ABSTRACT
Background:
Transgender people experience widespread prejudice discrimination, violence and other harms of stigma and trans-phobia (dislike of or prejudice against trans-sexual or transgender people). To study various modes in which transgenders experience the stigma and discrimination and to understand situations and circumstances under which they are vulnerable toward stigma and discrimination.
Materials and Methods:
The present study was a mixed-method study which was conducted during the months of January to June 2019 among 43 study participants. Focus group discussion and in-depth interview was conducted with these participants with subsequent transcription. Interpretative phenomenological analysis (IPA) was used for analysis.
Results:
Transgenders face discrimination and stigma in various setting including education, employment, healthcare, and various public setting. Difficulties in getting government identity cards (ID), facing difficulties in changing ID cards after transition, discrimination in getting bank loan, homelessness, travelling rejections were considered as major obstacles and discrimination by the study participants.
Conclusion:
Multilevel interventions are needed for transgender populations, including legal protections, improvement of various settings. Inclusive measures should be taken to improve their status focusing on social stigma coupled with psychological pain and economic hardship.
Keywords: Discrimination, qualitative exploration, stigma, transgender
Background
The third gender, that is, “Transgender” signifies those individuals who are different in their biological constructions. They are different for the stereotype gender roles. Their gender makes them different and compelled to face discrimination in society. According to the definition, transgender, often shortened as trans, is an umbrella term; in addition to including people whose gender identity is the opposite of their assigned sex (trans men and trans women), it may also include people who are non-binary or genderqueer.[1] Despite of all the constitutional rights, they are denied to have their basic rights like Right to Personal Liberty, Freedom of Expression, and Right to Education, Empowerment, and Right against discrimination, exploitation and violence etc.[2] The 2015 U.S. Transgender Survey (UTS) is the largest survey examining the experiences of transgender people in the United States, with 27,715 respondents from all 50 states, provides a detailed look at the experiences of transgender people.[3] There is a pervasive pattern of discrimination and prejudice against transgendered people within society. Both economic discrimination and experiencing violence could be the result of a larger social climate that severely sanctions people for not conforming to society’s norms concerning gender; as such, both would be strongly associated with each other. Most of the studies have relied on fairly limited measures of discrimination, focusing primarily on workplace discrimination[4] not exploring in detail on the overall discrimination and stigma faced. We are exploring the importance of the measures to reduce discrimination, stigma and violence in various settings including education, employment, healthcare, and public settings which has not been explored in detail in India in the past. This research explores the lived realities of transgenders who enter the Hijra community and the various forms of social exclusion that these individuals face.
Objectives
To explore various modes in which transgenders experience the stigma and discrimination and to understand situations and circumstances under which they are vulnerable toward stigma and discrimination.
Materials and Methods
The present study was a qualitative study done in Chennai city focusing mainly on the in depth interview. A total of 8 focus group discussions and 14 in-depth interviews (IDIs) were conducted along with free listing and pile sorting. The study was conducted during the months of January to June 2019 among 43 study participants (Transgender of all age groups).Exclusion criteria being cisgenders, lesbians, gays, bisexuals, non-consenting transgender.They were recruited using a non-probability snowball sampling technique. The study participants were interviewed at the location and at the time of their convenience and after obtaining written informed consent. Institutional ethics committee clearance was obtained before start of study.
Qualitative methodology
To explore various modes in which transgenders experience the stigma and discrimination and to understand situations and circumstances under which they are vulnerable toward stigma and discrimination investigators conducted a total eight focus group discussions and 14 in-depth Interview (IDI). Also, free listing and pile sorting were used to collect relevant qualitative data.
