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Azhar S, Ahmad I, Guzman Herrera MM, Tariq N, Lerner R. "I would prefer to be dead than to live this way": Lived experiences of stigma and discrimination against khwaja sira in Swat, Pakistan. Glob Ment Health (Camb) 2024; 11:e60. [PMID: 38774887 PMCID: PMC11106546 DOI: 10.1017/gmh.2024.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/28/2024] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
Due to their identification as third gender people, khwaja sira have historically been subjected to experiences of social marginalization. However, the extant literature has not fully explored the lived experiences of stigma and discrimination against khwaja sira in the Swat Valley of Khyber Pakhtunkhwa, Pakistan. To address this gap, we conducted 45 interviews with khwaja sira in Mingora, Swat, Khyber Pakhtunkhwa to better understand their experiences of gender-nonconformity stigma and discrimination in various social contexts, including within their families, in accessing health care, and within education and work contexts. Applying Minority Stress Theory and utilizing thematic content analysis, the present study identified three dimensions of gender-nonconformity stigma: (1) internalized stigma, namely feelings of shame and embarrassment; (2) perceived stigma, namely opinions others had of khwaja sira regarding lack of employability or engagement in sex work; and (3) enacted stigma, namely exclusion from families, in educational settings, in religious spaces, and in healthcare settings. Findings should inform future social intervention and community practice engagements with khwaja sira communities in Pakistan.
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Affiliation(s)
- Sameena Azhar
- Graduate School of Social Service, Fordham University,New York, NY, USA
| | - Imtyaz Ahmad
- Graduate School of Social Service, Fordham University,New York, NY, USA
- Department of Political Science, Hazara University, Mansehra, Pakistan
| | | | - Nadeem Tariq
- Department of Pakistan Studies, National University of Modern Languages (NUML), Islamabad, Pakistan
| | - Riya Lerner
- Graduate School of Social Service, Fordham University,New York, NY, USA
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Raj P, Dubey A. Comprehending Health of the Transgender Population in India Through Bibliometric Analysis. Int J Public Health 2024; 69:1606598. [PMID: 38665638 PMCID: PMC11043523 DOI: 10.3389/ijph.2024.1606598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Objective: In India research on health issues of transgender populations are very recent and limited though transgenders are an important sub-group of the population. Hence, this study attempts to understand the state of transgender health research in India through a systematic review of literature. Methods: A systematic literature review was conducted using bibliometric analysis. Initially, 132 studies were identified, and only 37 articles meeting selection criteria were subsequently selected for review using PRISMA 2020 guidelines. The research landscape was examined with tools such as Biblioshiny, Arc-GIS (10.1), and Vos-Viewer. Results: The review highlights that existing literature on transgender health in India mainly focuses on sexual health while neglecting their overall health status. It also emphasises the skewed geographical coverage of these studies. Based on the analysis, the interdisciplinary nature of the subject is illustrated in a three-field plot and through term co-occurrence. These indicate the need for culture-specific gender-affirmative services promoting a holistic approach to comprehend the health of transgender populations in India. Conclusion: In India research on transgender health is lopsided and at an initial stage. There is a need to develop diverse research focus on various health issues of transgenders that should also be geographically representative. Future in-depth research on this subject will enable optimizing resource allocation, developing effective gender-inclusive policies, and support holistic planning for better health status of transgender people in India, and other countries with similar socio-cultural background.
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Affiliation(s)
- Papia Raj
- Department of Humanities and Social Sciences, Indian Institute of Technology Patna, Patna, Bihar, India
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Zanwar PP, Taylor R, Hill-Jarrett TG, Tsoy E, Flatt JD, Mirza Z, Hill CV, Perianayagam A. Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:327. [PMID: 38541326 PMCID: PMC10970139 DOI: 10.3390/ijerph21030327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 04/28/2024]
Abstract
India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions.
