Violence, Stigma, and Poverty Shape HIV Risk of Transgender Women in India: An Interview With Abhina Aher

Abhina Aher at AIDS 2018 in Amsterdam, the Netherlands
Terri Wilder

Abhina Aher is the national program manager with the India HIV/AIDS Alliance. She's an advocate for the rights of transgender people in India, and her work is internationally recognized. Aher presented a poster at the International AIDS Conference in Amsterdam called Hidden and Covered: Underreporting of Violence, a Transgender Women Project, Even After Empowerment Process, and discussed the poster and the issues that transgender women in India face with TheBody.

Terri Wilder: Can you tell me a little bit about your poster? If you'll just take me through the background methods, the results, and your conclusions?

Abhina Aher: Thank you, Terri, for giving this opportunity. We represent the India HIV/AIDS Alliance, and this poster is presented from the program called Wajood, which means empowerment.

Now, what you need to understand is that in India, when we talk about the transgender community, it's just not black and white. We have different identities that come under the larger umbrella of the transgender community.

We have been implementing the program with them for the last two-and-a-half years, and we found that the major barriers that transgender people are facing for service access are violence, service denial, stigma, discrimination, gender inequality, and lack of support from their own family members.

Terri, you have to understand, a lot of transgender women, especially at a young age when they come out to their families as transgender people, they've been kicked out, and they've been left to survive by themselves. They don't have any money. They don't have any legal documentation. They don't have any certificates. And they have to travel to other states and stay there in precarious conditions that are very vulnerable for them.

As a result, a huge amount of violence happens. We did a demographic [survey] of the people that we are working with, and we found out that the majority of people who are facing violence are between 18 and 35 years.

Now, this is also the sexually reproductive age, which means they are having a high number of sexual partners.

When we looked into the occupation of these people, we found out that the majority of them are relying on sex work. They have no other option than to do sex work. Which means, every day, they are vulnerable for violence, and stigma, and trauma.

Further, when we sought this data, Terri, we wanted to understand what kind of crisis these people are facing. And we found out it is just not physical violence which is affecting them, but the trauma of being transgender women is much more intense. So, if you are a transgender woman, and if you've been bashed or belittled every day, by the way you look, the way you behave, the way you are, you know, your aspirations to live a healthy life dies, and you want to commit suicide. You want to die; you become subject to substance abuse. And you start hating yourself, big time. And that trauma is a very, very serious trauma.

I'm part of a hijra community. Now, a hijra community is basically a socioeconomic identity, which means that we are close to the gods. We are god-women, because we castrate ourselves. We don't have a vagina or something like that. Because we don't have any organ on our body, which would present either male or female, that's the reason why we are considered to be pious and pure.

In India, there's a saying that whatever it is, it will come true. So, we have a particular way of behaving. Like, for example, there is a very famous hijra [hand] clap, if you look at it. This is a very specific clap that you cannot clap, but I can do that because this is part of the culture, of the community. We have a separate vocabulary, which has been developed in the community.

It's a community which has developed among them to create support for the transgender women. But since we consider ourselves as god-women, many times we don't want to access health care services. Because we see that nothing will happen to us. You know, we will be cured by the gods. We don't have to have any other medication for curing ourselves.

What we found out is, there's a lot of forced sex happening on [transgender women] -- forced sex, rapes, humiliation -- and the majority of this forced sex which was happening was from rowdy people, goondas, the people who are goons; and they are exploiting people, and they are hampering people, other related aspects.

Other than that, there are also family members of the goondas, the family members of transgender people are also doing forced rape, collective rapes on them, which is traumatizing. You can imagine, you are at the age of 12 and 13, when you are expressing yourself as a transgender woman, and your own uncles and your own cousins and brothers are raping you. That will force you to leave your house.

I am the survivor of rape. I remember when I was [school age], other children who were older than me actually raped me. There were 10 male children who raped me. And they beat me up; they tore my clothes apart. Because, for them, I was an unusual case. For them, I was an abnormal person. Many times, these physical injuries do not get medical treatment or do not get reported within the periphery of the legal paradigm.

Because I fear to go to a law enforcement agency, to the police, and say, "Listen, I've been harassed; I've been raped."

The police would say, "Huh? You've been raped? No, you must have gone by yourself." You know? Police will not understand that I could be a subject of a violence case, because for the police, also, I am an unwanted entity of society. They don't want to address that case.

What we are seeing is that forced crisis, forced rapes and other related aspects, affect the empowerment of transgender women. As a result of that, they fail to live their life with aspiration. They're always traumatized. They don't access help. And they always feel inferior in front of any other gender.

Unfortunately, Terri, the data are not recorded well enough for the transgender community. The data are only recorded in binary -- either male or female. And that is a larger issue.

So, I'm trapped in a vicious circle. People don't know my numbers. People don't know the intensity of trauma that I'm going through. There are no resources, and my community is dying on the roots.

TW: We're at an international HIV conference. So, when transgender women experience violence, as you said, they're going to be less likely to access any kind of health care. So, are there alternative ways for the transgender community to access health care, in terms of HIV testing? Is there a program that's just for transgender women that is trusted and safe so that the women, at a minimum, could get tested for HIV?

AA: In India, we are doing, Terri, a couple of things. One thing that we are doing is that we are sensitizing health care providers, with the help of transgenders. So, first, we are empowering transgenders. Then we are using them to empower health care providers -- where transgenders are openly talking about their physical issues with their health care providers. And that is helping.

The other thing is that we also have some community clinics where everybody from the community is providing services to the community. So, it's a community-led clinic. So, even a doctor's community, from a sexual minority region, a nurse's community, a counselor's community.

TW: When you say community, they are transgender?

AA: No, they are from sexual minority people. But some of them could be men having sex with men [MSM]. Some of them would be transgenders -- all the community.

They feel safe to come and access the services. We have almost tested around 10,000 people, who are from the MSM and transgender community. Out of them, around 4,000 transgender people have come forward and are getting tested and tested.

But the HIV prevalence rate among transgenders at the national level is 7.5% at this point in time. And some of the states, and some of the cities, could go to 40% and 50%. Because you see that 51% of the population is completely surviving on sex.

And the other people, who are also doing begging; they are also doing sex work, which is hidden in nature. So, I'm begging throughout the day, but in the night, I will stand for the sex work. You know? They don't have any other option besides that, because they are not only taking care of themselves; they are taking care of their families, also. A lot of them are actually giving money to their families for survival. And that's a larger issue that is at this point.

TW: So, if our readers wanted more information about your organization, is there a website they could go to?

AA: Yes, absolutely. My organization's name is India HIV/AIDS Alliance. And you can go to our website. It is called Alliance India.

TW: Perfect. Thank you so much.

AA: Thank you so much, Terri, for covering our news.

This transcript has been lightly edited for clarity and brevity.