Gender Affirmative Care Clinic Nested in Mainstream Care: How much Separation Is Required?

We read the article titled “Gender Affirmative Care Clinic: an Overview” with great interest.[1] The authors effectively emphasized the need for a gender affirmative care team made up of educated and experienced healthcare professionals and allied professionals who have the skill, competencies, and compassion to provide inclusive care for the transgender and gender diverse population (TDG).[2] It is imperative to create a cadre of such professionals who are trained and sensitized in transgender health, which is being deliberated to be a part of the medical curriculum by the National Medical Council in India. While such efforts are being made by the stakeholders and government, we must acknowledge the sparse pool of human resources and infrastructure to provide high-quality specialized care to the TGD population in India considering that their population as per Census 2011 is 4,87,803 and is projected to increase by a factor of 10 in the 2021 Census.[3] It takes time and experience to acquire the expertise of an astute clinician, which must be drawn from the mainstream medical system.

Similar to the demands of other genders, the TGD community requires access to medical, surgical, reproductive, emergency, and mental health care throughout their lives, in addition to gender affirming medical and surgical care. Only if the care is integrated into a tertiary care system is this conceivable. Therefore, it should be a nested component of mainstream care with specific sensitivity and empathy to their needs rather than offering services in a silo. NACO has engaged with the All India Institute of Medical Sciences, New Delhi, to set up a center of excellence for gender affirmation care as well as provide linkage to holistic care for all of their health needs (personal communication to second author). The National Health Authority (NHA) and the Ministry of Social Justice and Empowerment signed a Memorandum of Understanding (MoU) on August 24, 2022 to provide transgender people with a comprehensive medical package under Ayushman Bharat-PMJAY to seek treatment in any of the AB PM-JAY empaneled hospitals nationwide, where specific packages are available.[3] This program can be used right away at the approved centers instead of developing new channels of service, which could take several years.

Thus, it is vital to integrate the patient care, training, and research related to this particular segment of the population within designated health facilities in a sensitive and empathetic manner, involving all the concerned departments.[4] Social separation can be provided to these patients while preventing clinical separation by designating specific outpatient hours in the evening, we also propose care coordinators from their own community to serve as liaison officers between the various departments to facilitate priority and streamlined care and reduce unnecessary hospital visits and unpleasant interactions.

Conflict of Interest

None declared.

• References

• 1 Sharma S, Sharma B. Gender affirmative care clinic: an overview. Indian J Plast Surg 2022; 55 (02) 144-148 DOI: 10.1055/s-0042-1749103.
• 2 Alencar Albuquerque G, de Lima Garcia C, da Silva Quirino G. et al. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC Int Health Hum Rights 2016; 16: 2 DOI: 10.1186/s12914-015-0072-9.
• 3 Ministry of Social Justice & Empowerment. Welfare of Transgenders. 2019. Acessed September 26, 2022 at: https://pib.gov.in/PressReleasePage.aspx?PRID=1575534
• 4 Fredriksen-Goldsen KI, Hoy-Ellis CP, Goldsen J, Emlet CA, Hooyman NR. Creating a vision for the future: key competencies and strategies for culturally competent practice with lesbian, gay, bisexual, and transgender (LGBT) older adults in the health and human services. J Gerontol Soc Work 2014; 57 (2-4): 80-107

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Artikel online veröffentlicht:
22. Dezember 2022