Content Warning: Violence towards transgender women

This week’s column looks at a paper called Mental Health and Challenges of Transgender Women: A Qualitative Study in Brazil and India (Gomes de Jesus, J., Belden, C. M., Huynh, H. V., Malta, M., LeGrand, S., Kaza, V. G. K., & Whetten, K. (2020). International Journal of Transgender Health, 21(4), 418-430.

There is extreme variability between how people of different countries across the globe feel about transgender individuals. When people from 23 different countries were asked about their beliefs regarding transgender rights the countries found to be most accepting were Spain, Sweden, and Argentina. Among the less accepting countries were South Korea, Hungry, and Russia. Notably India, the United States, and Brazil scored in the middle. While this data is from 2016 keep in mind that it is the result of centuries long global cultural shifts. Specifically, it cannot be forgotten the forced influence of European colonialism on indigenous and native cultures regarding sex and gender.

The authors of our next TPATH article spotlight do not shy away from this important historical context. They conducted a study to learn about the mental health challenges among transgender women in Brazil and  . In their introduction they discuss how both of these countries historically had a more welcoming atmosphere towards, and distinct role for, gender diverse individuals. In Brazil gender diverse individuals frequently held important social roles and were seen as blessings. In India there are both transgender individuals and ‘hijras’, who are culturally distinct from the larger umbrella term of ‘transgender.’ Specifically these individuals seek initiation into the community. Historically Hijras were revered, gave blessings, and were invited to give blessings at important events.  In both countries European colonization drastically altered the way transgender individuals were perceived leading to decreased rights, prejudice, and discrimination. The authors of this study aimed to understand the mental health and perspective of transgender women in regions of these two countries.

To do this they collaborated with community leaders from Hyderabad, India and Rio de Janeiro, Brazil to find a group of transgender women to participate in the study. All participants from Hyderabad identified as Hijra and those from Rio identified as transgender women or  . In total there were 35 participants, 12 from Brazil and 23 from India. Data was collected via surveys and focus groups.

The surveys conducted asked participants about three categories of experiences; stigma and discrimination, violence, and suicidality. Survey data revealed that 100% of the participants reported incidences of being ‘made fun of’ or insulted because they are transgender. Over half of participants from Hyderabad and Rio reported poor treatment in healthcare and people acting as if they cannot be trusted Regarding violence 96% of the women from Hyderabad experienced intimate partner violence compared to 16.7% of the women from Rio. One quarter of the women from Rio and nearly two-thirds of the women from Hyderabad experienced physical or verbal threats for sex. Lastly over half of the participants from both locations disclosed they had thought seriously about suicide.

The survey data collected in this study is important, however on its own it is one dimensional. On one hand it is an empirical exploration of an overlooked population – transgender women from non-western/European countries. On the other hand it reports what is already well known and espoused by many within the transgender community. That experiences of discrimination, prejudice, violence, and abuse toward transgender women are frequent and rampant. Luckily these authors followed up on the survey data with focus groups to further understand these women’s’ experiences.

Authors of this study included multiple quotations from the participants. The quotes selected for final inclusion in the article were chosen because authors felt they most illustrated the major research findings. Regarding stigma and discrimination the women from Hyderabad described in multiple quotes being cast away and abused by their family. One Brazilian participant stated ‘All ‘trasvesti’ that you will interview have the same story. We are all kicked out of our family, or we just ran away after years of violence… My family is my sisters [others in the trasvesti community]… I even wanted to kill myself. They were there for me when I needed them most…”. There are many other quotes included in this study that illustrate specific examples of discrimination, violence, and suicidality, however the above quote encapsulates an important point about the importance of community.

In many ways this study is very well done. With the abundance of direct quotes from the focus groups alongside the survey data readers can gain a deeper understanding of these women’s experiences. The authors did make some comparisons between the women from different regions however with such a small sample size the utility of these comparisons is questionable. They discussed how prevalent intimate partner violence (IPV) was for the women from Hyderabad but also mention systemic reviews finding high rates of IPV among cisgender women as well. In their discussion, the authors of this study placed their findings into the context of the political policies occurring in these countries and even intentionally outlined how policies can and should be adjusted to protect these communities from harm. For instance, when discussing lethal violence against transgender individuals in Brazil they mentioned the 2019 ruling of the Brazilian Supreme Court criminalizing acts of hate or discrimination towards transgender individuals.

Another positive aspect about this study was that it focused on the most marginalized subgroup within the trans community – indigenous trans women and trans women of  . However, there were aspects of this study as a whole that gave me pause. The title highlights that this article will be about ‘mental health’ struggles and the background discusses the field’s lack of knowledge about ‘coping strategies’ among this population. However, the majority of the article focused on experiences with violence and discrimination leaving only a small portion to discuss suicidality. Additionally, on its own suicidality is a very small part of mental health. Luckily, they did ask about the likelihood of following up for a mental health problem. To this 40% of the women from Rio answered they were likely to follow up while only 4% of the women from Hyderabad felt they would likely follow up.  Much value could have been added to this study if more pertinent and nuanced questions about mental health and suicide had been prioritized. Additionally with the studies’ current framing, it is easy to view India and Brazil as monolithic in their policies regarding and treatment of trans women. However, there are important regional differences. For example in  , India (and other states like Delhi, West Bengal, Rajasthan etc.) government supported shelters for trans women were opened this past summer.

Overall, this article is a decent example of what all researchers in transgender health should do. This includes working with local community organizations, acknowledging intersectionality and cultural context, and making clear and relevant policy recommendations. Including these practices when conducting research about transgender individuals is incredibly important but not always common practice. Beyond that researcher need to start asking themselves not only what does their study add to the body of knowledge about transgender individuals but how will it help them and improve their lives. While important to highlight these experiences if researchers solely present their descriptive data without community informed, solution-oriented recommendations the work can bridge on exploitation.

You can follow Nat Mulkey @
This article was reviewed by Amrita Sarkar, Advisor: India HIV/AIDS Alliance


  1. Feder, J.L., King B., Singer-Vine J., This is How 23 Countries Feel about Transgender Rights. Buzzfeed News. December 2016
  2. A. Transgender people have always existed. ACLU. June 2016.
  3. Mohan M. Le Poidevin O. Pre-colonial communities’ history of gender fluidity. BBC. July 2020.
  4. Gomes de Jesus, J., Belden, C. M., Huynh, H. V., Malta, M., LeGrand, S., Kaza, V. G. K., & Whetten, K. (2020). Mental health and challenges of transgender women: A qualitative study in Brazil and India. International Journal of Transgender Health, 21(4), 418-430.
  5. Laxmi T, Guari S. Payal K. et. Al. Transgender – Hijra Strategy. NACP IV working groups, version 1.o. May 2021.
  6. Rumi F. Bihar’s first transgender shelter home set up in Patna. The times of India. June 2021.
  7. Arora S. Gol to set up Garima Grihas for trans-gender persons to provide safe shelter. Current Affairs Adda. July 2021.

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