Overview of Quality of Life of Older Lesbians and Trans Women in India

REGULAR ARTICLE

A. Mani

International Rough Set Society 9/1B, Jatin Bagchi Road, Kolkata-700029, India Email: [email protected] Web: http://www.logicamani.in

ARTICLE HISTORY

Compiled August 3, 2019

ABSTRACT It is well-known that lesbians, trans and queer women face considerable discrimination, exclusion, stigmatization, and abuse in India. That is over and above the misogyny and discrimination faced by women in the patriarchal country. LGBTQIA people were also criminalized by law till recently. In spite of all the oppression and discrimination, lesbians and trans women have always existed in the country. A number of small sample studies with limited focus have been conducted by academic bodies, NGOs, and few state transgender boards over the past few years. Some of these studies provide direct or indirect insight into the quality of life of older trans women and lesbians (QOLO). In this research, these studies are reviewed in detail from a QOLO perspective, and a number of critical conclusions are arrived at by the present author. Further, an enhanced version of QOL (and QOLO) for lesbians is also proposed by her. It is hoped that this research would be useful for motivating interdisciplinary work in a relatively neglected area.

KEYWORDS Lesbians, Trans Women, Indigenous Cultural Identities, Discrimination, Stigmatization, Aging, WHOQOL, Quality Of Life, India

1. Introduction

Beyond the genderism, transphobia, opposition to inclusive sex education, and stigmatization of same-sex relationships perpetrated by patriarchy, the Indian legal system has had followed colonial era laws on homosexuality, adultery, and gender discrimination till recently. Legal recognition of trans identities was ensured through the NALSA judgment in the year 2014 (see Mani (2014b), Orinam (2014)) and homosexuality was decriminalized as recently as in 2018. Apart from recognizing the right to self identify one’s gender, the judgment also called for a number of measures for ending the discrimination and social isolation of gender diverse people. It may be noted that gender diverse people within indigenous cultural/professional communities have historically been the most visible part of the LGBTQIA population in India because of global initiatives on AIDS eradication. It should be noted that no laws based on the NALSA judgment are in place as of this writing, and same sex marriages are not recognized by the courts (see Orinam(2019)). Naturally, all this has affected the state of studies on the LGBTQ population in the country. About 30% of India’s population is aged over 45 years, 15% above 55 years, and women have a life-expectancy of 70.3 years (UNFPA(2017)). There are 29 states and 7 union territories in India. Of these, only the states of Kerala, Tamil Nadu, and West Bengal have dedicated trans boards for the empowerment of trans people and indigenous gender/cultural/professional identities. These boards are expected to facilitate processing of identity documents, provide housing, healthcare, vocational training, and placement at the very least. A few subjective accounts of and fewer quantitative accounts about the lives of lesbians in India are available. Both lesbians and trans women are perceived as socially deviant women in India. Upper class and older members of both classes are typically closeted (a person is closeted if and only if their gender identity or sexual orientation is not common knowledge in the person’s social and professional circles), while lower class trans women are more visible due to ostracization. Because trans women face transphobia in addition, it makes sense to study both classes in parallel. The second section is devoted to older lesbians, related QOL challenges, and an enhanced version of QOL for the study of Indian lesbians is also proposed by the present author. The proposal is intended to change the direction of subjective approaches to the subject in relation to the question; How can subjective accounts be improved for the purposes of mining data relating to QOL? Data on LGBTQ population has never been collected in census and no large sample studies on the well-being of lesbians and trans women have been conducted because of this state-of- affairs. This is all the more alarming because the number of people aged above 60 years is expected to increase by 50% in the next five years UNFPA-Team (2017). A number of small sample studies on people of indigenous cultures aged between 15 and 65 years (including some

2 trans women), have been conducted by academic research groups, NGOs, and trans welfare boards. The aim of this overview is to critically examine these for insight into the state of older lesbians and trans women in the country. The present study is constrained by the availability or otherwise of such studies, their limitations, future prospects and not by demographic bias. Fur- ther, while researchers do have theoretical understandings of the states (on the basis of existing narratives) in which older lesbians and trans women exist, it is not possible to connect related frameworks with available work on QOL because the latter suﬀer from too many deﬁciencies. A strong conclusion of this paper is that the geriatric age for trans women should be taken to be 40. Directions for future studies have also been proposed on the basis of the main conclusions of this study.

