HIV-SEROPOSITIVE ARAVANIS/ALIS IN SEX WORK SUFFER TRIPLE DISCRIMINATION IN THE INDIAN HEALTH CARE SYSTEM

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HIV-SEROPOSITIVE ARAVANIS/ALIS IN SEX WORK SUFFER
TRIPLE DISCRIMINATION IN THE INDIAN HEALTH CARE
SYSTEM

• Venkatesan Chakrapani,
• Priya Babu, Timothy Ebenezer

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ISSUE

• Aravanis/Alis/Hijras (male-to-female transgender/
  transsexuals) have been in India for centuries.
  Through they are tolerated by the Indian
  society they are not accepted and are being
  discriminated in various ways.
• An unknown number of Hijras/Alis involve in sex
  work since they are denied other job
  opportunities. But in reality, the public
  considers all Alis as sex workers.
• Being an HIV-seropositive Ali further increases
  the discrimination, even from the health care
  providers.

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DESCRIPTION

• The ordeal of three HIV-seropositive
  Aravanis/Alis who had urological problems are
  described in this presentation.

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PATIENT-1

• A known HIV-positive Ali (35 years) developed
  urethral stricture/stenosis following
  self-emasculation. Suprapubic cystotomy with
  Foleys cathetherization was done in a Government
  hospital in Chennai. Even though she was eligible
  for urethroplasty she could not undergo that
  procedure because of her HIV status. She was thus
  forced to remain with Foleys catheter for almost
  three years, changing the catheter by herself
  periodically. After much struggle and after
  providing materials like goggles and special
  boots through NGOs/CBOs, the urologists finally
  agreed to do urethroplasty.

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PATIENT-2

• A known HIV-positive Ali (19 years) developed
  urethral obstruction following emasculation by an
  unqualified person (quack). Suprapubic
  cystotomy with Foleys cathetherization was done
  in a governmental hospital in Chennai. She was
  not operated since the doctors wanted her to get
  treatment for AIDS first and then come back to
  them. After a few weeks, there was block in the
  Foleys catheter. The doctors/nurses did not
  change the catheter but asked an HIV-positive
  volunteer who accompanied her to change the
  catheter and declined to do the necessary
  surgical procedure.

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PATIENT-3

• 60-yr-old Ali of unknown HIV status
  (emasculated by ThaiAmma) got admitted in a govt.
  hospital. She had urethral stenosis that led to
  bilateral hydronephrosis (obstructive uropathy)
  and thus ultimately to chronic renal failure. No
  attempt was made in the medical ward to
  catheterize her since they did not know
  hermaphrodites anatomy. The first author (who
  is a physician) was asked by an Ali to come and
  see that patient. Using a paediatric Ryles tube
  urethral catheterization was done by the author.
  Two days later that patient died.

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DISCUSSION

• HIV status of the Ali (or any patient) alone
  should not prevent the health care providers from
  providing necessary medical or surgical
  management.
• HIV/AIDS education and training on
  transgender/transsexual issues to the healthcare
  providers is a must to provide quality health
  care to the Ali community.
• Anti-discrimination laws must be seriously
  considered.
• Alternative job opportunities should be provided
  to those Alis.
• The legal status of sex reassignment surgery
  should be clarified and should be done in
  Government hospitals so that quacks will not be
  approached by Alis for emasculation procedure.