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1. Content Hijra culture Aims and objectives of research Methodology Results Limitations Recommendations 2.

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Presentation on theme: "1. Content Hijra culture Aims and objectives of research Methodology Results Limitations Recommendations 2."— Presentation transcript:

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2 Content Hijra culture Aims and objectives of research Methodology Results Limitations Recommendations 2

3 Hijra Culture Hijra is: “the name given to a full- time female impersonator who is a member of a traditional social organisation…of hijras, who worship the goddess Bahuchara Mata. Hijras may be eunuchs with partial surgical sex reassignment; their sexuoerotic role is as women with men” (Nanda 1999, p. 169) 3

4 Hijra Culture Subcontinent – Bangladesh, India, Pakistan, Nepal and Sri Lanka Estimated hijra population – 5,000 in Dhaka Hierarchy of hijra community – Gurus and Chelas Source of Income – Badhai – Blessing of fertility for newborns and newlyweds – Cholla Manga – Collecting/Begging money from markets – Commercial sex work (CSW) 4

5 Hijra Culture Rejected from: Family – Lack of social support – Mental health School – Lack of education Society – Health services – Within hijra society Religion Constitution 5

6 Aims and Objectives To understand where the hijra access treatment or advice on health issues whether through a recognised medical practitioner, a non-medical practitioner or other routes of access. To investigate reasons why the hijra choose one health provider as opposed to another. To explore if health organisations provide services to the hijra population. To explore any health needs in this community which are not being met at present. 6

7 Methodology Heterogeneity sampling – Age distribution – Geographical distribution – Level of income – Castration status – HIV status – Which hijra community they associated with – Type of employment 7

8 Methodology In-depth interviews (10) Key informant interviews (5) – Service Providers Focus group discussions (2) – Ghunguri community 1 group of 5 gurus Participants had undergone castration or urethral reconstruction – Shyambazari community 1 group of 5 chelas Participants had not undergone castration or urethral reconstruction 8

9 Methodology Access – Hijra guide – ICDDR,B Ethics – TCD and ICDDR,B – Consent forms and services information Pilot test Conventional Content Analysis – Hsieh and Shannon (2005) and Ezzy (2002) 9

10 Results Provision of Services NGO Clinics (Badhan Hijra Sangha and Shustha Jibon) – Funded by FHI and USAID – Services provided STI (sexually transmitted infection) checks and related medication Counselling Free condoms and lubricant HIV Voluntary Counselling and Treatment Free prescriptions for general health problems Somewhere to rest TB testing 10

11 Provision of Services – No hepatitis testing or treatment – Not comprehensive “The Badhan NGO provides free medicine only for STIs. Aside from these diseases, we suffer from…psychological problems, addiction etc. that are totally ignored…it is necessary to establish a modern mental health unit” – Community Politics * 11

12 Community Politics “They only invite us for the World AIDS Day rally. They charged 150-200 Taka donation for that rally” “We have to do something to stop the corruption in Badhan and Shustha Jibon” 12

13 Provision of Services Drug Sellers (not pharmacists) – “free prescription but medicine has to be bought from here” Traditional healers Medical doctor – Difference in communities Cutter / dai ma (midwife) Rome American Hospital – Urethral reconstructive surgery (500) – Vaginoplasty (0) – Breast enhancement (0) – Hormone therapy (not recommended) 13

14 Barriers - Financial Extra prescriptions for STIs Different experience between communities – “Local private medical doctor usually give me a discount. I always pay 50% bill” RAH – Local hijra tax – Financing options available “50% today, 50% later” 14

15 Barriers - Accessibility Distance – Convenience and cost Availability – One day a week – 12-14 patients – Identify as male or men who have sex with men. Urban V’s Rural – “If anyone exposes her hijra identity there, it would be hard for her to live and access medical services” – Travel to India 15

16 Barriers- Discrimination Doctors at NGOS were “very much sensitised” Private clinics and hospitals – “They neglect us, regarding us as sex workers. Sometimes the doctors behave as if we are creatures of a different planet…In Government hospitals we need to stand in a queue to see a doctor and there we have to face a dilemma; whether we should stand in the gent’s or ladies line, or both of them sometimes do not allow us enter their line” Disclosure of being CSW Lack of training 16

17 Transitioning – Hormone Usage Contraceptive Pill – Mayabori and Shukhi Guru Hijra friend Drug seller NGO – not promoted now – Side effects Kidney/liver damage (6) Headaches (4) Breasts development not guaranteed (1) No knowledge (4) No answer (2) 17

18 Transitioning – Hormone Usage Steroids – Only two participants Decartion Fyrectin Oradexon – Cow steroid, illegal – More beautiful = more sex clients – Side effects mentioned Spots Loss of physical fitness Gained weight 18

19 Transitioning – Castration Ritual – Non-medical, member of hijra community – Bahuchara Mata Goddess – 40 days of rest Side Effects – Pain – Urethral problem – Bleeding – Infection – Death Legality 19

20 Transitioning – Urethral Reconstruction at RAH Early days: – Carried out at night – No STI/HIV tests pre procedure – No mental health check Today: – Local hijra approve of procedure – STI/HIV tests are carried out – No mental health check Some urethral problems – Advised to stay 3-4 days, most leave early Legality 20

21 Transitioning – Vaginoplasty and Breast Enhancement at RAH Neither performed to date Expensive procedures Some interested Concerns – Expected ability to give birth – Hygiene “Everybody would like to have sex with her. So it would be necessary to wash that everyday otherwise she would get some infection” 21

22 Limitations Feud between hijra communities – Time – Skewed answers No financial assistance – Translators – Cutter/dai ma – Dhaka district Location of FGDs 22

23 Recommendations – Future Research Why hijra do not avail of certain services – HIV VCT and counselling – Vaginoplasty This research did not cover in depth – Dental health – Mental health – Addiction services Difference between communities Neutral venue for FGDs and IDIs 23

24 Recommendations – Implementation One-stop shop – Trialled in New York (Melendez and Pinto 2009) – Improve distribution of information mental health facilities, HIV VCT services and transitioning services – Provide Hepatitis service – Difference of opinions Further health promotion with community Medical Universities curriculum 24

25 Recommendations – Implementation Financing system – General health – Transitioning services Discussion with hijra near RAH Audit by donors – Community Politics Future projects – Rolling Continuation Channel Program 25

26 Conclusions Increased knowledge – First of its kind in Bangladesh Highlighted gaps and barriers in healthcare provision Use of findings by other subcontinent countries Global, human rights issue 26

27 Acknowledgements Participants Centre for Global Health, Trinity College Dublin, Ireland – Eilish McAuliffe (BSc, MSc, MBA) – Susan Bradley (BSc, PGCE, MSc) International Centre for Diarrhoeal Disease Research, Bangladesh – Dr. Sharful Islam Khan (PhD, MD, BSc) – Md. Nazmul Alam (BSc) Hijra Guide and Translators – Kanok Bala – Md. Rashid Mamun – Md. Jishan Talukder 27

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