1.1. Background

This subsection is intended to clarify the terminology and concepts of sex, gender and sexuality used in this paper. From a modern scientiﬁc perspective, the sex (or biological sex) of a person is best seen as a tuple of parameters corresponding to hormonal, brain, clinical, chromosomal, and physical sex, epigenetics and more. Gender is plural term that refers to gender identity, ex- pression and gender as a social construct. Serano (2016) clariﬁes much on these. It is important to distinguish between the terms in any rational discourse. It is a fact that modern biology is yet to properly adapt itself to these advances in terminology as evidenced by textbooks stuck in some concept clinical/anatomical sex (Melmed et al. (2012) is an example of such a book) and genderism. Further trans-inclusive guidelines as in Coleman et al. (2011) are not part of the core training of the medical community (including doctors, nurses, administrators, trainers and ayahs) in India. People belonging to indigenous cultural and professional identities (that include gender diverse people), henceforth referred to as Indcpgids, are less understood because of myths and disinformation (see Dutta (2013)). An example of a poorly informed article is Kalra (2012) – wherein the author assumes that all Hijras are eunuchs (a common myth). Indcpgids such as Hijra, Thirunangai, Kinnar, and Kothi (that are based on culture, class, caste, sexuality and gender) do not necessarily fall under concepts of gender identity. The socially ostracized Hijra community, that has its own language, rituals, rules and occupational preferences, consists of castrated males, binary/non-binary trans women, intersex people, cis men and even cis women. Kothis are groups of lower class gay men that may indulge in occasional cross-dressing. A thirunangai, on the other hand may be a trans woman or a trans gender person or even a

3 woman with congenital adrenal hyperplasia, belonging to lower socioeconomic classes. A number of studies, originating in India, use the term transgender to refer to people of all Indcpgids. This is very problematic and will be referred to as the sloppy gender problem. The percentage of trans women among these Indcpgids is not uniformly high. Gender identity of a person is the person’s innate sense of gender and is intrinsic to the person in question. Studies show that it is strongly influenced by prenatal development. It has been shown to be hardwired modulo different assumptions and connections with genetics are also known. There are studies that also relate gender identity to brain structure, hormones in brain, and other modern biological markers of sex (see Diamond (2006); Reed and Diamond (2016); Spizzirri et al. (2018) for example). If a person identifies as a woman or as a transgender woman and if she was assigned a different gender at birth, then the person is a trans woman – in the former case she is said to be identifying on the binary. Only when people are assigned wrong gender at birth, and have sufficient dysphoria do they seem to express the incoherence with their gender identity. According to Mani (2014a) sufficiency of dysphoria can be characterized in terms of possible attribute sets. Even in 2019, trans persons do not enjoy equal legal protection from sexual and physical violence in India. Further, they have lower life expectancy in India — the average is much less than 56.2 years (the figure for Tamil Nadu). This suggests that any trans person aged over 40 should be evaluated from a geriatric perspective. In the Indian context, Indcpgids form the most visible and inhumanly discriminated group within LGBTQIA. Most lesbians remain closeted because of the generally oppressive, homophobic, and patriarchal Indian society. The 2011 census, estimated the total population of Indcpgids (recognized as communities) at 0.49 Million. This figure is known to be a bad underestimate for reasons such as inherent defects in the estimation procedure, lack of gender sensitivity in design, vagueness of the category used and hostile survey environment. Binary identified trans people were also excluded in the census by design. There are studies on the health of trans women in particular and trans persons in general, but these are not directly related to their QOL.

