Gender Violence: The Health Impact: Gender-Based Violence and LGBTQI communities
December 4, 2014 Leave a comment
by L. Ramakrishnan
We understand violence as the “intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation” (Krug et al., 2002). Gender, as a fundamental axis of power difference privileging men over women, serves as a basis for much of the violence we see in the world today.
While gender-based violence has come to signify violence against women, the violence faced by lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities is perpetuated by the same patriarchal rules that work to keep the categories ‘women’ and ‘men’ and the norms and expectations associated with these, separate and unequal (Pharr, 1988).
Gay: Persons (usually men) exclusively or predominantly attracted to members of their own gender, regardless of their sexual behavior or relationship status
Lesbian: Women exclusively or predominantly attracted to other women, regardless of their sexual behavior or relationship status
Bisexual: Persons significantly attracted to individuals of more than one gender, regardless of their behaviour or relationship status
Transgender: Persons whose personal gender identification runs contrary to the gender associated with their biological sex assignment, regardless of their sexual behavior, attraction or relationship status
Gender-nonconforming: Individuals, particularly children, who, by their external appearance, mannerisms, behavior or activities, fail to conform to the gender associated with their assigned biological sex. Some gender-nonconforming children may grow into a transgender identity as adults, others lesbian, gay or bisexual, and yet others heterosexual.
Cisgender: Persons who are not transgender
Queer: Often used as an umbrella term for people of non-normative sexualities or genders
Intersex: Persons whose biological sex is intermediate between male and female, as defined with respect to chromosomes, genitals, gonadal tissue and/or typical levels of sex hormones.
For a more detailed explanation of these terms, please click here.
LGBTQI people, by virtue of sex, gender or sexuality, encounter violence of varying intensities, from ridicule to physical, emotional and sexual assault, to murder. Scales of violence range from the inter-personal to the state-sanctioned. Some examples and their impact are below.
“What will others say?”
“No son of mine is going to be that way”
Families are often the first sites of violence against LGBTQI people, with many parents perpetuating differential treatment commencing from the moment the child is determined to be a boy or a girl, and enforcing gender-specific expectations on the child at every stage of development.
Embarrassment, shame, anger, emotional and occasionally physical violence meet the child or young adult who is does not conform to the behavior expected of his/her gender, whether a girl-assigned child who does not manifest the nurturing, domestic and compliant qualities required for ascension into traditional heterosexual womanhood and motherhood, or a male-assigned infant who does not grow up to be an athletic boy and dutifully transform into a ‘real’ man a.k.a. breadwinner, husband, and father who will ensure continuity of the family line.
“Paro’s mother reads her personal diary, finds out she has had relationships with women, and calls up all her friends asking them if they have had sexual relations with her…[t]he subsequent shame Paro experiences because of her mother’s action caused the termination of many of these friendships. This episode also triggers a series of physically violent cycles between the mother and the daughter, where Paro is beaten up.” (Fernandez and Gomathy, 2003)
Visibly gender-nonconforming children, or those whose romantic and sexual interests as adolescents or young adults approaching “marriageable” age appear to be directed towards the same gender, are often taken by anxious parents to healthcare providers, in the hope that medical interventions will help restore their children to normative sexuality or gender (Ramakrishnan, 2011).
Perhaps the most insidious violence perpetrated by families of LGBTQI people on those whose romantic/sexual attractions lie elsewhere is forced marriage to individuals of the other sex. This is a crime whose victims extend beyond the gay/lesbian individuals and include their spouses who are often unaware of this incompatibility until after marriage, and – in some cases – children.
Individuals who are same-gender attracted, but who are not otherwise conspicuous with respect to non-conforming gender expression, find it arguably more difficult to have their sexual orientation taken seriously within the family and elsewhere. Invisibility and dismissal by family of one’s orientation as inconsequential, or as a phase that can be overcome by marriage, can be as oppressive as other forms of violence.
