Whither sexual and reproductive health services for marginalized groups

Avantika Chaturvedi, CNS Correspondent, India
Photo credit: CNS: citizen-news.org
Sex is still a taboo word in Indian society and that is why the sexual health of the individual is ignored even in the normal population. When mainstream society is largely unaware about its sexual and reproductive health (SRH), then one shudders to think of the situation in the marginalized populations of sex workers, injecting drug users (IDUs), men who have sex with men (MSM), and transgenders (TG). Amongst these, MSMs and TGs are more disadvantaged in accessing SRH services because of their different sexual orientation.

Talking to CNS, Deepak Kumar Kulshrestha, state co-coordinator for Pehchaan Programme of India HIV/AIDs Alliance, said that it is largely due to ignorance on part of the MSM pouplation that they find it difficult to reach SRH services. He said that they are often not aware about these services being available for them. They only know about the services around STI and HIV testing that are provided through targeted interventions, whereas SRH services encompass a range of services including partner notification, counselling, positive partner testing, etc. all of  which are being provided by Family Planning Association of India. Another factor, according to him, is that specific projects are either working exclusively for the MSM and transgender populations or they are exclusively working on providing SRH services. These silos need to be broken.

Deepak also stressed upon the need of SRH services for young and unmarried MSM and transgenders. SRH services become all the more important when a female partner comes into the life of an MSM, mostly through a forced marriage brought upon by the family. He further said that counselling is a very important component of SRH services for young MSMs and transgenders. It is very important for young MSMs to know about their sexual and reproductive health so that they can avail the services when needed.

According to Deepak, the main reason that makes MSMs and transgenders vulnerable against accessing SRH services is the fear of getting identified by their family. Communication gap between the partners is another reason, as the female partner is rarely in a position to ask for HIV and STI testing get done by the husband. Thirdly, social taboo and discrimination makes it difficult for MSM and transgender population to avail services. Thus, NGOs need to focus on having a separate space where the female partners of MSMs can come and avail the services because unless the female partners of MSMs and MSMs themselves understand the importance of the SRH services, they will not be able to use the services and prevent STI and HIV infections. It would be good for NGOs to tie up with Family Planning Association India and Population Services India, who are working in the field of SRH, to create awareness about SRH services with the help of counselling and advocacy camps.

Imraan Khan, Project Manager of Bharosa Trust, feels that one reason for the MSM and transgenders (most of whom work on daily wages) not being able to avail the existing SRH services is because of the inconvenient timings of intergrated counselling and testing centres (ICTC). Second reason is discrimination, harassment, and judgmental behavior of others. He said that as ICTC services are for everyone, so when an MSM or transgender visits the centre his/her behavior is stigmatized. He felt that NGOs can intervene at grass root level and can visit the concerned centre and sensitise them on this issue. But the government and state bodies too need to chip in and hold sensitizing trainings for health care practitioners.

He  said that on talking to MSM groups he found that many of think that because they are MSMs so they have HIV. It is crucial to give MSMs and transgenders correct information and address their self stigma and discrimination so that they can avail the services without any hindrance. Imran lamented the absence of counselling around mental health. “It is important to remove the internalised self stigma and shame of such an individual before motivating for HIV testing. The individual has to be mentally prepared to avail the services.Unless their basic need of being accepted in society gets fulfilled they cannot focus on HIV and STI testing.”

Avantika Chaturvedi, Citizen News Services - CNS
October 17, 2015