1.2. QOL: WHOQOL-BREF

QOL is an inexact concept that may vary over time, and depend on previous instances of assessment. Most instruments of QOL seek to measure causal indicators of the same. In most of the empirical quantitative studies, translations (one/two-way) of the 26-item WHOQOL-BREF

4 or variants were used instead of WHOQOL-100 or other measures of QOL. WHOQOL-BREF has questions from the physical health (seven items), psychological health (six items), social relationships (three items), and environment domain (eight items). The reader is referred to WHO (2012) for details. In Mani (2016), the nature and existence of connections between loneliness, exclusion, sexuality and suicidal tendencies are considered in some detail. It is also known that loneliness can have a number of negative eﬀects on humans that include: reduced lifespan, health problems, lowered level of trust levels in others, feelings of social incompetence, victim mentality and self consciousness. A closely related concept is that of depersonalization. It Costa and Colizzi (2016) can be regarded as a common symptom of gender dysphoria. A person experiencing depersonalization would feel that certain feelings and experiences of oneself or the world as unreal. Depersonalization does not alter perception of reality, but induces a level of detachment from the world and numbing of emotions. These are among the things that can distort WHOQOL domain scores because trans people are likely to conceal their emotional pain.

2. QOL in Lesbian Studies

As mentioned earlier, the number of studies on lesbians and older lesbians (in the Indian context) from a QOL/medical perspective is very small. Those on older lesbians is even lesser. This is because till recently, the legal system had criminalized all same sex relationships, inclusive sex education is not compulsory for anybody, and religious bigotry is rampant (also see LABIA-Collective (2013)). Reports in the LGBTQ press conﬁrm that non-closeted lesbians, face discrimination and intense harassment everywhere, legal protections are absent, and are at risk of losing their jobs. Most lesbians, therefore, remain closeted. Most lesbian studies, such as Bhaskaran (2004); Chatterjee (2018); Saskia et al. (2007); Thadani (1996), use a narrative perspective towards highlighting the complexity of their plight, freeing them from stigmatization, and reforming society at large. While a few privileged lesbians manage to attain a reasonable quality of existence, for the overwhelming majority the situation is terrible. In Bhaskaran (2004) (pages 124-146), few cases of persecution of lesbians since the late eighties have been documented – speaking of any reasonable quality of life in such circumstances sound like a distant dream. A number of online and print LGBTQ magazines such as Swakanthey (of Sappho for Equality), Scripts (of Labia Collective), and Gaysi-Family, have featured anecdotal accounts of younger lesbians in real life. The focus of most women seems to be restricted to such an approach to activism (where the personal is the political).

5 The support system for lesbians (Bhaskaran (2004)) within women’s groups has also been not in place (though, things have improved in urban locales in the last decade). Women, in general, are not economically independent in the country and tend to live within the limited freedom granted by the hetero sexist brahminical patriarchy (Chakravarti (1993)). While narrative research can serve as stepping stones for concrete quantitative studies, WHOQOL is not a reliable tool for handling the complexity of oppression and stigmatization that queer women face as they tend to develop multiple layers of withdrawal shields (in a voluntary or involuntary way) to avoid active interaction. Vanita (2005) provides few glimpses into lesbian unions in pre-modern India. It is shown that contemporary same-sex marriages have antecedents in traditional narratives. Though they are separated by space, time, genre, and context, some patterns of representation do emerge. Apparently, these do not carry enough force to induce an inclusive culture. In a two layered study (Shrivatsava and Singh (2015)) involving 15 middle class lesbians aged between 17 and 42 years, it was found that most of them were rejected by their parents because of their orientation, and most found much support from LGBT communities and few friends. In addition, parents were found to behave in criminal bigoted ways against their daughters (as indicated by anecdotes in the study).

2.1. Study-1: Jaipur

A small sample (N = 100) study of LGBTQ people (aged less than 50 years) in Jaipur, Ra- jasthan is reported in Ghosh and Paliwal (2018). The sample included 9 lesbians and 55 trans people, and it was found that 44.4% of lesbians, 65% of gay men, 39% of bisexuals, and 74.1% of transgender people perceive a low or very low level of QOL. In the study an old Hindi version of WHOQOL (Saxena et al. (1998)) was used. It should be mentioned that the report has a number of gross erroneous assertions such as “According to UNDP in India, Hijra is an um- brella term for all sexual minorities”. It states that Hijra cultures are India’s answer to support systems for sexual minorities. Further DSM-III as opposed to DSM-V is referred to for ideas of gender identity disorder. As of this writing, no longer versions of the report are available.

