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\begin{document}


\def\RunningAuthor{Sugyanta Priyadarshini and Sukanta Chandra Swain}
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\articleType{Original Article}
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\title{Impact of COVID-19 on the Socioeconomic life and Psychology of Transgenders: Insights from India\textbf{\space }}
\author{Sugyanta~Priyadarshini\textsuperscript{*}\textsuperscript{1}, 
            Sukanta~Chandra~Swain\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Research Scholar, Kalinga Institute of Industrial Technology, Deemed to be University, Bhubaneswar, Odisha, India }~\\{\textsuperscript{2}Kalinga Institute of Industrial Technology, Deemed to be University, Bhubaneswar, Odisha, India }}

\begin{abstract}
India's COVID-19 lockdown has left transgender people at heightened risk of hunger and poverty since most of them make their living on streets by begging, street entertainment, and paid sex. They are not socially privileged to operate within the online world as they are predominantly dependent on social interactions and functions such as weddings or baby showers. Ideology is endangering transgender people from coronavirus. Transgender people are a socially marginalized community who is forced into slums where social distancing is challenging, making it a hotbed for Coronavirus. Further, the absence of healthcare backup and lack of awareness increases the looming fear among the transgender community regarding the budding impact of COVID-19. A substantial rate of economic instability, as well as social discrimination, was visible before the pandemic, thereby worsening their situation with a lack of food, fund, insecurity, safety, and mental health concern during COVID-19. This study focuses on the impact of the Coronavirus crisis on the socioeconomic life of Transgender people taking into account the explosion in unemployment, adding to an already disproportionate healthcare support system pushing them further to the margins. The study comes forward with useful suggestions based on content analysis of published and aired information to reduce the existing woes of transgender people during COVID-19. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}COVID-19,\newline Transgender,\newline Psychology,\newline Mental Health,\newline Economic instability,\newline India
\end{keywords}
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\section{\textbf{Introduction}}
COVID-19, otherwise known as Coronavirus disease, which was recently discovered in December 2019, has now taken millions of lives globally. According to the WHO report, by May 9, 2020, 3, 759, 967 positive cases were verified, and 259,474 deaths were recorded worldwide resulting from the coronavirus pandemic \unskip~\citep{797162:19015798}. Following the data provided by the Indian Government, 56,342 confirmed cases were recorded, and approximately 1,886 people have lost their lives due to the complications related to COVID-19 \unskip~\citep{797162:19015798}. Social distancing helps to limit contact, thereby preventing the spread of infection. India ramps up efforts to contain nascent coronavirus epidemic by a complete lockdown. In order to curb the spread of coronavirus pandemic, all educational institutes, working spaces, commercial establishments, transportation services are shut down, and social, religious and political gathering is prohibited from March 24, 2020, in India \unskip~\citep{797162:19015794}. The pandemic is affecting the Indian economy adversely, thereby putting economic risk over the health of countrymen by checking the physical movement of masses during the pandemic. However, the war against the deadly invisible virus has opened a battlefront for the existence of millions of daily paid workers, especially the community of transgender people. India's COVID-19 lockdown has left transgender people at heightened risk of hunger and poverty. The transgender community is one segment of India's vast informal sector whose livelihood is entirely dependent on daily wages and gig jobs, including begging, street entertainment, and paid sex. The lost livelihood opportunities due to lockdown leave them vulnerable to unemployment and tragedy. The Finance Minister of India on March 26, 2020, extended a stimulus package of approximately 22 billion USD for specific vulnerable groups, including people below the poverty line, disabled, older and widowed persons, daily wage earners and farmers leaving out targeted community of transgender people \unskip~\citep{797162:19015801}. However, the Kerala state government has announced a relief kit (including temporary housing and food facilities) for 1000 registered transgender persons in its COVID-19 response strategy \unskip~\citep{797162:19015796}. Uttar Pradesh state governments have declared financial aid, including bulk rations, for the next six months. Even if the steps undertaken by Government are laudable, there is no mention of transgender people as beneficiaries in any of these propositions \unskip~\citep{797162:19015803}. On April 29, 2020, one transgender person died from COVID-19 in Indore\unskip~\citep{797162:19015789}. On May 3, 2020, Tamil Nadu reported a transgender person, the first in the state, affected by novel coronavirus infection \unskip~\citep{797162:19015802}.  

