Gauri, a 27-year-old transwoman, left her village in Dharashiv district in 2019, to come to Pune in search of a job and start her gender transition. Today, she lives alone in Pune, where she works as a domestic worker in offices and homes. When times are dire, she resorts to begging to make ends meet.
For Gauri, life is shifting from bad to worse after the Mitr Clinic she used to visit in Pune’s Kasabpeth abruptly shut in February.
“I am extremely worried. I don’t know where I will get Gender Affirming Hormone Therapy, laser treatments or even HIV tests without being discriminated against,” she said. “People don’t treat us properly, let alone employ us. Availing treatment at private clinics or government hospitals is often impossible without facing harassment or humiliation.“
Gauri’s distress reflects the broader struggles of the transgender community in India, especially following the recent closure of Mitr Clinics after the US government decided in January to pause foreign aid for 90 days. These clinics began operations with funding from the United States Agency for International Development. They were launched in Hyderabad, Pune and Thane in 2021 and were the first of their kind – designed specifically to cater to the unique healthcare needs of transgender individuals.
However, these clinics were abruptly shuttered in the last week of February following US President Donald Trump’s freeze on foreign aid.
A former Mitr Clinic staffer, on condition of anonymity, said the clinics’ sudden closure has left a gaping hole in the community’s healthcare landscape. Being community-run clinics meant that the clinic teams went the extra mile to solve the problems of the clients.
“They depended on us for affordable care, for being treated with dignity and respect, and being accepted for who they were. Our clients trusted us with their lives, and we’re deeply concerned about the uncertainty and anxiety this has caused, particularly for those in the midst of ongoing treatment. As clinic team members, we’re still receiving daily calls from worried clients, and it’s heartbreaking to have no clear answer for them,” said the employee.
India’s three Mitr Clinics were primarily staffed by members of the transgender community. In addition to free HIV testing, prevention, and treatment services, the clinics provided gender-affirming care and laser hair-removal services at subsidised rates. These clinics also offered mental health support and counseling, while also helping transgender individuals access government social and welfare programmes.
These services also encouraged people to get tested and seek HIV care. Research suggests that transgender women are at high risk for HIV infection and face multiple barriers to HIV care. A recent study published in The Lancet also reveals that transwomen are 49 times more likely to have HIV when compared to the general population. Similarly, studies found that GAHT is said to reduce depression, anxiety and improve psychological functioning and quality of life among transgender people.
Newslaundry learned that HIV self-testing kits were available at the clinics and were preferred by the community because they provided privacy and confidentiality.
A former employee of the clinic said that between February 2021 and March 2023, the three clinics in Thane, Pune and Hyderabad registered over 4,000 clients, with an HIV burden of seven percent. Of the total registered clients, 2,007 individuals (78 percent) reported that they had never previously registered with any government or civil society HIV intervention.
More than half a dozen transpeople told this reporter that they depended on the Mitr Clinics, predominantly due to the community-led, welcoming, and stigma-free environment. They also said that while private doctors do their best to help them on a personal level, they too face limitations in providing support.
Rani Kawde, 35, started visiting the Mitr Clinic two years ago for hormone treatment. With its sudden shutdown, Kawade doesn’t know where to go to continue her treatment. “The doctors and staff at private clinics will never treat us with the same kindness and understanding we received at Mitr. The government should really consider starting alternatives to these clinics," said Kawade, a Shirdi native who has been living in Pune for the last 13 years.
Aarohi Dabhane, 26, a model, echoed the same concern. “It’s not just about the subsidised fees at Mitr clinics; it’s about the comfort we felt there. We didn’t have to think twice before going because the doctors and staff truly understood us. Now, it’s going to be really difficult. I have no idea where to go for treatment,” she said.
Ruhani Chavhan, 28, a Pimpri resident, said, “That clinic was a blessing for us. We received treatment at affordable rates, and they also offered counseling, which was really beneficial for our mental health. It was a one-stop centre that provided so much support. But now, we don’t know where to turn.”
“I first visited the Mitr Clinic in November 2022. Ever since, I’ve been receiving hormone therapy, which is very important for my transition. The treatment was affordable and the doctors and staff were kind, understanding and supportive, which made me feel comfortable. I was able to get HIV tests there several times without being treated badly,” said Gauri.
She added: “Even though people say things are getting better, the truth is that transgender people are still treated badly, and things aren’t really changing as much as they should.”
Santoshi Kadam, 52, a transwoman from Hadapsar, Pune, who works as a makeup artist, told Newslaundry, “It’s really important to feel comfortable and safe when receiving treatment. I’ve been going to the Mitr Clinic for the last four years and have been receiving hormone therapy there. They also helped with skin care. While non-HIV treatments weren’t exactly free, they were offered at very affordable rates.”
Siya, 23, a transwoman working as a sales manager at a real estate firm, says that on account of being well-educated and having a well-paying job, she can still afford the treatments at other clinics without facing much discrimination. “But many transpeople are unemployed and face constant discrimination. For them, the Mitr Clinic was a safe space where they could receive quality treatment at minimal costs without the fear of harassment or humiliation. With the clinic’s closure, they’ll be deprived of that care, and it’s going to have a serious impact on their health,” she said.
Gauri said she doesn’t know where she’ll now go for hormone treatment.
“If we turn to private clinics or even the government, the costs are high, and we will face discrimination,” she says. “The staff there often look at us differently – they treat us like a burden and often think we’re involved in prostitution. They think that having transgender patients will hurt the clinic’s reputation or make other patients uncomfortable.”
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