2.2. Study-2: Hisar

In Traeen et al. (2009), QOL of 25 female and 175 male students of a university in Hisar, India have been studied. The authors deduce that compared to straight women in Hisar, lesbian/bisexual women scored slightly lower on the personal growth scale (p = .053), lower on

6 the subjective happiness scale (p < .05), and lower on the subjective well-being scale (p < .05). Lastly, straight women in Hisar reported being slightly more happy than lesbian/bisexual women (p = .052). Among women in Hisar, there were large eﬀect sizes on the personal growth scale, subjective happiness scale, and on the emotional traits of happiness and anger. The discrimi- natory social order’s bias against nonconforming younger women is clearly responsible for this scenario.

2.3. Enhanced WHOQOL for Lesbians, ELQOL

Given the absence of enough quantitative studies, it makes sense to try to estimate possible levels of QOL, and QOLO on the basis of known subjective accounts and interaction in closed public and private support groups. The proposed L-domain questions are intended to improve WHOQOL (when related data is available) and provide approximate measures of QOL in the absence of other QOL data. In the Indian context, social conditions are not well suited for large sample studies, and a number of factors that are not directly related to sexuality exert strong inﬂuence on sexual quality of life and consequently on QOL. For example, if a woman has limited or no economic independence, then she is likely to have fewer options in meeting other lesbians – but she can vastly improve her options through social skills. These aspects can be used to arrive at approximate QOL scores for lesbians without going into a detailed assessment of stigma, standard Sexual Quality of Life Questionnaire-Female (SQoL-F), and Aging Sexual Knowledge and Attitudes Scale (ASKAS) (if relevant). A researcher might want to ask questions relating to the following response options (these will be referred to as L-domain responses):

L1 Urban (1)/Rural (−1) L2 In gainful employment (2)/Underemployed (−2)/Unemployed (−4) L3 Living with Partner(s)(1)/Not Living with Partner(s)(−1)/Friends With Beneﬁts (0) L4 In a Lesbian Relationship (2)/In Lesbian Relationships (2)/Casual Relationships(1)/Seeking Lesbian Relationships (0)/Separated(−1)/In Forced Mar- riage (−2) L5 No Family support(−1)/Supportive Family(1)/Family Opposition(−4)/ Independent(2) L6 Out and Proud(2)/Out and Proud to Friends(1)/Closeted(−1)/Closeted with MOC(−2) L7 Have No Suicidal Tendencies(1)/Have Depression(−1)/Strong Suicidal Tendencies(−2) L8 Religious(−1)/Atheist(1)/Agnostic(1)/Anti Religious(1) L9 Use Inclusive Feminist Reasoning in Real Life: Often(2)/Frequently(1)/Sometimes(0)/No

7 Idea(−1) L10 Body Conﬁdence Level: High(2)/Good(1)/Moderate(0)/Poor(−1) L11 Sexual Performance: Excellent(2)/Good(1)/Satisfactory(1)/Unsatisfactory(−1) /Problems(−1) L12 Feelings of Guilt: None(1)/Sometimes (−1)/often (−2) L13 Community Support: None (−1)/Friends (1)/Queer Friends (2) L14 Workplace Support: harassment (−4)/None (0)/Some (1)/Policy Based (2)

In the present author’s opinion, patterns of possible responses deﬁne categories of women whose WHOQOL scores can be extended in similar ways for obtaining more representative values. In concrete terms, the proposed steps are (when WHOQOL scores are available):

• adjoin the L-domain to obtain an enhanced version of QOL, termed ELQOL, • compute Raw-Score L of L-Domain as simple sum of L1-L14 and refer to this as L.Score, • Deﬁne total ELQOL score as

T otal.Score = W HOQOL.Score + 5 ∗ L.Score

It is natural to expect that the WHOQOL score is predictable (to some degree of accuracy) from the L-score for lesbians alone. This suggests that L-domain questions can be targeted by authors of subjective studies such as targeted narratives (of which there are many). This calls for specialized training of scholars working from subjective perspectives to adjust their narratives to be less sparse (from a information theoretic and psychological perspective).

2.4. Trans Lesbians

The lived experiences of few privileged trans women in India who love women are somewhat known within activist and academic circles. But not much is known about the existence of trans lesbians belonging to underprivileged classes. In Alphonsa et al. (2015), it is implicitly stated that as many as 25% of those surveyed were trans lesbians. Out and proud trans lesbians aged 30 and above are known within activist circles. As of this writing, no QOL studies have been done on the subclass.