Ideology is endangering transgender people from coronavirus. Transgender people are considered as a blot on the prestige of the Indian patriarchal family. In due course, they get rejected by the families once they are identified. Ultimately, they end up in Hijrahood. The community of transgender is socially ostracized as it transgresses the general categories of the gender of 'male' and 'female,' thereby pushing them into begging or sex work. These are round the clock occupations and only source of income for them. 

Further, they are subjected to social exclusion, discrimination, lack of education facilities, medical facilities, and job opportunities. However, those who do not get into the culture of 'Hijrahood' and gain entry in mainstream jobs face another battle in itself in contemporary circumstances. While the whole world combats one on one against Covid-19, once again they lay ghettoed and ignored. According to census 2011, the total population of transgender is 4.88 Lakhs in India, and the majority of transgender people have enrolled themselves in begging and paid sex for their livelihood.  However, the lockdown has unsettled their lives and has ultimately halted their income by pushing them deeper into the crisis to make ends meet. The National Institute of Social Defense has provided Rs 1500 to around 4500 transgender people from different states, which is commendable but is no less than a drop in the ocean as they are a strength of 4.88 lakhs\unskip~\citep{797162:19015800}. Social isolation, lack of healthcare support system, discrimination, and absence of daily income has left the transgender community in India distressed amid the nationwide lockdown. The idea of social distancing and work from home has proved to be privileged. However, it has also rendered many people in transgender communities hungry and unable to sustain themselves. While social distancing protocols, travel restrictions, and curfews were practised to curtail the spread of coronavirus and to save lives \unskip~\citep{797162:19015799}, we are also witnessing several issues faced by the community of transgender people due to their lost livelihood opportunities. Approximately 2 million transgender people are estimated to be worst affected in India by the move taken by the government in the form of lockdown because most of them earn their livelihood on the streets \unskip~\citep{797162:19015793}.\textbf{\space }They are not socially privileged to operate within the online world as they are predominantly dependent on social interactions and functions\textbf{\space }such as weddings or baby showers. Henceforth, the restrictions on movement during the Covid-19 lockdown have multiplied the struggles and challenges faced by the transgender community. Panic-stricken transgender people confined to their home bunkers have remained penniless in this unprecedented lockdown.  
    
\section{\textbf{Discussion}}
Socioeconomic status measures the sociological and economic standing of an individual. It determines the socioeconomic position based on income, occupation, and health. The community of transgender people is susceptible to socioeconomic disadvantages. However, the outbreak of COVID-19 has exacerbated their socioeconomic issues. While the world is combating COVID-19 altogether, the community of transgender is fighting it all alone. However, as a result of decades of structural discrimination, social exclusion, and a jolt of violence, a majority of the transgender population is segregated from the mainstream, and they continue to depend on sex work, begging, and offering blessings in traditional rituals for their livelihood. However, after nationwide lockdown, their life has come to a grinding halt along with their daily income. Changes brought by COVID-19 in the lives and living of the transgender people have been discussed in this section.  

\textbf{Clogged Income Stream}

Since a majority of transgender people are solely reliant on dealing with public and community-oriented jobs, they are walloped in the times of pandemic. Like daily wage earners, the transgender people also earn on an everyday basis from their gig jobs. Due to the pandemic scenario, the hand to mouth transgender people are adversely affected and are left out to rely on their savings. A Pune-based transgender activist Sonali Dalvi voiced that, "Due to complete lockdown, the red light areas are closed, weddings and other forms of celebrations are cancelled or postponed, and shops are locked. The condition is very critical. I~hardly had any customers in the past ten days. If things last like this way, then certainly, I~will run out of cash and die out of hunger.'' Similarly, Sonam Nayak, a transgender person from Jaipur who is despondent with lockdown imposed by the government, stated that `We are running cashless and are in extreme need of monetary assistance. There is no financial aid from the government, and we do not know for how long we can sit and eat like this\unskip~\citep{797162:19015803}.