“[Homophobic bullying] is a moral outrage, a grave violation of human rights and a public health crisis” – UN Secretary-General Ban Ki-moon in 2011
Policing of gender roles and punishment for transgression extends to LGBTQI young people in educational institutions. Bullying from peers disproportionately targets children who are gender-nonconforming, overweight and/or living with disabilities (UNESCO, 2012). Violence may also be perpetrated in the form of physical and sexual abuse from teachers.
In one large-scale longitudinal study of over 9800 youth in the US, childhood gender-nonconformity predicted increased risk for sexual, physical, and psychological abuse and lifetime probable post-traumatic stress disorder (Roberts et al., 2012). Closer to home, a study of kothis (feminine same-gender attracted males) in six cities of India and Bangladesh indicated that 50% of the 240 respondents had experienced harassment and violence from classmates, teachers and non-teaching staff in school and college (Bondyopadhyay & Khan 2005).
Hostile educational environments, coupled with unsupportive families, lead many transgender or gender-nonconforming children to drop out of the educational system, resulting in lost opportunities for gainful employment as adults (MSJE, 2014).
Barring community-based organisations, progressive NGOs, and multinational companies that enforce LGBTQI-inclusive diversity and anti-harassment policies, most Indian workplaces are hostile to LGBTQI employees.
Violence against lesbian, gay and bisexual people in the workplace takes the form of homophobic comments and innuendo, directed at individuals who do not flaunt proof of their heterosexuality (Philip, quoted in Sriram, 2014). If the company includes sexual orientation in its diversity policy, individuals who are openly lesbian, gay or bisexual may be dealt with more cautiously for fear of punitive action, but may have to contend with sniggers and homophobic comments behind their back. Individuals who are in the closet may be subjected to the same heterosexist or homophobic water-cooler conversations as their heterosexual colleagues (Pai, 2013).
While very few openly transgender people make it through the educational system and are in a position to enter the formal workforce, anecdotal experiences suggest that transgender individuals trying to transition while employed contend with much resistance and hostility.
“Angel Glady, a transgender woman working in a private software firm in Chennai, … narrated the agony that she had gone through in her initial years as an [transgender] employee living as a man. Despite having disclosed to the Team Leader about her gender identity, she was forced to come to work in male attire. In addition, she also had to undergo physical discomfort such as using the male restroom. She then made a decision to quit after her failed attempts to make the Team Leader understand her situation. But Glady’s hard work and commitment paid off, when she was offered the same position in the same company again, post her transformation to a woman. The second time she made it clear that she would identify herself only as a woman… However, when she got back to work as a woman, she had to endure uncomfortable and piercing stares from her colleagues. Except for a few close friends, the others stayed away from her.” (Kannan and Deepthi, 2011)
Like most other institutions in society, healthcare institutions – including medical education – are grounded in heterosexist assumptions that are reflected in clinical practice. Many Indian medical textbooks echo antiquated and incorrect understandings of homosexuality as pathology or as psychiatric disorder, notions that have been discarded since 1992, when the World Health Organisation removed homosexuality from its International Classification of Diseases (ICD-10).
“Female homosexuality is known as tribadism or lesbianism … [t]he practice is usually indulged in by women who are mental degenerates or those who suffer from nymphomania (excessive sexual desire) … lesbians who are morbidly jealous of one another, when rejected may commit homicide, suicide or both”- excerpt from The Essentials of Forensic Medicine and Toxicology, 21st edition, 2002, by Dr. K. S. Narayan Reddy, MD, DCP, PhD, FAMS, FIMSA, FAFM, FAF Sc., FIAMS, cited in Guha Thakurta, 2014.
Little wonder that those lesbian, gay and bisexual people who can afford to conceal their sexuality when seeking healthcare, do so! This concealment is not without its hazards, though. Gynecologists routinely make assumptions of exclusive heterosexuality while seeing lesbian or bisexual clients and fail to ask vital questions about sexual activity or relationship status. Specialists in sexually transmitted diseases assume heterosexuality when the client appears gender-normative and neglect to assess sexual health and exposure to risk in a comprehensive manner.