8 3. QOL of Older Trans Women

A collection of anecdotes (Revathi (2011)) detailing the life of indigenous transgender people (including some percentage of trans women) was ﬁrst published in Tamil. It had a big role in furthering the emergent transgender rights movement in Tamil Nadu that led to the establish- ment of a welfare board in the state in the year 2008. The then state government’s initiatives contributed to signiﬁcant gains for the trans people in the state as opposed to most other states in the country. Media reports state that the board has become dysfunctional in recent times with change in Government. The translation of the anecdotes mentioned has its problems; the word hijra is used all over the book as a collective term for Indcpgids. Santhi Amma’s account (p61-62), clearly shows that the Jamaat (an Indcpgid) has heterosexist ideas of gender and it would be reasonable to assume that Jamaats do not include trans lesbians from lower socioeconomic classes. A relevant quote is We accept them into the jamaat only if they are attracted to men. If they are attracted to women, we don’t let them in. We observe their dress and behaviour and decide if they are males or hijras. There is no chance of a male cheating us and getting into the jamaat.

3.1. Tamil Nadu

Few studies relating to the QOL of trans people belonging to lower socioeconomic classes in the state are available. None of these focus exclusively on older trans women. In the thesis Kisha et al. (2012), trans people and the attitude of society towards them from a psycho-social point of view have been studied. DSM-IV terminology and ideas are used and significantly some effort is made to connect the findings with QOL estimation. Tamil version of WHOQOL-BREF was used in the study. 200 trans women or trans people were studied from a general perspective towards estimation of QOL, self-esteem, social anxiety and other problems - half of these people were from urban areas, and all were from lower socioeconomic classes. The exact gender identity of those surveyed is not clearly stated in the study. The sample was divided into three age groups: 18 − 25, 26 − 35 and 36 − 50. About 35% of the sample belonged to the last age group. Only about 11% were graduates, about 70% were into sex work or begging and only 34% had monthly earnings above Rs.3500 ( $60). Almost 75% of the sample had some GCS (Gender Confirmation Surgery) under the State Government’s welfare scheme, and 13% of the sample were closeted.

9 It was found that WHOQOL-BREF scores for the oldest age group under the categories physical health, psychology, social relations and environment were 58, 56, 24, and 36 respectively -– these are apparently better than those of other age groups (ANOVA suggests that the differences are not significant). This means that at least some older trans women had adapted better to their environment than others including younger trans women. Grounded studies can help in throwing light on the adaptations. Graduates scored better than non graduates in relation to social relations and environment, while urban participants were more concerned about their appearance and the attitude of society towards them. Because older trans women can be expected to have had less access to educational opportunities, the intersectionality relative to adaptions points to shortcomings in the education system. Those living with their families had significantly lower self-esteem (estimated with the Rozenberg Self-Esteem scale) than those living alone or with other trans women. All participants had a higher level of social anxiety than normal values (estimated by the Brief Fear of Negative Evaluation scale).

3.1.1. The Vilipuram Study

In Mrinalini et al. (2013), 125 thirunangais residing in Villupuram district were studied. Most of the thirunangais are trans women apparently. The study reﬂects the result of positive action by the state welfare board for the upliftment of a severely discriminated socioeconomic class. 74.4% of the sample were literate with over 63 completing more than 10 years of education. 72.2% were above the age of 30, 94% owned their houses either as individuals or on group-ownership basis (because of state assistance), and over 88% earned over Rs. 5000 ( $86) per month. None of those surveyed believe in the caste system, about one ﬁfth had hostile relationships with their birth parents, surprisingly 96% of the participants had no problems with their non trans neighbors, and only 12% maintain neither cordial relationships nor hostile relationships with their peers. From the summary, it is easy to see that the participants had relatively high standards of living and would have scored well in WHOQOL-BREF. Because of lack of counselling and understanding of feminist principles, the thirunangais do feel some stigmatization - this follows from their perception of heterosexual and bisexual women. Mrinalini et al. (2013) reads this as jealousy. In fact, the thesis is not well-informed by feminist principles.