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Affiliation(s)
- Preeti Pushpalata Zanwar
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Irma Lerma Rangel College of Pharmacy, Texas A&M University, Kingsville, TX 78363, USA
- Jie Du Center for Innovation and Excellence for Drug Development, University of Pacific, Stockton, CA 95211, USA
- The National Institutes on Aging (NIA) Funded Network on Education, Biosocial Pathways, and Dementia in Diverse Populations (EBDDP), College Park, MD 20742, USA
| | - Robyn Taylor
- National Association of Chronic Disease Directors, Decatur, GA 30030, USA; (R.T.); (Z.M.)
| | - Tanisha G. Hill-Jarrett
- Memory and Aging Center, University of California, San Francisco, CA 94143, USA; (T.G.H.-J.); (E.T.)
- Global Brain Health Institute, University of California San Francisco & Trinity College Dublin, San Francisco, CA 94158, USA
| | - Elena Tsoy
- Memory and Aging Center, University of California, San Francisco, CA 94143, USA; (T.G.H.-J.); (E.T.)
- Global Brain Health Institute, University of California San Francisco & Trinity College Dublin, San Francisco, CA 94158, USA
| | - Jason D. Flatt
- School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
| | - Zunera Mirza
- National Association of Chronic Disease Directors, Decatur, GA 30030, USA; (R.T.); (Z.M.)
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Kumaraguru M, Chellappa LR, I MA, Jayaraman S. Association Between Perceived Stress and Salivary Biomarkers of Allostatic Load Among Gender Minorities in Chennai: An Observational Cross-Sectional Study. Cureus 2023; 15:e46065. [PMID: 37900445 PMCID: PMC10604589 DOI: 10.7759/cureus.46065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Background Transgender individuals in India experience immense psychosocial stressors, stigma, and violence. In response to stress, the body exhibits adaptive responses that necessitate the production of organic chemicals ensuing in the detection of blood serum and saliva. There are currently no laboratory tests that are confirmatory for the diagnosis of stress and facilitate necessary treatment to be carried out in a timely manner. Thus, potential salivary biomarkers could be a helpful tool in overseeing the efficacy of pharmacological treatment prescribed by a psychiatrist. Aim This study aimed to assess the correlation between perceived stress and salivary stress biomarker levels in transgender and gender nonconforming (TGNC) individuals in Chennai, India. Methodology Twenty-two TGNC individuals and 22 age-matched controls in Chennai were administered the Perceived Stress Scale-10 questionnaire. Following this, their saliva samples were collected using the passive drool technique and subjected to sandwich enzyme-linked immunosorbent assay (ELISA) technique for measuring salivary cortisol, salivary tumor necrosis factor-alpha (TNF-alpha), and salivary C-reactive protein (CRP). Independent t-test was used to compare salivary stress biomarker levels between the TGNC and age-matched control groups. Pearson's correlation test was done to correlate perceived stress and salivary stress biomarker levels in the TGNC group. Results Significant difference was seen between the TGNC and control groups with respect to salivary cortisol and salivary TNF-alpha levels, with the levels being higher in the TGNC group. A significant positive correlation was seen between perceived stress and salivary cortisol and between perceived stress and salivary TNF-alpha levels. Conclusion There is a significant correlation between perceived stress and salivary biomarkers of stress among TGNC people in Chennai.
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Affiliation(s)
- Mahalakshmi Kumaraguru
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Lalitha Rani Chellappa
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Meignana Arumugham I
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Selvaraj Jayaraman
- Department of Biochemistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Dixit V, Garg B, Mehta N, Kaur H, Malhotra R. The Third Gender in a Third World Country: Major Concerns and the "AIIMS Initiative". JOURNAL OF HUMAN RIGHTS AND SOCIAL WORK 2023; 8:1-6. [PMID: 37360666 PMCID: PMC10148579 DOI: 10.1007/s41134-023-00238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 06/28/2023]
Abstract
With a population dividend of around 1.3 billion, India is the largest democracy in the world that encompasses "unity in diversity". The kaleidoscope of the socio-cultural fabric comprises the transgender population too, which has a historical context dating back millennia and also plays a vital role as described in Hindu scriptures. The Indian transgender person's community shows a variety of gender identities and sexual orientations, which is unlikely from the West, forming a culturally unique gender group. In India, transgender persons were recognised as the 'third gender' in 2014. The third gender population of India is marginalised to a great extent in every sector. Often, transgender persons have been the subjects of sociology, psychology, and health issues. There was a dearth of data regarding their major health problems including bone health, which has not been reported in India and elsewhere before this study. Through a prospective cross-sectional study design, we aimed to determine the current health status of transgender persons with a special emphasis on bone health. Descriptive statistics were used for data analysis. The preliminary results of the study show poor bone health in the transgender population of India. The majority of transgender persons have low bone mineral density (BMD) at a much young age, even before the achievement of their peak bone mass. The health status of the transgender population in India is poor overall. Transgender persons have many impediments to optimal healthcare that requires holistic care. This study presents the current health challenges of the transgender population with a special emphasis on their bone health status as 'AIIMS initiative'. This study also shows transgender persons human rights needs to be explicitly discussed. The stakeholders of social policies require an urgent attention to unfold the major concerns encompassing transgender persons.