Amongst the community of transgender people, there are precisely two categories: those who have acquired prominent positions in the mainstream society or have earned money over the years and those who are within the age-group 18-25 years and are engaged in minimal jobs. However, it is observed that those who fall under the second category are in disarray as they are discarded by their parents and have migrated to the cities recently. Maya Urmi Aher, a transgender activist, stated that "In order to fulfil their daily needs during the lockdown, they borrow from multiple loaning sources. The money is usually not borrowed from banks rather from private money lenders as they do not have proper documentation or identity proof to open a bank account. Moreover, there is a constant suspicion among transgender people on the safety of their money in the bank accounts, owing to a general lack of education. Hence, they depend on private money lenders who charge higher interests, and they remain debt trapped. Further, in this context, Urmi Jadav stated that "There is a discussion on aid for labourers and underprivileged, but no one is talking about the difficulties faced by the transgender community during a lockdown? Is this community invisible to the authority? \unskip~\citep{797162:19015788}. However, during this dismal situation of the pandemic, the government needs to pay heed to its community of transgender people because this community is never given its due with dedicated policies that are specifically meant for them. 

\textbf{Deprived of a Square Meal Daily} \textbf{\space }

Transgender people face food insecurity in the wake of COVID-19. The section of transgender is particularly affected in coronavirus crisis because transgenderism under poverty is a persistent reality playing out in everyday life. Before pandemic, transgender people faced heightened barriers to food security due to longstanding issues ranging from social ostracization to lack of employment opportunities to wage gap. However, after the outbreak of COVID-19 in nationwide lockdown, transgender people are at heightened risk of hunger and poverty since most of them make their living on streets by begging, street entertainment, and paid sex. Grace, a Chennai-based transgender person, stated that ``Non-transgenders have the opportunity to go back home and depend on their family members when they are penniless. However, most of us are deprived of families, so we stay together. If the Government is providing 10kg rice for a family of 4-5 members, what will it do for a cluster of 25 transgender people living together? \unskip~\citep{797162:19015797}.

It is a matter of woe that the Indian government is very less concerned about food insecurity among transgender people. Many states of India have yet not taken any step inclusive of transgender people in their proposals related to financial aid, food distribution, and welfare schemes. This is because the states lack records of the actual population of transgender people in their official database. Since most of the transgender people have left their parental homes at an early age, they do not have their education degrees or date-of-birth proofs which are the essential documents to get an Aadhaar Card. Further, many of them are yet to receive their Transgender cards or residential proofs, which makes it difficult for them to receive Ration cards \unskip~\citep{797162:19015803}. Without having the Aadhaar Card or Ration Card, as such, transgender people are deprived of getting the benefits meant for the downtrodden. It has been substantiated by one of the transgender people interviewed. While interviewing a transgender Rudrani Chetri, she narrated, ``Most of the people in my community lack government id proofs like Aadhaar, DL, Passport, PAN, Ration, Voter ID cards and are ultimately excluded from food security schemes of Central or State government. Prime Minister Narendra Modi is extending the lockdown, and the day is not so far when we have to sleep empty stomach. By the time we get our documents in order and submit them to avail of the benefits, it will be way too late. The supply will only reach us when we become corpses \unskip~\citep{797162:19015792}. However, in this quarantine, the primary source of distress for the Transgender community is the lack of food. Therefore, if the government considers transgender people as poor people and categorize them under below poverty line and other welfare schemes, then they can fare better.  

\textbf{Psychological Disorder owing to Hostile Homes} \textbf{\space }

Transgender people living with hostile families undergo stress and trauma in the current lockdown, particularly those who have gone through Sex Reassignment Surgery lately. Dan Rebello is a transgender person who is experiencing hostility in the home during the lockdown. He works as a teacher in Thane. Dan has stopped talking to his parents as his parents have started commenting on his physical appearance and are thinking of getting him married. He is afraid that the verbal hostility may turn into physical abuse in a short period. Dan, suffering from anxiety issues, therefore, decided not to come outside his room in order to stay away from hostility \unskip~\citep{797162:19015788}. \textbf{\space }

