Discrimination against Hijra (transgender) in accessing Bangladesh public healthcare services

Abstract

In Bangladesh, the Hijra (transgender), who claim to be neither male nor female, are living in a marginalized condition and also considered as a high-risk population for HIV/AIDS epidemic. Access is a key concept in the study of healthcare which measures the capability of the health system to reach all levels of the population. Globally, transgenders have limited access to healthcare service deliveries due to discrimination against them as various studies revealed. There is a lack of understanding about healthcare access by Hijra in public health settings of Bangladesh. This study was designed: (i) to examine healthcare experiences of Hijra individuals, service providers and non-Hijra patients; (ii) to examine the health needs of Hijra in order to understand the service gaps from the perspectives of Hijra and service providers; and (iii) to identify possible interventions to improve Hijra healthcare in public hospitals. This is a qualitative study where purposive sampling technique was applied. A total of 25 in-depth interviews with Hijra, service providers and non-Hijra patients, and 3 key-informant interviews were conducted. Data were analyzed utilizing thematic analysis. The findings revealed that despite the recognition of the 'Hijra' gender by the government, only 'male' and 'female' genders were recorded in public hospital documentation. Hijra experienced verbal harassment, got blamed for health sufferings, and were denied equal treatment. They stated that prevention, test and treatment facilities for STI/HIV were inadequate and irregular for them. Moreover, service providers had a limited understanding of Hijra care and culture and they were reluctant to communicate with Hijra patients. According to service providers and non-Hijra patients, Hijra individuals acted as 'panic-makers' and showed 'poor' social manners in the care environment of hospitals. Several health needs and loopholes of public hospitals were reported by Hijra and service providers, with expectations for a change in the future. This study recommends that Hijra identity as a gender category be institutionally incorporated in the healthcare system. Moreover, adopting culturally competent education and training on Hijra care for service providers, promoting sensitization program for Hijra, building a health support network and adapting guidelines for Hijra care are suggestions from this study to decrease discrimination and increase equitable healthcare services for the Hijra population in public hospitals.