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Affiliation(s)
- Vivek Dixit
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Harleen Kaur
- Department of Psychology, Banaras Hindu University, Varanasi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Chakrapani V, Newman PA, Shunmugam M, Rawat S, Mohan BR, Baruah D, Tepjan S. A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people's health in India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001362. [PMID: 37079524 PMCID: PMC10118178 DOI: 10.1371/journal.pgph.0001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/18/2023] [Indexed: 04/21/2023]
Abstract
Amid incremental progress in establishing an enabling legal and policy environment for lesbian, gay, bisexual, transgender and queer-identified people, and people with intersex variations (LGBTQI+) in India, evidence gaps on LGBTQI+ health are of increasing concern. To that end, we conducted a scoping review to map and synthesize the current evidence base, identify research gaps, and provide recommendations for future research. We conducted a scoping review using the Joanna Briggs Institute methodology. We systematically searched 14 databases to identify peer-reviewed journal articles published in English language between January 1, 2010 and November 20, 2021, that reported empirical qualitative, quantitative or mixed methods data on LGBTQI+ people's health in India. Out of 3,003 results in total, we identified 177 eligible articles; 62% used quantitative, 31% qualitative, and 7% mixed methods. The majority (55%) focused on gay and other men who have sex with men (MSM), 16% transgender women, and 14% both of these populations; 4% focused on lesbian and bisexual women, and 2% on transmasculine people. Overall, studies reported high prevalence of HIV and sexually transmitted infections; multilevel risk factors for HIV; high levels of mental health burden linked to stigma, discrimination, and violence victimization; and non-availability of gender-affirmative medical care in government hospitals. Few longitudinal studies and intervention studies were identified. Findings suggest that LGBTQI+ health research in India needs to move beyond the predominant focus on HIV, and gay men/MSM and transgender women, to include mental health and non-communicable diseases, and individuals across the LGBTQI+ spectrum. Future research should build on largely descriptive studies to include explanatory and intervention studies, beyond urban to rural sites, and examine healthcare and service needs among LGBTQI+ people across the life course. Increased Indian government funding for LGBTQI+ health research, including dedicated support and training for early career researchers, is crucial to building a comprehensive and sustainable evidence base to inform targeted health policies and programs moving forward.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
- The Humsafar Trust, Mumbai, India
| | - Peter A. Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- VOICES-Thailand Foundation, Chiang Mai, Thailand
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
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Miller RK, O’Neill D, Pua YK, Atkinson CM, Martin FH. Mental health literacy in India and Australia and its relationship to attitudes towards LGBT people. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2022.2049630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Daniel O’Neill
- School of Psychology, The University of Newcastle, Ourimbah, NSW, Australia
| | - Yeow Khoon Pua
- School of Psychology, The University of Newcastle, Ourimbah, NSW, Australia
| | - Carmen M. Atkinson
- School of Psychology, The University of Newcastle, Ourimbah, NSW, Australia
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Galupo MP, Orphanidys JC. Transgender Black, Indigenous, and People of Color: Intersections of Oppression. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:1-4. [PMID: 35403113 PMCID: PMC8986269 DOI: 10.1080/26895269.2022.2020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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