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By: Frédérick Lavoie

Already marginalized, LGBT+ communities have been particularly affected by the pandemic. A study conducted in India, Canada and Thailand aims to better understand their situations in the context of the response to this and future health crises. 

Before the COVID-19 pandemic, Vidya Sagar lived only for lavani, a traditional dance from the State of Maharashtra. With the money she earned all across India, the 39-year-old transgender woman was able to support eleven members of her extended biological family, for whom she is the main breadwinner. 

A year later, she is still dancing, but without an audience, alone in front of her mirror, putting on makeup and dressing up to go to a highway toll booth where she now collects handouts from motorists in exchange for a prayer. 

“The first day I went there, in October, the sun was shining strong. We had to wear a mask and people were afraid of us. When we stood at the windows, we were ignored. I cried that day. But I didn’t let it get me down,” says Vidya Sagar, who welcomes us to her cramped room in a slum in Ulhasnagar, a suburb of Mumbai. 

Despite her determination, she now earns only half of what she did before the pandemic. And above all, she misses the stage a lot. “When I was dancing, I was relaxed. Now I’m always stressed,” says the woman who spent the first few months of the lockdown organizing the daily distribution of food rations for Ulhasnagar’s 250 or so transgender and other disadvantaged people. 

The precarious situation in which the pandemic has left Vidya Sagar is far from unique in her community. Almost all of the country’s nearly two million transgender women earn their income from informal activities requiring contact with the public. Members of this community, often referred to as hijras — a term that some of them consider derogatory, but which is still widely used — have a paradoxical status in India: for thousands of years, people have considered them to have mystical powers of blessing, while at the same time maintaining superstitious fears about them. They are thus confined to a handful of jobs: soliciting handouts in public places, blessing newborns, newlyweds and new businesses, and also sex work.

Vidya Sagar headshot
Québec Science / Zoya Thomas Lobo
Vidya Sagar prepares to briefly return to the stage for a lavani dance performance at an award ceremony for Mumbai’s transgender community in March 2021.

Research while helping 

How can we better support the various sexual minorities around the world in their particular challenges in the context of the pandemic? That’s the question Peter Newman, a professor in the Factor-Inwentash Faculty of Social Work at the University of Toronto, asked himself. When the world closed in on itself in March 2020, he was in Asia, meeting with his research partners about a large study on LGBT+ community inclusion in India and Thailand. A year later, he is still in Bangkok, but his project has changed. “We have changed our plans to address the inclusion challenges that were right there in front of us at the heart of this pandemic,” he explains. 

So he and his partners envisioned a peer counselling intervention that would not only document the personal experiences of people like Vidya Sagar, but also help them minimize the risks of SARS-CoV-2 infection and the impact of the pandemic on their mental health and socio-economic situation in India, Thailand and Canada. In each of these countries, 100 trans people, 100 men who have sex with men and 100 women who have sex with women will be interviewed. “We don’t just want to collect data. We want to engage in the community,” says Peter Newman. “The idea is also to be able to say, ’Oh, you’re running out of food and medicine,’ and guide participants to the appropriate resources.”  

This approach, known as motivational interviewing, is “client-centred” and “based on listening without judgement.” “We want to make people feel that we understand them,” says Peter Newman. Researchers take into account that LGBT+ communities have a distrust of institutions that are supposed to help them, such as the health system or law enforcement agencies, which have often contributed and still contribute to their marginalization. 

The motivational interviewing approach has proven its worth in the past, says Peter Newman, particularly with drug users. “You don’t tell people to stop [harmful] behaviour. Rather, the question is what they could do, given their situation, to reduce the risks involved. We want to decrease their risk level. In the case of sex workers, this means directing them to resources, such as food banks or financial housing assistance programs, which will allow them to move away from relying on sex work to meet their basic needs,” says the researcher. 

However, the pandemic context brings an additional challenge to conducting such a study: due to health measures, the three motivational interviews with each of the 900 volunteers had to be conducted entirely virtually, via video-conferencing. Not everyone has access to these technologies or the digital skills to use them. Communication becomes that much harder. This is without taking into account the loss of human contact, which can weaken communication. Still, Peter Newman sees great potential in these tools for the future of community interventions. “The advantage is that you can reach a large population without increasing the risk [of infection],” he says. Even in non-pandemic times, telemedicine interventions make it easier to reach people who are socially or geographically isolated. The fact that the counsellors also identify themselves as members of a sexual minority helps to build trust despite the distance,” says the professor. 

Trans women queue outside a church in Mumbai in October 2020 to receive food rations from an NGO.
Québec Science / Zoya Thomas Lobo
Trans women queue outside a church in Mumbai in October 2020 to receive food rations from an NGO.

Collateral damage 

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.

Beyond fear 

Among all the problems listed, one issue that is missing is COVID-19 itself. While many community members and Humsafar Trust staff have contracted it, the health issues that have come up for those who are LGBT+, while not minimizing them, do not compare to the collateral effects caused by the measures taken to contain the pandemic. 

Shruta Rawat also believes that government strategy of relying on fear and coercion to enforce health measures has exacerbated community problems. This observation is shared by Notisha Massaquoi, the University of Toronto post-doctoral fellow overseeing the Canadian portion of the study. Furthermore, “our work around HIV over the past decades has shown that the fear-based approach does not work [for changing behaviour].” 

She notes that in Canada, too, the strategies used by the authorities have not been equally effective for everyone. “In Toronto, 83% of people infected with the coronavirus were racialized people [while they make up half the population],” Notisha Massaquoi points out, citing data released by the city in July 2020. As for sexual minorities and other marginalized communities, factors such as employment, transportation and housing increase their risk of exposure to the virus.

Trans woman sitting on the street.
Québec Science / Zoya Thomas Lobo
The pandemic has forced many trans women to find alternative ways to earn a living. Due to a lack of clients, some sex workers (like this anonymous one) have had to turn to begging at traffic lights.

Notisha Massaquoi believes that research findings will highlight the “intersectionality” (or overlap) of discrimination based on ethnicity, sexual orientation and gender identity. “A whole segment of the population in Canada does not enjoy the privileges” generally associated with rich countries compared to countries like India and Thailand, she says. 

Peter Newman believes that the study will help community organizations in all three countries to “develop their capacity to work with marginalized people” in times of crisis over the long term. He also hopes that governments will pay attention to research findings and to pandemic experiences specific to LGBT+ people. “Before the next crisis strikes, we must ask ourselves how to avoid a situation in which [health] measures only take into account the reality of straight couples with 2.4 children."

Woman with camera

Zoya, photojournalist

For Zoya Thomas Lobo, the COVID-19 pandemic has been both a hardship and a launching pad. As is the case for many transgender women, the 10-month suspension of Mumbai’s commuter train service has cut her off from her main livelihood, which was collecting handouts from passengers in compartments reserved for women. But the pandemic has also given her something new. 

In mid-April 2020, when Indian Prime Minister Narendra Modi announced an initial lockdown extension, she was the only photographer in Mumbai to capture the spontaneous protests — quickly dispersed by police — by thousands of migrant workers demanding special trains to take them back to their villages. After a year and a half of trying to break into journalism, she had her first exclusive, sold her first piece of work, and was recognized by her colleagues as “the first transgender photojournalist in Mumbai and Maharashtra.” As a heterosexual cisgender man, the author of this story wanted to work with Zoya Thomas Lobo to add an intimate and informed insider’s perspective on the issues experienced by her community.   

While she continues to work the trains to support herself while dreaming of a stable job in Indian news media, Zoya Thomas Lobo has her first major photo report, in Québec Science. 

Top image: Québec Science / Zoya Thomas Lobo