Point of views DOI:__________________________________________________________________________________ http://doi.org/10.4038/joshhm.v3i0.63 The shifting landscape of Gender Identity and the situation in Sri Lanka Dr A.S. Malalagama, Consultant Psychiatrist, Base Hospital Warakapola, Sri Lanka Email: [email protected], https://orcid.org/0000-0002-5507-9815 DOI: Gender non conformity- a revolution and Pakistan intersex and transgender Gender binarism is entrenched in cultures of individuals are known as “hijra” and have Sri Lanka and most other Asian and Mediterranean countries. Gender non been identified as a third gender1,3. South conformity was not heard of, a generation Sulawesi, Indonesia, identifies five genders, ago. Even today, majority are unaware of including bissu, calalai’, and calabai’1. gender pluralism and non-conformity and use the words sex and gender interchangeably. Gender spectrum and transgenderism Gender identity is an individual’s perception and self-awareness of being male or female or Gender non-conforming individuals are a combination of male and female or neither identified under the umbrella term, gender male nor female. It is different from sex, queer, which includes agender, androgyny, sexual orientation or gender role. Gender gender fluid and pangender4. Transgender identity lies in a spectrum as any other refers to the broad spectrum of individuals biological parameter such as height or who transiently or persistently identify with a weight1. A recent survey of a thousand gender different from their sex assigned at millennials found that half of them think birth (American Psychiatric Association). gender is a spectrum. In the recent past, there Prevalence is 1 in 30 000 natal males and 1 in are an increasing number of reports on 100 000 natal females5 .The prevalence of youngsters questioning their gender identity. self-reported transgender identity in children, A person’s gender is the complex adolescents and adults is 0.5 to 1.3%6. interrelationship between three dimensions: Body (experience of our own body, how Transgenderism should not be confused with society interacts with and genders bodies), intersex, transvestism and fetishistic identity (our deeply held, internal sense of transvestism, three conditions in which a self as a male or a female) and expression person would assume a gender identity (how we present our gender and how society different to the expected. Intersex or perceive, interact with and shape our gender). hermaphrodites are born with both female Sexual identity: is in the perineum identified and male sexual characteristics due to by external genitalia determined biologically. hormonal defects such as Congenital adrenal Gender identity: is in the cerebrum identified hyperplasia. Fetishistic transvestism is the by intellectual faculties determined wearing of clothes of the opposite sex culturally2. principally to obtain sexual excitement7 . Dual- role transvestism/ cross dressing is the Gender non conformity existed throughout wearing of clothes of the opposite sex for history social and economic advantages or to enjoy the temporary experience of living in the Cultures with genders outside of a binary opposite sex7 . Hence, there are reasons other structure, or which identifies a third gender is than transgenderism for a person to assume a found on every continent of the world different gender identity. Sometimes it may throughout history1. Native Americans be difficult to differentiate between identified a third or fourth gender. In India transsexuals, hermaphrodites and Sri Lanka Journal of Sexual Health and HIV Medicine (Sri Lanka JoSHH), Volume 3, December 2017 45 Point of views __________________________________________________________________________________ transvestites. Buhrich and McConaghy (1977) identification documents, health care, described different stages representing a insurance and justice system13 . continuum from transvestism to transsexuality8 . Some of the transvestites In 2016, at least 22 deaths of transgender who start cross dressing before puberty are people in the US were due to fatal violence, presenting with gender dysphoria in later life the most ever recorded. Some of these cases and request for gender reassignment involved clear anti-transgender bias. In procedures reflecting the overlap between others, the victim’s transgender status may the above conditions9 . have put them at risk in other ways, such as forcing them into homelessness14. Gender dysphoria, previously known as Gender Identity Disorders is a strong and LGBT people are more than twice as likely as persistent cross gender identification and a Blacks or Jews and more than four times as persistent discomfort with their sex or likely as Muslims to be attacked in a violent sense of inappropriateness in the gender hate crime15. Transgender people are 7 times role of that sex10. Gender dysphoria is more likely to experience physical violence classified as mental disorders and are when interacting with the police compared to therefore included in the DSM-IV and ICD-107 . cisgenders16. Is gender dysphoria a mental illness? The prevalence of suicide attempts is 41% among transgenders, which is more than 20 This is a controversial issue. Gender dysphoria times the general population and is also was classified as a mental disorder along with higher than the 10-20% of lesbian, gay and other disorders of gender identity based on bisexual adults who report ever attempting historical theories surrounding its cause and suicide17. because psychiatrists traditionally managed transgender patients11. But this classification There is a strong association between gender has worsened the associated stigma. non-conformity and hate crime. As the definition of transphobia suggests, women LGBT activists have worked hard to declassify who are perceived as masculine and men who gender dysphoria from mental disorders. are perceived as feminine, thus not Denmark is the first country to be successful. conforming to normative standards of gender, A study by Robles et al raises the question are more likely to elicit an adverse reaction. about the validity of classifying gender This is backed by research suggesting that it is dysphoria as a mental disorder which perceived gender transgression that may be concluded that ‘’Distress and impairment at the root of both transphobic and which are considered essential characteristics homophobic hate crime18. of mental disorders, could be explained in the case of gender dysphoria by experiences of A survey by Human Rights watch in 4 districts social rejection and violence rather than being in Sri Lanka among transgender and inherent features of transgender identity’’12. homosexual people between October 2015 and January 2016 reported legal Discrimination against gender non discrimination towards this group, especially conforming people with regards to identification documents, health care and interaction with police19. Report of the National Transgender Discrimination Survey in 2011 showed that Even though there is no law specifically gender non-conforming people face criminalizing transgender or intersex people, discrimination in every sphere of life including the offense of “cheat*ing+ by personation” education, employment, family life, housing, under section 399 of the Penal Code has been used to target transgender persons for arrest, Sri Lanka Journal of Sexual Health and HIV Medicine (Sri Lanka JoSHH), Volume 3, December 2017 46 Point of views __________________________________________________________________________________ assuming that appearing in a gender identity Transgender people worldwide are much that is different from the sex assigned at birth more heavily involved in prostitution than the has the malicious intent of cheating others19. population at large, due to limited The National Identity Card (NIC), the main employment opportunities. Also, they engage identification document in Sri Lanka is issued in transactional sex in exchange for money for on the information based on birth certificate. sex reassignment surgeries. In the U.S in 2011, The sex assigned at birth stated in the NIC is 26% of transgender people had lost their jobs different to the identified gender in due to gender identity/expression and 11% transgendered, which leads to confusion had done sex work for income13. among misinformed government and private officials who request the NIC to provide Sexual health and risk for Sexually various services. Requests to change their Transmitted Infections (STIs) among name and gender in the NIC have been transgender population rejected by authorities depriving this group of basic human rights to apply for jobs, open Depression and anxiety, as well as illicit bank accounts and obtain a passport/ driving substance use to manage anticipatory anxiety licence and travel. related to transphobia, may contribute to high risk sexual behavior among transgender In the same report, male to female men22.Due to a power differential, transgender people have reported several transgender clients may not feel empowered incidents of sexual abuse by police and arrests to make decisions regarding drug use, 19. condom use, and high risk sexual behavior, making them vulnerable to traumatic sexual Demand for transgendered in the sex experiences and STI exposure22. industry Little research is done to understand risk for In Thailand and Philippines particularly HIV and other STIs among transgender men transsexuals have a platform to speak out who have sex with men