Transgender communities every so often suffer from discrimination in gaining access to housing, which forces them into slums where social isolation is impossible, and the threat of\textbf{\space }coronavirus infection is absolute. Urmi Jadhav, a Mumbai-based transgender activist, stated that ``the impact of social ostracization has exacerbated during this pandemic situation. The risk of spreading infection among transgender people will increase because of their living conditions. Most of the transgender people stay in a close group in cramped spaces. The rooms are small and dingy, with no proper ventilation. They cannot afford air coolers or air conditioners during this summer. Most of them do not have smartphones and are cut off from the outside world. These circumstances bring in depression and frustration among transgender people making their lives go down the spiral. \unskip~\citep{797162:19015793}.  

Further, the risk of getting infected by coronavirus is high in transgender people as most of them are into substance use and are thus at high risk of contracting HIV \unskip~\citep{797162:19015792}. This led to the housing complexes asking transgender to evacuate their rented accommodation. Facing intensified social stigma and transphobia in hours of the pandemic, few transgender people have urged the Ministry of Finance, Home Affairs, and Social Justice \& Empowerment (MoSJE) for immediate assistance \unskip~\citep{797162:19015789}.  

\textbf{Unusual Mental Health due to uncertainty amid COVID-19} \textbf{\space }

The hospital system across the country has postponed non-emergency surgeries and procedures to prioritize care for COVID-19 patients. Gender affirming medical and surgical care is essential for transgender people but is currently considered as one of the non-emergency surgeries, thereby keeping them on hold. However, postponement of these essential but non-emergency surgeries has taken a dangerous mental toll in transgender patients who have either undergone the preliminary stages of the surgical care or for those who are on the verge of the medical care. This postponement may bring anxiety, depression, traumatic stress, and anger in them. For instance, Sasha, a freelancer transgender writer who lives with her family in Bangalore, is on the verge of transition since September 2019 through hormone therapy. However, she is unable to meet her doctor due to lockdown, who is 20km away. She is unable to recognize the changes in her body due to the therapy and is afraid of the consequences of being overdosed.  Being a victim of depression and anxiety, Sasha is unable to spend an entire day with her family. Simran Arora, a renowned transgender consultant in National Backward Classes Finance and Development Corporation (NBCFDC) under the Ministry of Social Justice and Empowerment, stated that amid lockdown, transgender is facing emotional issues resulting from financial distress. They are exposed to intense depression and anxiety issues due to increased social isolation, job loss, and financial stress. In this context, Pam, a New-Delhi based transgender make-up artist, is facing anxiety issues due to the uncertainty of her job after the lockdown. Out of her meager income, she was planning for a complete transition into a woman which she considers impossible now. The anxiety is bringing forth a panic attack, which is life-threatening \unskip~\citep{797162:19015795}. Amid this lockdown, the transgender community\textbf{\space }is\textbf{\space }battling depression, anxiety, panic attacks, trauma, and stigma along with the lack of access to hormonal therapies, medicines, foodstuff, and money, which are the need of the hour. \textbf{\space }

\textbf{Stigma and HIV Leading to Distress} \textbf{\space }

Transphobic posters were found stuck on Ameerpet Metro stations, Raj Bhavan Road and Banjara Hills Road at Hyderabad, which reads, ``Talking to a transgender person will give you coronavirus.'' This brings in to light the existing social stigma against transgender people in India. The fear of stigmatization in the hands of healthcare professionals discourages transgender people from accessing healthcare amenities, which push them away from reporting the symptoms for Covid-19. Aher, a transgender respondent voiced that, "There is an absolute stigma in the healthcare system. There are no specified beds for transgender people; they are either put into a male or female ward. Even if they face the symptoms of COVID-19, they prefer remaining silent since they know they have nowhere to go \unskip~\citep{797162:19015788}. Due to a lack of awareness and healthcare support system, there is a growing fear in the middle of the transgender community regarding the vulnerability of COVID-19 on HIV positive transgender people. According to UN AIDS estimate, about 68\% of transgender people diagnosed HIV positive are aware about their status, thereby being more susceptible to anxiety and trauma. The living conditions and nature of work of transgender people expose them to HIV. The HIV positive transgender people need ART (antiretroviral therapy) medication every month, but healthcare professionals are unavailable to address their concern. Shonali, an HIV positive Kolkata based sex worker, stated that, "her next health checkup has been postponed indefinitely. If things continue this way, she will die." Kalki Subramanian, an activist from Sahodari Foundation, which helps trans women narrated that, ``ART (antiretroviral therapy) medication should remain uninterrupted, but the unavailability of doctors makes the HIV positive transgender population vulnerable to COVID-19 \unskip~\citep{797162:19015795}. \textbf{\space }