10 3.2. Kerala

The state of Kerala has a transgender board, a trans policy (since the year 2014), and a number of schemes in place for the betterment of trans people. It is the ﬁrst state in India to have a trans policy that was mandated by the NALSA judgment. The estimate for out and proud trans people was a mere 4000 of a total of 25, 000 trans people in the state. Provisions for education, employment, housing, health, and other areas are part of the policy. Free GCS and skill training were also put into place in the year 2016. As per the policy report, about 54% of trans people in Kerala have a monthly income of less than Rs.5000. QOL of ’transgender’ people in the state of Kerala is studied in Aneesh (2017). The terminology used in the study is vague, statistics for trans women are not clear as a consequence, and synthetic datasets have not been published. Of the 100 trans people surveyed, 78 were in the age group 30–40. Almost 70% of those surveyed, earned at least Rs5000 per month. WHOQOL- BREF was used and it was found that most participants had moderate to high QOL. Age speciﬁc information is not mentioned in the paper. It is also claimed that the surveyed people have higher QOL because of their relative high monthly income and the fact that their job relies on soft skills.

3.3. West Bengal

While a number of NGOs have been involved in trans activism and health care programs in West Bengal, not much has been done for trans women and trans people (irrespective of age). No health care benefits, GCS, housing, livelihood assistance, or pension benefits are provided by the state transgender development board. This information was confirmed Mani (2018) through queries under the right to information act (RTI). Over a three-year period, the board had spent about Rs. 48 lakhs for in-house expenses, and community meetings mainly. In Naskar et al. (2018), a mix of trans and cis people associated with indigenous cultural groups are studied from the district of Burdwan in West Bengal. The non closeted trans population in the district was estimated at 96 and an effective sample of 71 was analyzed. WHOQOL-BREF was used for assessing QOL of the sample, 27% of which consisted of people aged over 45 years, a paltry 10% had studied for at least twelve years, and over 50% earned over Rs. 8500 per month. Almost 55% of participants earned through begging in trains, everybody had experienced verbal abuse, 79% were physically abused, 33.3% were sexually abused, and 20% attempted suicide at least once in their lifetime. About 43% of the sample had poor QOL (scores below 50 were taken to be poor and

11 those above 200 as good). In the social relationship domain, the mean QOL score was 47.4. It was over 50 in other domains and highest scores were in the environment domain. Aging had negative correlation with QOL and no geriatric programmes are in place for them. The immediate causal factors for this scenario are lack of education, opportunities, abuse of various kinds, and exclusion. A problematic feature of this study is the complete lack of diﬀerentiation between trans women, trans men, drag queens and kings, masculine women, feminine men, and others who do not follow normative gender laws.

3.3.1. KUC Study

A study of health care access of trans women in the Kolkata urban conglomerate (KUC) was recently conducted by an NGO. Detailed information from 26 trans women was collected in the survey. The present author has performed a critical analysis of the raw data set, and proposed new health care access indices. All participants faced signiﬁcant barriers to health care access due to the actions of doctors, staﬀ and other visitors. Exactly two of the participants were over 35 years of age, they were below the poverty line, had faced more discrimination at the hands of doctors, and frequently consumed alcohol and drugs. The research paper is still unpublished as of this writing. The study addresses a part of WHOQOL. Further studies are required for validation of the heath care access score. It was noted that there are inadequate number of studies on the topic of health-care access of trans women. Sociological approaches tend to overlook this aspect because similar measures lack universality or depth. The UN for example, uses many health-care-access-related indices. But these are based on a small set of parameters and are not suited for grounded studies. In contrast, the literature on transphobia and genderism scales is fairly substantial (see Morrison et al. (2017) and Hill and Willoughby (2005); Tebbe et al. (2014); Worthen (2016)). The research paper suggests the following interesting problem: How can the transphobia and genderism degrees of perpetrators be estimated through minimally intrusive questions addressed to the victims/survivors?