Despite decades of scientific evidence confirming that sexual orientation (APA 2009) and gender identity (Lev, 2004) are not amendable to external attempts at modification, ignorant and unscrupulous medical providers in India continue – to this day – to subject LGBTQI adolescents and young adults to psychotropic drugs, electro-shock therapy and other unscientific and discredited practices that achieve little more than undermining the physical and mental health of the clients. Such aversion therapy is often carried out at the behest of the parents of the client, but occasionally clients request it for themselves, unable to bear the ordeal of struggling to survive in a homophobic world.
A gay man in Bangalore who was subjected to aversion therapy explained: “She connected some wire to my left hand and tried the machine, but it didn’t work for some time. She repaired it and then asked me to look at man’s photo. I saw the photo for some time and she gave me a shock. Then she asked me to change and look at a woman’s photo. Like this she kept asking me to change and giving me shock when looking at the man’s photo. The shock was very painful. I couldn’t continue after two or three and told her I wanted to stop.” (Mr V, client, cited in Narrain and Chandran, undated)
Treatment meted out by healthcare establishments to transgender clients is worse. It is not uncommon for doctors, upon seeing a transgender woman in the clinic or ward, to summon all colleagues and students, and make the person expose her genitals to the crowd without consent, for a supposedly educational demonstration. Transgender people in India who seek medical (hormonal or surgical) intervention find it an uphill task to locate providers who are both clinically competent and sensitive to their gender issues.
Intersex infants born with ambiguous genitalia face violence through the scalpel of pediatric surgeons who believe they know best for the infant in terms of surgery and gender assignment, despite increasing evidence that the patients, as adults, are often dissatisfied with the outcome of these surgical decisions (Guterman, 2012).
State-sanctioned violence against LGBTQI people is manifested most prominently in Section 377 of the Indian Penal Code. A relic from India’s colonial past, IPC 377 criminalises all forms of penetrative sexual activity that do not involve a penis and vagina. The charge of criminality applies even if these acts involve consenting adults in private, thus undermining the LGBTQI communities’ constitutionally granted rights to freedom, equality, dignity, and privacy. A frequent claim by opponents of LGBTQI rights is that IPC 377 has been infrequently used to prosecute community members. The reality is that it makes the community vulnerable to blackmail and extortion, and to harrassment from the police.
The Delhi High Court, in its path-breaking Naz Foundation verdict of 2009, ruled IPC 377 unconstitutional and asked for it to be read down to exclude consensual adult relationships. However, the Supreme Court reinstated the Section, in its original form, in Dec 2013, after the four-year reprieve granted by the Naz judgement.
A subsequent judgement, NALSA vs. Union of India, passed in April 2014, asserts the rights of transgender people to enjoy full citizenship, and directs all ministries and their state counterparts to ensure inclusion of transgender people within the ambit of their schemes, provisions and entitlements. Viewed globally as one of the most far-reaching judgements in the domain of transgender law, the NALSA judgement, however, will fall short until it is implemented in its entirety, and as long as IPC 377 continues to be valid, denying sexual rights to many in the transgender community.
Violence perpetrated by the law enforcement against LGBTQI people is not limited to use of IPC 377. Community members, especially working class transgender women, are routinely picked up on charges such as ‘public nuisance’ and incarcerated and/or exploited. In 2006, Pandian/Pandiammal, a transgender person who was repeatedly and brutally sexually abused by the police in Chennai, chose to immolate herself in front of the police station. In their 2007 ruling, Justice AP Shah and Justice P Jyothimani ordered the Government of Tamil Nadu to provide compensation to the next of kin (MSJE, 2014): this case became one of those cited by Justice Shah in his subsequent judgement of 2009.
Some strategies to be implemented within the short- and medium- term include:
- Developing peer- and professional support systems including mental health interventions for LGBTQI people bearing the brunt of violence
- Instituting psychosocial support for parents of LGBTQI individuals to better understand their children and deal with them in non-violent ways.