\textbf{Enlarged Discrimination in Health-Care Facilities} \textbf{\space }

The right to necessary healthcare facilities is a fundamental human right, which is over and over again denied to the community of transgender people. In the course of the COVID-19 pandemic\textbf{, }the consequences of denying the fundamental healthcare rights by healthcare professionals towards transgender are far-reaching. Societal stigma resulting in discrimination leads to the systematic exclusion of the transgender community from the healthcare sector. According to the National Centre for Transgender Equality (NCTE), the compromised immune system of transgender people is at a higher risk of coronavirus infection \unskip~\citep{797162:19015803}. Lack of job opportunities and social exclusion push them into acute poverty, thereby depending on sex work and begging for their bread and butter \unskip~\citep{797162:19015790}. Consequently, the nature of their work makes them vulnerable to coronavirus infection. Further, the visible discrimination in the provision of healthcare entitlements places transgender children as well as older transgender persons at a higher risk of COVID-19 \unskip~\citep{797162:19015791}. Seema, a West Bengal based transgender, expressed her concern over COVID-19 quarantine isolation wards saying, "If transgender people get infected by a coronavirus, then they will either be quarantined at female or male ward making against their choice of gender identity. This will further outrage the transgender patient suffering from COVID-19. \unskip~\citep{797162:19015790} Similarly, Rakhal, a transgender respondent pointed out that ``The transgender person fighting with coronavirus undergoes not only physical and emotional trauma but also endures dirty looks and sarcastic comments from healthcare providers and fellow patients in the ward. \unskip~\citep{797162:19015790} These statements illustrate that patients suffering from COVID-19 may encounter rigid discrimination and prejudice because of their gender identity, which will expose them to hatred and harassment. The history of transgender discrimination in the healthcare system prohibits them from reporting the symptoms of coronavirus infection, thereby increasing the pace of spreading of the infection. Despite the attempts undertaken by the Indian government and international human rights law, the community of transgender people is exposed to discrimination in healthcare services \unskip~\citep{797162:19015800}. The right to healthcare for the transgender community is either not valued or not protected. During the current nationwide lockdown, the Indian government has shutdown public places to curtail the spread of COVID-19, which renders a majority of transgender people running out of cash, thereby increasing the fatality rate in the transgender community. It is sad to note that, while the whole world is combatting the COVID-19 outbreak\textbf{, }the community of transgender is struggling through eras of social elimination and layers of discrimination, which has been enforced on them because of their unique gender identity. \textbf{\space }

\textbf{Tips for Policy Prescription}

The government must incorporate disputes of the section of transgender people in their policies and schemes for disaster vindication given the COVID-19 outbreak. Owing to the prejudices that the community of transgender have handled since centuries and keeping an eye on heightened vulnerability during the COVID-19 lockdown, specific measures should be taken by Government of India in favour of the community of transgender people,

\textbf{Ensuring Food Security}

Documentation must not be a ground for denying ration to the transgender community. Further, the community of transgender must be provided with free ration to tide over the lockdown. The State coordinators of transgender cell functioning under the social justice department need to gear up by instructing all districts to distribute free rations among transgender people. Vehicles must be made available at the district level to distribute foodstuffs in remote areas of every state. The community of transgender must be included under the purview of all policies, actions, and financial aid declared by the Finance Minister of India on March 26, 2020.

\textbf{The Endowment of Financial Aid}

A majority of transgender people have lost their livelihood due to nationwide lockdown during COVID-19. The income of hand to mouth transgender people have dwindled to zero making it difficult for their survival. The government should ensure cash transfer in favour of this community, irrespective of identity documentation. Indian government should direct nationalized banks to enable the registration of transgender members in every state to channelize the cash transfers.

