay, bisexual, transgender, and queer (LGBTQ) community in Bengaluru (Bangalore) celebrates a landmark judgment that decriminalised homosexuality on Thursday 6 September. The Supreme Court ruling could pave the way to healthcare reforms in a country that has been largely insensitive to the community’s needs. But the process could be arduous, say doctors.

Access to healthcare is a major issue for the gay community, and one raised by Indu Malhotra, one of the five judges in the hearings that led to the decriminalisation Section 377 of the Indian Penal Code, after they found it discriminatory and unconstitutional.

Introduced under British colonial rule in 1861, Section 377 allowed for life imprisonment for “unnatural offences . . . carnal intercourse against the order of nature.” In 2015, almost 1500 people were arrested under Section 377.

“Unfortunately, even something as basic as access to healthcare is still very much contested as the stigma associated with being LGBTQ is quite phenomenal,” said Thelma Narayan, director for academics and policy action at the Society for Community Health Awareness Research and Action, a charity based in Bengaluru.

Prasad Raj Dandekar, a radiation oncologist from Mumbai, points to glaring inadequacies in the understanding of LGBTQ health issues. “People often have terrible experiences, such as being ridiculed or threatened or being offered cures, including electroconvulsive therapy, when they seek medical treatment,” he told The BMJ, adding that LGBTQ doctors faced the same kind of insensitivity.

Earlier this year Dandekar founded Health Professionals for Queer Indians, which trains doctors and medical students in how to meet the health needs of LGBTQ people. His group is part of a ripple of change in medicine in India. In June the Indian Psychiatric Society urged its 5500 members to stop treating homosexuality as an illness.

LGBTQ people have disproportionately high rates of mental and sexual ill health, and their criminalisation presents barriers to care. “People have been under a lot of legal and societal pressure, due to which the depression rate is quite high,” Dandekar said. When it comes to issues relating to sexual health, reluctance to seek help is even greater. “People were scared to seek help because they have faced a lot of discrimination,” said Pavan Sonar, a psychiatrist in Mumbai.

The judgment will provide a further impetus for change, and the government’s and society’s response will be pivotal. The community’s health concerns include HIV and other sexually transmitted diseases. The prevalence of HIV is an estimated 4.3% among gay men but 0.26% in the general population.

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