- Strengthening capacities of health care providers to ensure gender- and sexuality-sensitive, stigma-free and clinically competent services to LGBTQI people in need
- Making conversion therapy a punishable offence
- Policy advocacy towards zero-tolerance for bullying and other forms of violence in educational institutions, with mechanisms for redressal
- Decriminalisation of consenting sexual relationships among adults
- Comprehensive Non-Discrimination laws that include sexuality and gender identity within their scope, and are enforceable across institutions in the public and private sector
In the long term, addressing violence against LGBTQI communities requires one to tackle the root causes of this violence, i.e. the tyranny of gender roles and their imposition across all institutions from family to law and society. All movements engaged in social justice and dismantling oppression have a stake in this, and need to work in solidarity with each other.
APA Task Force on Appropriate Therapeutic Responses to Sexual Orientation. 2009. Report of the Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Washington, DC: American Psychological Association.
Bondyopadhyay, A. and S. Khan. 2005. From the front line: A report of a study into the impact of social, legal and judicial impediments to sexual health promotion, care and support for males who have sex with males in Bangladesh and India. Naz Foundation International
Fernandez, B. and N.B. Gomathy. 2003. The nature of violence faced by lesbian women in India. Mumbai: Research Centre on Violence Against Women, Tata Institute of Social Sciences.
Guha Thakurta, T. 2014. The homophobic doctor. Varta Blog. Online at http://varta2013.blogspot.com/2014/03/the-homophobic-doctor.html
Guterman, L. 2012. Why Are Doctors Still Performing Genital Surgery on Infants? Open Society Foundations blog. Online at http://www.opensocietyfoundations.org/voices/why-are-doctors-still-performing-genital-surgery-on-infants
Kannan, D. and S. Deepthi. 2011. LGBT Voices: Report of a panel discussion held during Chennai Pride 2011. Online at http://orinam.net/lgbt-voices-report-of-a-panel-discussion-held-during-chennai-pride-2011
Krug E.G., L.L. Dahlberg, J.A. Mercy, A.B. Zwi and R. Lozano. Eds. 2002. World report on violence and health. Geneva, World Health Organization
Lev, A.I. 2004. Transgender Emergence: Therapeutic Guidelines for Working with Gender-Variant People and Their Families. Haworth Press.
MSJE, 2014. Report of the Expert Committee on the Issues relating to Transgender Persons. New Delhi, Ministry of Social Justice and Empowerment. Online at http://socialjustice.nic.in/transgenderpersons.php
Narrain, A. and V. Chandran. Undated. “It’s not my job to tell you it’s okay to be gay…” Medicalisation of Homosexuality: A Queer Critique. Manuscript.
Orinam, 2014. Sex, Gender and Sexuality: a primer. Online at http://orinam.net/content/wp-content/uploads/2011/10/Orinam_GSS101.pdf
Pai, N. 2013. Inclusion without Explosion. The Orinam blog. Online at http://orinam.net/inclusion-without-explosion/
Pharr, S. 1988. Homophobia: a weapon of sexism. Arkansas, Chardon Press.
Ramakrishnan, L. 2011. Why Women Need To Ally With The LGBT Cause. Women’s Web. Online at http://www.womensweb.in/articles/women-ally-lgbt-cause/
Roberts, A.L., M. Rosario, H.L. Corliss, K.C. Koenen and S.B. Austin. 2012. Childhood Gender Nonconformity: A Risk Indicator for Childhood Abuse and Posttraumatic Stress in Youth. Pediatrics. http://pediatrics.aappublications.org/content/early/2012/02/15/peds.2011-1804
Sriram, H. 2014. Corporate India is not ready for gay employees as yet. Hindustan Times. Online at http://www.scribd.com/doc/203510405/Hindustan-Times-Delhi-2014-01-29
UNESCO, 2012. Education Sector Responses to Homophobic Bullying. Paris: United Nations Educational, Scientific and Cultural Organization. Online at http://www.lgbt-education.info/doc/unesco/UNESCO_Homophobic_bullying_2012.pdf
L. Ramakrishnan is a biologist by training. He is affiliated with the NGO SAATHII that works towards access to healthcare, legal and social services for marginalised populations, including those affected by the HIV/AIDS epidemic and LGBTQI communities.