\textbf{Access to Health-care Services}

HIV positive transgender patients need Antiretroviral Therapy (ART) monthly. It should be considered an essential and emergency process that should not be neglected during the COVID-19 pandemic. Although ART drugs are used for the treatment of COVID 19, the administration should guarantee sufficient provision of the drugs for HIV positive transgender patients. Continuous supply of all vital medication to transgender persons comprising ART medicines, tuberculosis care and treatment, hormone therapy, and other gender-affirming procedures should be ensured. Healthcare professionals should ensure that the transgender individuals showing the symptoms of coronavirus infection should not be harassed and denied treatment at hospitals. Further, police should strictly monitor that no transgender person should be harassed while travelling to collect their medication.

\textbf{Ensuring Shelter Security}

It is recommended that the Government should ensure that the house owner cannot force a transgender person to evacuate their rental flat due to their failure in paying rent. Additionally, the government should notify all property-owners for the suspension of rent payment for at least three months. Transgender residing in slums should be provided with food, water, and sanitation facilities at their doorstep to curtail their physical movement. 

\textbf{Making Sanitation Essentials Accessible}

In order to prevent the spread of coronavirus infection, the proper sanitary facility is a requirement. Most transgender people stay in crowded slums with limited or no access to water and toilet facility. The unhygienic and unhealthy lifestyle in slum exposes them to coronavirus infection. Further, their financial instability due to lockdown does not permit them to buy soaps, sanitizers, and masks. The government must take initiatives in providing the aforementioned items free of cost through Anganwadi centres and other NGOs.

\textbf{Access to Documentation}

Access to documentation is one of the critical problems faced by the community of transgender people. However, it should not act as a limitation to access the welfare services extended by the government. Examining the records on case-by-case, a new set of documents may be made available favouring the interest of the transgender community \unskip~\citep{797162:19015787}.

Every state has primary responsibility as well as the capacity to safeguard the rights of the community across the country, especially in times of such a grave medico-health pandemic. 
    
\section{\textbf{Conclusions}}
The transgender community is one segment of India's vast informal sector whose livelihood is entirely dependent on daily wages and gig jobs, including begging, street entertainment, and paid sex. Since a majority of transgender people are daily-earners, social distancing, the only way to get rid of the claws of the virus, has struck them. Consequently, lost livelihood opportunities during COVID-19 lockdown leave them vulnerable to unemployment and tragedy. Lack of essential documentation, including Aadhaar, ration card, voter ID, or bank account does not certify them to come under the coverage of government welfare schemes as well as social security schemes such as the provision of rations and pensions which makes it unbearable to endure in these tough times of lockdown. Consequently, a prolonged situation of today's type may be proved to be a silent killer by worsening the socioeconomic status and psychological state of the transgender people. Since they have been slowly gaining their legal and social identity, they are not to be left with their luck during the current pandemic situation so that whatsoever identity they have established will be in vain. 

Moreover, there should be precise policy prescriptions for the interest of the said community so that they will be more than the daily earners. It must be ensured that, in days to come, transgender people are educated enough in order to be eligible for a befitted job so that they can work from home during quarantine and do not depend on menial jobs for their livelihood. Formal education and skill development need to be channelized among transgender people such that their survival does not get endangered in a nation-wide lockdown. For the purpose, there should be awareness among the cisgender community regarding the legitimate existence of the transgender so that the latter will not drop-out from Schools/Colleges owing to humiliation by the peers and teachers. Besides, parents of transgender people must be sensitized about the rights and emotions of their trans-children. 
    
\section{\textbf{Acknowledgement}}
The authors are grateful towards the transgender respondents who expressed their deep down emotions that greatly assisted the research work. Additionally, authors extend gratitude towards KIIT University for providing a healthy environment for conducting the research. 

\textbf{Declaration for Funding and Conflict of interests}

This Paper is independent of any funding organization. No assistance has been given by any funding agency/organization for conducting this research. There is no conflict of interest. 
    

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