India’s transgender law heightens HIV treatment barriers

Transgender women in Bihar state lost welfare payments after India amended its transgender rights laws, writes Jigyasa Mishra.

[Patna, India/SciDev.Net] When Ankita, a transgender woman living with HIV in India’s eastern state of Bihar, stopped receiving a monthly government welfare payment, she could no longer afford her regular hospital visits.

Ankita sings and begs at railway stations and bus stands in Patna for a living. Like other people living with HIV, she receives monthly handouts of 1,500 Indian rupees (around $16) as part of a Bihar state government scheme called Shatabdi AIDS Pirit Kalyan Yojana.

Missing these payments meant she couldn’t afford her regular visits to the Antiretroviral Therapy (ART) centre in Patna which costs her 500 rupees (US$5.2 )in bus and rickshaw fares.

“I barely make enough to afford my food and rent,” Ankita told SciDev.Net.

“Going to the ART centre is an added cost I can’t take care of.”

Indian transgender rights activists fear that the new Transgender Persons (Protection of Rights) Amendment Act, 2026, could make it even harder for people like Ankita to access welfare schemes and essential healthcare.

The Act removes the right of transgender people to self-identify, instead imposing a series of medical and bureaucratic checks for legal verification of their gender identity. It officially became law after receiving the president’s assent on 30 March.

“If treatment starts depending on medical certificates too, it will only make accessing HIV care harder for trans women like me.”

Angel, transgender HIV patient, Bihar state

Reshma, a Bihar-based trans activist told SciDev.Net: “Our new transgender bill is a huge problem, creating another barrier for a community that already faces widespread discrimination in healthcare.

“When legal recognition becomes more restrictive, transgender people are less likely to seek timely care, undermining HIV prevention, treatment adherence, and broader public health goals.”

Access barriers

For trans women in Bihar, the barriers to HIV care appear long before they reach an ART centre, according to local activists. Even though treatment is free, accessing it carries a cost, which many from the community cannot afford.

India’s transgender community already faces extreme social and economic marginalisation. A 2018 study commissioned by the National Human Rights Commission found that 96 per cent of India’s transgender population were denied jobs and ended up in low-paid, unsafe forms of employment, including begging and sex work.

All the transgender women SciDev.Net spoke to asked to withhold their surnames due to stigma and discrimination.

Angel, another trans woman from Bihar, based in Sitamarhi district, told SciDev.Net: “Many of us already struggle with Aadhaar [personal identification] cards, hospital records, and IDs not matching our gender.

“If treatment starts depending on medical certificates too, it will only make accessing HIV care harder for trans women like me.”

Angel said she had skipped her last two scheduled visits to the ART centre because she could not afford the cost of traveling there and was burdened with two months’ rent due to her guru.

In India, most of the young transwomen live as Chela with a senior transwoman whom they consider their guru (head). The heads often take a certain amount of income from their chelas’ income.

“I sing and beg on the toll roads and bus stops, here, in Sitamarhi and Darbhanga,” said Angel.

“I don’t earn enough to go to the ART centre, but I have to give some part of it to my guru. For people like me this 1,500 rupees would have been a blessing if it wasn’t stalled for the past two months.”

J. Javed, an HIV nodal officer and chief medical officer for Sitamarhi district, told SciDev.Net: “The payment is sometimes delayed by the state, and beneficiaries receive two months’ honorarium together instead of the regular monthly disbursement.”

However, Angel and Ankita have been unable to access the payment for four months.

Mental health toll

Health professionals say the situation has repercussions for transwomen’s mental as well as physical health.

Abhinav Pandey, a mental health specialist and doctor who runs a clinic in Lucknow district, said: “ART only works with adherence, and interruptions due to whatever reasons create resistance. In cases like this, most of the times, physical health and mental health are correlated, which is why several health departments have designated counsellors.”

He says that an HIV-positive person who lacks access to proper healthcare, medication, privacy, or emotional support can be more vulnerable to mental health conditions with anxiety, depression, trauma, isolation and even suicidal thoughts could be common symptoms.

He added: “The stress does not come only from the illness itself, but from the social realities surrounding it. And for trans individuals, these risks are often intensified. Many already face rejection from families, violence, unstable housing, unemployment, healthcare discrimination, and social exclusion.”

Implementation ‘failures’

On paper, India’s HIV policy contains protections for transgender people. The National AIDS Control Organisation (NACO) has also attempted to respond to the elevated prevalence rate of HIV among high-risk groups, including transgender people, by instituting targeted intervention programmes at a national level.

However, policy implementation failures are common, including identity documentation gaps, confidentiality breaches, lack of staff training and interrupted welfare support, says Reshma, who works with more than 2,500 trans women in Bihar state.

These failures are not confined to Bihar. In Uttar Pradesh’s Deoria district, Priya, a 27-year-old transgender sex worker living with HIV, says she stopped visiting the ART centre regularly after repeatedly being called by the name she had before she transitioned, even after submitting her new identity card with her new name on it.

She told SciDev.Net: “It’s humiliating. People around me stare when they see a woman next to them and hear a male name being announced for her.

“Being a trans person is a vulnerability in itself, and then being HIV positive brings a lost more discrimination.”

While the HIV medicines are free at the ART centre, she says: “every visit costs me my dignity”.

‘Embarrassed and excluded’

“Sometimes I delay treatment because I don’t have the strength to face the stares and whispers following my name announcement,” Priya added.

“I try to look and sound bold and confident, but mentally I feel embarrassed and excluded.”

The treatment that Ankita, Angel and Priya described is in direct contravention of the National HIV Counselling and Testing Guidelines, 2024, which state that “the principles of counselling include acceptance, individualisation, non-judgmental attitude, confidentiality, empathy, and self-awareness”.

Counsellors occupy an important role in the HIV response programme, according to the guidelines, developed by NACO. They are supposed to offer information, emotional support, and facilitate access to treatment.

Priya still remembers the day her frustration boiled over at the ART centre, resulting in a heated exchange with the counsellor. She said: “There are seven questions that a counsellor is supposed to ask to assess HIV risk.  But mine asked me nearly 20 questions, including why I chose a partner of a certain sex, whether it was more pleasurable than the other, and what all genders I had ‘tried’. That’s when I yelled at him and left the centre.”

After the incident, she stopped talking to counsellors at the ART centre. “I didn’t feel safe or heard,” she added.

‘Uphold dignity’

Activists warn that the new law amendment will reinforce these existing barriers.

“By narrowing the recognition of transgender identities, the recent amendment risks increasing stigma and psychological distress, creating additional barriers to healthcare and HIV treatment for transgender people,” said Reshma.

Venkatesan Chakrapani, chairperson of the Centre for Sexuality and Health Research and Policy, told SciDev.Net: “The solution for the already marginalised community can never be another layer of verification but removing the barriers that keep transgender people away from care.

“The government must remove bureaucratic barriers, uphold dignity in healthcare, and ensure that no transgender person has to choose between survival, identity and treatment.”

This reporting was supported by an independent journalism grant from the Thakur Foundation. The Foundation had no role in the reporting, editing, or editorial decisions related to this story.

This piece was produced by SciDev.Net’s Global desk.