The following steps were done for Focussed Group Discussion (FGD):
A topic guide was prepared
The study participants were chosen by snowball sampling method
Sampling was done mainly through the contacts of known transgenders selected throughout Chennai city
The participants were requested to join the scheduled interview and discussions at a specific time convenient for them also
Necessary arrangements were made for uninterrupted FGD
Written informed consent was obtained for participation and audio recording of the proceedings was done
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Facilitators were trained in qualitative methods and were well versed in the regional language
FGDs were conducted with the transgenders who are the study participants, who were willing to participate.
Each FGD lasted for about 45 minutes.
Each FGD comprised a maximum of 10 participants (minimum 8 participants) from the Community. The study population comprised the transgenders of various age groups.
Data was collected till information got saturated
Topic guide and interview schedule for the FGD and IDI was prepared using the below given flowchart [Figure 1].
Figure 1.
Topic guide and interview schedule for the FGD and IDI
The analysis of FGDs was done through a conventional content analysis approach. Data were analyzed and managed simultaneously by sketching ideas, taking field notes, summarizing field notes, identifying codes, reducing codes into themes in Microsoft Excel, and finally developing categories. Smith’s salience score was calculated and the reasons with higher Smith’s S values were pile sorted. Smith’s S value refers to the importance, representativeness, or prominence of items to individuals or to the group. The analysis of free list and pile sort data was done using Anthropac software.
Interpretative phenomenological analysis (IPA) was also used for this research as it involves sensitive psychological issues.
Results
A total of 43 participants throughout Chennai city participated in the study through 8 FGD (8–10 participants in each FGD), 14 IDI, free listing, and pile sorting. The majority of the participants are from the age group 35–45 (48.5%), followed by 25–35 (41.1%). The majority belonged to Hindu religion (61.7%) and more than half of them had primary level of education (51.4%). Majority of the women were involved in begging whereas there was one professional who is not working. To explore about the various discrimination and stigma faced, the free listing exercise was done [Table 1].
Table 1.
Perceived discrimination and stigma among transgender population
| Participant | Perceived factors | Group |
|---|---|---|
| 1 | School dropout | Education |
| 4 | Bullying | |
| 13 | Lack family support | |
| 11 | No job opportunities | |
| 6 | Workplace harassment | Employment |
| 2 | Healthcare negligence | Healthcare |
| 19 | Homelessness | |
| 10 | Travelling rejection | |
| 3 | Difficulty in access to public toilets | Public setting |
| 5 | ID card issues | |
| 7 | Challenges in taking loan | |
| 8 | Abuse and safety issues |
A multidimensional scaling and hierarchical cluster analysis were done with pile sort data to get a collective picture of discrimination and sigma faced by transgenders. Results were categorized as: “school dropout’, physical bullying”, “lack of family support”, “lack of job opportunities”, “ harassment in work place”, “ negligence in healthcare setting”, “homelessness”, “travelling rejections”, “difficulty in accessing public toilet”, “ difficulties in getting ID cards”, “ challenges in taking loans”.
Focussed Group Discussion
A total of 8 FGDs were conducted to explore more about the situations and circumstances under which they are vulnerable toward stigma and discrimination. Totally 43 people participated and each FGD had 8–10 participants. The results of the FGD are reported according to the themes in [Table 2]. Main themes and categories discussed in FGD.
Table 2.
Response for circumstances under which transgender population face discrimination: Each domain discussed in FGD
| Circumstances | Domains | Response |
|---|---|---|
| Educational setting | Transition period in school life | Abuse from co-students and imitation, school dropout due to lack of family support |
| Employment/workplace | Job opportunities, harassment | Lack of job opportunities, increased work load, sexual harassment in workplace |
| Healthcare field | Emergency care, for surgery | Need more empathy, negligence/ignorance, no help for surgery, various health issues |
| Public setting | Accommodation, travel related, access to public toilet | Homelessness, verbal abuse and safety issues during travel, rejection to use public toilet are the major issues |
| Other issues | ID cards, bank loans, no acceptance, crime against transgender, legal protection | Difficulty in getting/changing ID cards, no acceptance from family members and general public, increasing crime against them, lack of awareness on the legal rights and protection |
In-Depth Interview
A total of 14 depth interviews were conducted until the point of saturation. The themes that emerged from the IDIs are presented below as headings and supported by quotes from the participants. Each quote is accompanied by the occupation and age of the participant in parentheses [Table 3].
