Sex work, gender transition, family rejection and depressive symptoms among transgender women in India

Abstract

Background: Transgender women in India face unique stressors associated with minority experiences, such as experiences of gender transition and participation in sex work. However, the relationship between sex work, transition and mental health outcomes is understudied in this population.

Aims: This article aims to examine the association between gender transition status, sex work, family rejection and depressive symptoms among transgender women in India.

Methods: Data comes from a cross-sectional epidemiological study with transgender women from three states of India; Karnataka, Maharashtra and Tamil Nadu (N = 1366). Multivariate regressions were used to examine the association between sex work status and gender transition and how gender transition, and sex work are associated with depressive symptoms.

Results: 70% of the sample reported being in sex work and over 82% endorsed taking some form of gender transition service. Those who reported being in sex work were significantly more likely to have undergone breast augmentation, hormonal therapy and gender affirming surgery. Those who reported ever being married were less likely to report gender affirming surgery and were more likely to report hormonal therapy. Additionally, being in sex work, undergoing transition, leaving home because of sexual orientation, and being married were significantly associated with depressive symptoms.

Discussion: Community-led organizations and other service agencies must incorporate intersectional experiences and identities, including sex work and gender transition, in their programs to further social and health justice for transgender women in India. Policy and programmatic implications are discussed.

Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1939220

Keywords:

• Gender transition
• India
• mental health
• sex work
• transgender women

Acknowledgment

We would like to thank the implementing team members from Swasti, Vrutti and Catalyst Management Services for their contribution and support in designing of the programme, research, and data collection.

Disclosure statement

The authors have no conflict of interest to declare.

Notes

1 Badhai: blessing newborn babies and newlywed couples. Mangti: begging in trains and public places; Pan: sex work. These livelihood occupations became more common after the transgender community was suppressed by the colonial British authorities

2 Gharana: clan/community headed by a nayak (supreme leader) under which gurus (masters) and chelas (disciples) are organized.

3 Sex reassignment surgery is an obsolete term and is generally replaced by gender affirming surgery.

4 National Legal Services Authority v. Union of India (2014) is a landmark decision by the Supreme Court of India which declared transgender people the “third gender,” and upheld the right to self-determination of gender identity as male, female or third gender.