How Kerala transgenders are faring amidst the COVID-19 pandemic.

Abstract

Dear Editor, We read the article by Asadi[1] with great interest where the authors have described how an empowered transgender community gains the ability to handle adversities. The transgenders are a vulnerable group in this pandemic. The 2011 census and 2015 Kerala transgender survey estimates 3,902[2] and 25,000[3] self revealed transgenders, respectively, in Kerala. With a high literacy rate of 94%,[2] the transgenders in Kerala depict a strong community with empowered members who actively voice their rights and needs. An article by Madhavan[4] and other literature[5] reveal transgenders have high prevalence and risk factors for non-communicable, communicable diseases, HIV, high tobacco consumption and other conditions, which makes them prone to COVID-19 adversities. Older transgenders are at a higher risk due to weaker immunity, possible presence of comorbidities, emotional and financial issues. The pandemic scenario would leave many on hormone replacement therapy and with scheduled gender reassignment surgeries unable to continue with it. Lack of familial support, stress about COVID and non-COVID conditions including post-surgical care are major issues. Majority mostly rely on daily wage/unsteady jobs including begging and paid sex. The pandemic has impinged drastically on their outdoor work and income generation. Their stay in overcrowded circumstances makes social distancing difficult posing high transmission threat. Inability to pay rents during such periods of non-earning makes secure shelter difficult. However, Kerala became the first state to provide relief in the form of temporary housing and food facilities to transgenders who had registered with the government during the lockdown. This falls in line with the State Policy for Transgenders in Kerala, 2015[3] which noted inclusiveness of transgenders in the socio-economic and political spectrum as pivotal; and The Transgender Persons (Protection of Rights) Act, 2019 which has a component of access to welfare measures including healthcare. The Transgender cell,[3] a first in the country, functioning under the Social Justice Department caters to this population’s needs including operating a 24 × 7 distress counselling helpline. Many live together in large households and such clusters might need more provisions than an average household. Those who choose temporary shelters like lodges find cooking facilities inaccessible even after receiving raw materials. Steps to provide cooked food are taken in transgender care homes. Special arrangements for vaccinating transgenders and providing kits containing sanitizers and masks are under process to ensure coverage in the second wave. Kerala’s Kudumbashree system (Women Self Help Group) has empowered transgender ‘neighbourhood groups’ in eight districts that enthusiastically worked towards public service during COVID-19. Augmentation of such groups across the state and country can prove highly effective. The government welcomed 0.015% transgenders who enrolled in as COVID-19 volunteers in the pandemic control activities of the state.[6] Transgender identity options are being included in all Kerala government application forms to aid in identification and improve service coverage to the invisible pocket-sects of this populace. Health workers may be motivated further to give equitable care by promoting provision for essential primary medical and advanced care through telemedicine services, addressing mental health issues to provide psychosocial support amidst the pandemic scare and infection. Financial support and sponsorship SHSRC-K Conflicts of interest There are no conflicts of interest.