Table 3.
Themes and verbatim obtained from in depth interview:
| Theme | Finding | Response |
|---|---|---|
| Discrimination in school life | When asked about specific discrimination in school, respondent reveals as follows | “…………I cannot describe in words how much discrimination we face during school life (clears throat), it was really hard to explain the physical changes to co students and also to family members” (shop owner, aged 34 years) “……….our co students literally tease us, not allow to study peacefully. They imitate us & ultimately, we drop out with no support” ( begging, aged 25 years) |
| Workplace harassment | Employment related issues were probed | “…….first of all, no one gives us job….lot of comments about physical changes and we face lot of sexual abuse (cries)….…” (private job, aged 30 years) “……….our work load is always high when compared to others and we are underpaid….people think , begging is our only job…….We need more peer support & earning opportunities” ( professional, aged 36 years) |
| Issues in healthcare setting | When asked about circumstances of discrimination in hospital facility, response was as follows | “……negligence and ignorance when we seek healthcare for our issues is common and there is also lot of stigma” ( industrial workers, aged 43 years) “………no one is ready to help me for surgery related issues & it’s very expensive they say……and we have lot of unrevealed health issues” ( private job, aged 29 years) |
| Public place related and other issues | Discrimination in various setting was asked | “ no one gives us home and we face lot of disrespect…….people fear of travelling with us, I faced tremendous difficulty in getting loans/ID cards, we really need strong law…….(said angrily)” ( owns business, aged 45 years) “……We are often mobilized for sex work which often most of the time against our wish….” (Sex workers, aged 34 years) “…….I don’t know much about safe sex practice which ultimately elevate our vulnerability to HIV and other sexually transmitted infections….” (Begging, aged 44 years) |
Discussion
In the present study, transgenders admit that they face discrimination and stigma in various setting including education, employment, healthcare, and various public settings. Also difficulties in getting government identity cards (ID), facing difficulties in changing ID cards after transition, discrimination in getting bank loan, homelessness, travelling rejections were considered as major obstacles and discrimination by the study participants. Perceived violence and stigma among our study participants are comparable to the other study findings from various setting.[5,6,7]
During the study one of the study participants discussed that they need more peer support and opportunities to earn which is similar to the findings from the study conducted in Mumbai city.[8] Issues faced by our study participants in various settings are compared to the study results of Indian research where lack of family support leading to various psychosocial consequences are highlighted.[9] Our study participants admit that they face discrimination in accessing healthcare which is also highlighted in another research article from India[10] where socio-economic barriers, lack of health insurance, exclusion from social protection schemes, and health systems barriers are addressed.
One of the major strength of our study is we included transgender population from various sectors covering most of the occupations. There are also limitations of the study where coping strategies for the various discrimination and stigma is not explored to greater extent. Also social desirability bias when reporting sensitive information, and some nuances may have been overlooked in translating interviews.
Conclusion
As evident from the qualitative analysis, transgender individuals have specific healthcare and social needs; however, they face multiple obstacles to accessing quality healthcare ranging from social stigma and discrimination to lack of awareness and inferior services. Community mobilization interventions offer a promising vulnerability reduction strategy for transgenders, and could be effective in safeguarding transgender rights and reducing disease vulnerability. Strengthening legal protection, inclusive measures along with multilevel interventions to address transgender issues is needed.
Key points and take home message
Since not much research especially qualitative studies have been done among transgenders from various sectors, this article will definitely contribute for their welfare measures. Challenges and obstacles faced in various settings have been explored in detail. There is an imperative need for enhancing interventions along with legal measures to address specific issues.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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