A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people’s health in India

Abstract

Amid incremental progress in establishing an enabling legal and policy environment for lesbian, gay, bisexual, transgender and queer-identified people, and people with intersex variations (LGBTQI+) in India, evidence gaps on LGBTQI+ health are of increasing concern. To that end, we conducted a scoping review to map and synthesize the current evidence base, identify research gaps, and provide recommendations for future research. We conducted a scoping review using the Joanna Briggs Institute methodology. We systematically searched 14 databases to identify peer-reviewed journal articles published in English language between January 1, 2010 and November 20, 2021, that reported empirical qualitative, quantitative or mixed methods data on LGBTQI+ people’s health in India. Out of 3,003 results in total, we identified 177 eligible articles; 62% used quantitative, 31% qualitative, and 7% mixed methods. The majority (55%) focused on gay and other men who have sex with men (MSM), 16% transgender women, and 14% both of these populations; 4% focused on lesbian and bisexual women, and 2% on transmasculine people. Overall, studies reported high prevalence of HIV and sexually transmitted infections; multilevel risk factors for HIV; high levels of mental health burden linked to stigma, discrimination, and violence victimization; and non-availability of gender-affirmative medical care in government hospitals. Few longitudinal studies and intervention studies were identified. Findings suggest that LGBTQI+ health research in India needs to move beyond the predominant focus on HIV, and gay men/MSM and transgender women, to include mental health and non-communicable diseases, and individuals across the LGBTQI+ spectrum. Future research should build on largely descriptive studies to include explanatory and intervention studies, beyond urban to rural sites, and examine healthcare and service needs among LGBTQI+ people across the life course. Increased Indian government funding for LGBTQI+ health research, including dedicated support and training for early career researchers, is crucial to building a comprehensive and sustainable evidence base to inform targeted health policies and programs moving forward.

Barriers and facilitators for adherence to antiretroviral therapy, and strategies to address the barriers in key populations, Mumbai–A qualitative study

“…Thus, counsellors providing services to key population should be trained to counsel about disclosure of HIV-positive status not only to biological families (in key population who stay with their family members) but also non-biological families (for those who stay in community household settings). Addressing various types of stigma (such as anticipated or experienced stigma) from general community, peers, or health care settings should also be included in these training programmes [ 39 – 41 ]. An important cause of anticipated stigma is the ‘green book’—it is a record book which includes details of HIV management and PLHIV are supposed to carry this book during their visits to the ART centre.…”

Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India

“…Nevertheless, as seen within the results of this study and those of previous studies, the intersectional stigma formed by HIV stigma and MSM stigma demand both be addressed together for treatment improvement. 7 , 16 , 35 , 36 Thus, in addition to educational programs on HIV, there is a need to initiate programs and education on sexual diversity.…”

“… 12 – 14 The same has been found true for MSMLH in India, who face intersecting stigmas based on sexual orientation (MSM stigma) and HIV status. 15 – 17 However, further exploration is necessary to broaden awareness of how multiple stigmas faced by MSM influence HIV treatment engagement within the Indian context. Using Intersectionality Theory and the Health Stigma and Discrimination framework, we hoped to further understand and explain how multiple discrete identities may impact HIV care engagement for this population within the Indian cultural context.…”

“…Previous studies from India have shown that MSMLH experience barriers in access to ART and social support to a greater degree than the general public. 16 , 18 The consequences of specific stigma manifestations, such as within the family, society, and hospital settings, are known to impact HIV care engagement globally, 19 – 21 however, have not been fully discerned within this population. Additionally, the impact of disclosure and familial support has not been well studied.…”