3.4. Karnataka

In Alphonsa et al. (2015), the results of a study on QOL of older trans people (aged above 40 years) including a majority of trans women, and at least one binary identiﬁed trans women are reported. The sample size was 60. 88.3% of the participants were in the age group 40 − 50 years. About 23.3% of the participants were uneducated, but three-fourths of thise surveyed

12 earned their livelihood through begging, and 58.3% had earnings of over Rs10000 per month. About 85% of the participants had some kind of GCS (bilateral orchiectomy or orchiectomy or vaginoplasty), and 20% of the trans women were lesbians. WHOQOL-BREF was used and it was found that 45% of the participants had a good quality of life, 35% had a QOL that was neither good nor poor, 13.3% had a very good QOL, while 3.3% had poor or very poor QOL. The mean QOL scores for the four domains (physical health, psychological health, social relationships and environment) was found to be 69.7, 64.9, 66.5, 65.0 with standard deviation of 17.5, 18.5, 11.7 and 13.8 respectively. The mean QOL scores for the four domains (physical health, psychological health, social relationships and environment) was found to be 69.7, 64.9, 66.5, 65.0 with standard deviations of 17.5, 18.5, 11.7 and 13.8 respectively. The overall mean, minimum, and maximum QOL were respectively 266.1 (standard deviation was 51.8), 109, and 376 respectively. Moderate positive correlation (0.53) was found between QOL score and income. QOL and education level were found to be uncorrelated. The authors attribute the lack of diﬀerence between those who had some type of GCS and those that did not have to their present age. In the present author’s opinion the type of GCS has not been taken into account.

3.5. Stigma-Related Studies

In Chakrapani et al. (2017), a trans identity stigma scale is proposed that seeks to measure stigmatization (and discrimination) caused by a hetero normative, cis-sexist and misogynist society with the help of a 14-item questionnaire. In the associated study, a convenience sample of 300 Indcpgids and trans women was used. The study suﬀers from the sloppy gender problem, and nearly 75% of the sample may not be be identifying as trans women. The dataset associated with Chakrapani et al. (2017) is apparently not available in synthetic form. The number of trans people aged above 40 years can be estimated to be in the range 15 − 20% of the sample, and clearly their quality of life must have been adversely aﬀected by the stigmatization. 22% of the participants were above thirty years of age. They described low self-worth related to being a transgender person and sex worker, and their inability to meet the normative roles of ‘marriage’ and procreation, which were linked to partnership instability. Further, felt and internalized stigma appear to reinforce study participants’ perceptions that they must expect and accept stigma, and violence in community interactions.

13 4. Conclusions

From the critical overview, it should be clear that very few studies have been done on older trans women and lesbians in India. More resources should be allocated for quantitative studies for a proper approach to understanding the eﬀect of long term discrimination and ostracization. As of now, suitable policies on positive discrimination and support do not exist or are not well grounded in quantitative studies. Existing studies suggest that the geriatric age of trans women should be taken to be 40. Available studies suﬀer from the following problems:

(1) The sloppy gender problem mentioned in the introduction hinders proper comparison and possible interventions because most studies have been restricted to Indcpgids. (2) If a trans woman or a lesbian has decided to stop aspiring for a better life (at least in the near future) and has resigned herself to her fate (possibly due to stigmatization), then her WHOQOL-BREF scores are likely to be distorted. This calls for improvements to the questionnaire. (3) Most studies have used relatively small samples, and synthetic versions of datasets are not available to the public. Data analysis has not been of suﬃcient quality in most of the studies, and not enough stress seems to have been placed on the education of participants. Intrusive statistical assumptions used in analyzing data in many studies have also resulted in obscure conclusions. (4) The type of GCS undergone by participants is never mentioned. (5) No eﬀort has been placed on integrating standard Sexual Quality of Life Questionnaire- Female (SQoL-F), and Aging Sexual Knowledge and Attitudes Scale (ASKAS) (if relevant) with WHOQOL.

It is hoped that this research is successful in drawing attention to the problems mentioned above. A new strategy for studying QOL of lesbians has also been proposed in this research. A detailed study of the proposal will be part of future work. Importantly, the strategy seeks to bridge the gap between subjective studies on lesbians and trans women with quantitative approaches by way of adjustment of the focus of subjective studies towards questions of the latter kind. It is also hoped that more resources will be allocated for positive discrimination, quantitative lesbian, and trans studies including QOL in the country.

14 References

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