Abstract
Hijras are referred to as the third gender and a gender non-conforming group of people in South Asia which include transgender, transsexuals, transvestites, and intersex persons (Sartaj et al., 2020). In November 2013, the Government of Bangladesh implemented a policy decision to formally recognize the hijra, commonly identified in Bangladesh as neither man nor woman, as a third gender (Aziz & Azhar, 2019). More than 100,000 hijra people live in Bangladesh (Sifat, 2020a). They are deprived of basic human rights, such as access to primary health care services, housing facilities, food, and employment opportunities (Aziz & Azhar, 2019).
The first case of COVID-19 was reported in Bangladesh on 8 March (Biswas et al., 2020). Bangladesh has become the 24th worst-affected country globally, with 445,281 confirmed cases and 6,350 deaths of COVID-19 (Worldometer, 2020). As the COVID-19 pandemic rages on, it is clearer that there has been an enormous magnitude of devastation around the world (Sifat, 2020b). During the COVID-19 pandemic, mental disorders including anxiety, depressive disorders, discrimination, and suicide as well as domestic violence are increasing in Bangladesh (Sifat, 2020c). Hijras have been adversely impacted by the pandemic and particularly with the lockdown of the country. They have always faced social stigma, discrimination, isolation, and separation, and it appears that this has worsened. People still have a “bad perception” of the hijra community members. They are the among the most marginalized members of society who are suffering from the crisis of COVID-19 lockdown (Matin et al., 2020).
Hijra people are usually engaged in informal work by collecting money from shops, blessing a newly-wed couple or a newborn child in return for money, dancing and singing at functions, and some are engaged in sex work to survive. The impending lockdown, with no indication of receiving income at any time soon, led to a rise in their mental stress levels. Fears of economics and food shortages have put unnecessary stressors on a population still anxious and sensitized (Rashid et al., 2020). A recent survey related to the impact of lockdown on the hijra or third gender communities found that about 83% of respondents had not earned “a single penny in the last two weeks”, and 59% did not get any support from aid programs (Knight, 2020). Another research found that due to lockdown, most of the hijras were mentally anxious about money (94%) and food (68%). About 16 % of hijra respondents experienced mental abuse, but relatively few faced physical torture and violence (Matin et al., 2020).
People with psychiatric illnesses are less likely to undergo tests for medical comorbidity. Discrimination and stigma associated with mental illness can make it more difficult for individuals at risk to access health care at the right time (Lee et al., 2020). The multiple and intersecting discrimination and the consequent vulnerabilities experienced by hijras place them at a higher risk of mental health problems, anxiety, and depression. The severe economic and health effects and increased transphobia arising from the pandemic could make the situation worse. Unfortunately, the direct and indirect vulnerability of hijra people to COVID-19 threats can increase the risk of a mental health crisis. Reading more negative news during quarantine creates a negative effect on hijra people. Mental pressure increases health risk and triggers various illnesses and long-term psychological complications (Rashid et al., 2020).
During the lockdown, systematic discrimination has impacted access to primary health care for the hijra people. The medical infrastructure is still over-pressurized, with aspects such as testing and getting treatment for people belonging to the community proving challenging. Because the wards are separated into male-female binaries, there is no center for hijra community members. They are also unable to access medical health care due to discrimination, lack of legal identification documents, and patient rights violations in healthcare settings. Their fear of being stigmatized and ridiculed discourages them from accessing healthcare facilities, and this leaves them at increased risk of not being tested or treated for COVID-19. Also, healthcare providers’ discriminatory attitudes could hijra people from pursuing timely treatment and care for COVID-19, compounding their mental health risks (Akhter, 2020).
Bangladesh’s psychological reactions to the COVID-19 lockdown are likely worse among minority groups with regards to fear, anxiety, depression, and suicidal thoughts. There is a need for widespread education campaigns across the country, both to increase knowledge and belief about mental illness and to create change about mental health and to reduce discrimination against people who have a mental illness. The government should establish mental health cells in all the districts and sub-districts areas, especially for minority groups of people. The government, non-governmental organizations (NGOs), voluntary organizations, and youth-led projects should launch a free counseling service to help hijra people suffering from mental distress and anxiety. At the very least, both during the pandemic and at peace time, a basic safety net that includes access to primary care must be provided to the hijra community.
