There have been delays in the schedule for completing the study. And ironically, the pandemic itself is to blame. In all three countries, the approval processes undertaken by institutional ethics committees have been slowed down.
In early March 2021, when we visit the offices of the Humsafar Trust, the organization mandated to conduct the Indian portion of the study and which has been working with the LGBT+ population for more than a quarter of a century in Mumbai, the go-ahead to recruit volunteers has still not been given. But Humsafar Trust workers already know all too well the pandemic’s harmful effects on their clients.
Raj Kanojiya, a trans man and contributor to the organization, recounts the many calls he has received at night over the past few months. On the other end of the line, there were people on the verge of suicide because the lockdown had forced them to return to their families, who knew nothing about their sexual identity. “They were told, ‘Now dress and behave like a woman. We’re going to get you married.’”
Shruta Rawat, research officer at the Humsafar Trust, adds that many people in the process of transitioning have encountered the reality that hormone treatments are not considered essential medication. “In order to survive, some have had to spend the money they were saving for sex reassignment surgery,” she says.
The pandemic has also significantly disrupted access to HIV testing and anti-retroviral treatment, notes Rawat. A problem corroborated by dancer Vidya Sagar, whose HIV-positive trans friend died in late January 2021, after experiencing difficulties with medication supply linked to lockdown measures.
As for state aid, it has rarely reached its intended targets because of bureaucratic inflexibility. In the case of trans women, for example, even though they have been recognized as a “third sex” in India since 2014, very few have the paperwork associated with their new gender identity. “Of the 23,000 people we have helped across the country, we were only able to link 83 of them to a government assistance program that gave them a one-time payment of 1,500 rupees [equivalent to $26],” says Rawat.
Urmi Jadav, an employee of the Humsafar Trust for twenty years and the study’s trans women’s peer counsellor, notes that people who had never done sex work for a living have recently begun to engage in it.
As for those who were already engaged in it, they found themselves in an even more precarious situation. This is the case of S., 35 years old, whom we meet at her home, as she is preparing to go to work.
After months of surviving on rations provided by an NGO, in late 2020, she began once again to go to an unused railway track on Mumbai’s suburban train network after dark to wait for customers. “Before the lockdown, the pricing system was different. Today, people have no money. Once you could ask them for 200 or 500 rupees for a sexual service, now sometimes we only get 100 rupees for it,” says S. Fortunately, she was able to count on her understanding landlord, who agreed to accept late rent without interest during the pandemic.
Unlike Vidya Sagar, who is skeptical about the actual virulence of COVID-19, S. follows sanitary measures to the letter, even with her clients. In addition to a condom, she now requires them to wear a mask and to disinfect their hands with hydroalcoholic gel, as advised by an NGO working with trans women.
Skepticism about the pandemic and the propensity to follow health guidelines in the LGBT+ communities are the two issues that the study seeks to measure.