Venkatesan Chakrapani, Priya Babu, Timothy Ebenezer

1. HIV-SEROPOSITIVE ARAVANIS/ALIS IN SEX WORK SUFFER TRIPLE DISCRIMINATION IN THE INDIAN HEALTH CARE SYSTEM Venkatesan Chakrapani, Priya Babu, Timothy Ebenezer Venkatesan C, et al III International Conference on AIDS. "AIDS India 2000", Chennai, Dec 2001

2. ISSUE • Aravanis/Alis/Hijras (male-to-female transgender/ transsexuals) have been in India for centuries. Through they are ‘tolerated’ by the Indian society they are not ‘accepted’ and are being discriminated in various ways. • An unknown number of Hijras/Alis involve in sex work since they are denied other job opportunities. But in reality, the public considers all Alis as sex workers. • Being an HIV-seropositive Ali further increases the discrimination, even from the health care providers. Venkatesan C, et al III International Conference on AIDS. "AIDS India 2000", Chennai, Dec 2001

3. DESCRIPTION The ordeal of three HIV-seropositive Aravanis/Alis who had urological problems are described in this presentation. Venkatesan C, et al III International Conference on AIDS. "AIDS India 2000", Chennai, Dec 2001

4. PATIENT-1 A known HIV-positive Ali (35 years) developed urethral stricture/stenosis following self-emasculation. Suprapubic cystotomy with Foley’s cathetherization was done in a Government hospital in Chennai. Even though she was eligible for urethroplasty she could not undergo that procedure because of her HIV status. She was thus forced to remain with Foley’s catheter for almost three years, changing the catheter by herself periodically. After much struggle and after providing materials like goggles and special boots through NGOs/CBOs, the urologists finally agreed to do urethroplasty. Venkatesan C, et al III International Conference on AIDS. "AIDS India 2000", Chennai, Dec 2001

5. PATIENT-2 A known HIV-positive Ali (19 years) developed urethral obstruction following emasculation by an unqualified person (‘quack’). Suprapubic cystotomy with Foley’s cathetherization was done in a governmental hospital in Chennai. She was not operated since the doctors wanted her to “get treatment for AIDS first and then come back” to them. After a few weeks, there was block in the Foley’s catheter. The doctors/nurses did not change the catheter but asked an HIV-positive volunteer who accompanied her to change the catheter and declined to do the necessary surgical procedure. Venkatesan C, et al III International Conference on AIDS. "AIDS India 2000", Chennai, Dec 2001

6. PATIENT-3 60-yr-old Ali of unknown HIV status (emasculated by ThaiAmma) got admitted in a govt. hospital. She had urethral stenosis that led to bilateral hydronephrosis (obstructive uropathy) and thus ultimately to chronic renal failure. No attempt was made in the medical ward to catheterize her since they did not know “hermaphrodite’s anatomy”. The first author (who is a physician) was asked by an Ali to come and see that patient. Using a paediatric Ryle’s tube urethral catheterization was done by the author. Two days later that patient died. Venkatesan C, et al III International Conference on AIDS. "AIDS India 2000", Chennai, Dec 2001

7. DISCUSSION • HIV status of the Ali (or any patient) alone should not prevent the health care providers from providing necessary medical or surgical management. • HIV/AIDS education and training on transgender/transsexual issues to the healthcare providers is a must to provide quality health care to the Ali community. • Anti-discrimination laws must be seriously considered. • Alternative job opportunities should be provided to those Alis. • The legal status of sex reassignment surgery should be clarified and should be done in Government hospitals so that quacks will not be approached by Alis for emasculation procedure. Venkatesan C, et al III International Conference on AIDS. "AIDS India 2000", Chennai, Dec 2001