Decriminalization of section 377: Much more needs to be done

In a historic and unanimous judgment delivered this month on 7th Sept, the Supreme Court of India decriminalized section 377 of the Indian Penal Code (IPC), as per which homosexuality is a punishable offence, stating that “Section 377 is irrational, arbitrary and incomprehensible” and termed “sexual orientation as biological phenomenon, says any discrimination on this grounds is violative of fundamental rights”.

Homosexuality has mostly been perceived in terms of sexuality and sexual relationship with a same sex partner. But, this is not the only or its most relevant aspect. There are several related issues, which need to be dealt with to bring the LGBT community into the mainstream.

While the Supreme Court has protected their sexual rights, there is still a long road ahead before they can enjoy other civil rights as do the heterosexuals including the right to equality (under Article 14 of the constitution of India), right to live with dignity without discrimination (under Article 15), right to life and liberty (under Article 21), right to privacy (under Article 21) and right to freedom of expression (under Article 19).

Right to health and access to healthcare (under Article 21), right to reputation (under Article 21), right to education (under Article 21), right to marriage, right to shelter, right to inherit property, right to form associations, right to adoption, protection from domestic violence, right to employment, right to insurance are some other challenges that also need to be addressed.

Limited or lack of access to basic health care, negative encounters with hospital staff and inadequately trained health care providers are barriers to care for the LGBT community. It’s difficult for them to get health insurance. These barriers must to be overcome.

All health care providers must be educated and trained in LGBT patient-centered care to ensure that the LGBT individuals do not receive substandard care and services, and also that their health issues are taken care of with sensitivity and without any discrimination or bias. Not only doctors and paramedical staff, other hospital staff members such as security guard, receptionist, office clerks etc. should be trained in verbal and nonverbal communication.

Communicating without being judgmental is the first step towards building trust and respect.

Some health-related issues pertaining to LGBT are:

·         Disparities and improving healthcare and services for older LGBT populations

·         Health-related behaviors and outcomes in chronic conditions among transgender Medicare beneficiaries

·         Health indicators for older sexual minority individuals

·         Need to improve measures of sexual orientation and gender identity to identify LGBT older adults

·         Sexual orientation differences in risk factors for cardiovascular disease in men

·         Prevalence of diabetes by sexual orientation

·         A complex case of a trans-feminine youth with a BRCA1 mutation

·         Victimization and suicidality among transgender individuals

·         Co-occurrence of gender dysphoria and autism spectrum disorder symptoms in adults

·         Perceived stress and depressive symptoms among sexual minority young adults

·         Prevalence and correlates of prescription drug misuse among sexual minority men

·         Identifying and counting individuals with differences of sex development in population health research

·         Disaggregation of data by sexual orientation, gender identity, and sex assigned at birth

·         Chronic conditions disparities

·         Health outcomes of gender-affirming interventions

·         Self-harm and suicide prevention for sexual and gender minority (SGM) youth

·         Assessment of and appropriate responses to gender incongruence

·         Preventive health care and screenings

·         Protective influence of families and schools

·         Minority stress and resilience factors

·         Racial and ethnic disparities

·         Substance use among SGM youth

·         HIV prevention, including Pre-exposure prophylaxis uptake and adherence

·         Methodological and ethical issues in conducting research with SGM youth

·         Improving LGBT clinical and cultural competency.

·         Changes to laws and policies that affect the health of SGM populations, as well as issues related to healthcare coverage and access

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA