Transgenders are people who have a different gender identity from what they are born with – for instance, a male who feels like a female or a female who feels like a male would come under the category of transgenders. This is due to reasons related to the mind and body; circumstances also contribute to the same. Usually transgenders cannot take control of this feeling.

We avoid the use of the word “defect”, and call it a gender identity. Physically it is evident in a very small percentage of babies, but most of them do not have any physical form to indicate they are transgenders. Usually, it becomes evident when they are entering their adolescence as this is when sexual attitudes develop.

Dealing with such boys in a sensitive manner is very important. Counseling, love and acceptance of their identity help them through this situation. Sometimes, counseling helps them to gain hold over their lives. However, in spite of that if they are still convinced about their female identity, sex change surgery is a choice.

Earlier, the “aravanis” or transgenders in India are used to crude procedures known as “Dayamma Kai” which means a senior transgender who cuts off the penis and the testes to give them a female identity. Surgery is an option now, where the transgenders go to doctors who put them through surgical processes for the same. Usually, a surgery for sex change / reconstruction is quite expensive and requires several procedures, all accompanied by hormone therapy and counseling.

After surgery from male to female, there is a reduction in the production of male hormones, and transgenders feel this gives them a more feminine appearance. However, for female to male surgery or for advanced options, usually, hormone replacement, plastic surgery and other procedures have to be taken up to reconstruct the penile / vaginal organ.

Several issues accompany a sex change including urinary incontinence, risks of infection and medical complications including damage to internal organs. Hormone therapy that accompanies a sex change surgery also has its side effects. In a medical environment, some of these risks can be minimized. However in a crude transgender-cultural procedure, there is even the risk of death.

A person who has a feeling of a female trapped in a male body (or vice versa) undergoes a lot of mental distress. They feel hatred for the genital organ that has “trapped them” with this identity. In order to overcome this and feel natural, feel like themselves, surgery is seen as an option that gives them the desired identity and life. Sometimes, they also go through surgery because of peer pressure and ridicule from other transgenders.

Those who have sex with a transgender are usually homosexual men. Other male clients who are looking for a different sexual experience or for a cheaper, more easily available option also tend to approach transgenders.

The reason why transgenders are classed under high-risk groups for sexually transmitted infections including HIV is because they practice anal, oral or thigh sex. Anal sex carries a high risk for transmission of infection as there is more friction and possibility of ulcers, tears and wounds in the region.

It is difficult for someone who is evidently a transgender, to hold a job or to work among the general public as members of the public view them with mistrust. Their way of life too, tends to be somewhat nomadic as they have been turned out of their homes. They try to cash in on public ridicule and fear by begging as one of their main sources of income, besides getting into the sex trade. TAI has been making an effort to change their life, and provide them skill training and alternate sources of income.

Transgenders belong to a marginalized section of society for whom special efforts have to enable them to mainstream. Many of them are very talented and well-educated but are denied the opportunity to be good citizens; in fact many do not have even the basic rights of any other person. The government has given them concessions so that they are provided a chance to live in society as responsible citizens.

TAI works with marginalized communities who are usually street-based sex workers. Poverty is a very important reason for these members to take to sex work. There are also other factors such as trafficking, and members of the family such as parents or husbands forcing them into sex trade. Once they enter the sex trade and get identified as sex workers it is usually very difficult for them to completely leave the trade.

Poor and marginalized groups solicit sex for very small money. It can be for income as little as 20 rupees or in exchange for a meal. TAI works with many such poor sections of sex workers who do not have an idea where their next meal will come from. These sex workers are usually street-based and live in very high hazards of violence and health issues.

As organizations such as TAI work for prevention of STDs/HIV/AIDS among these high-risk groups it is not possible them to moralize or make any judgment about sex work. In an effort to reduce their risk, TAI works to provide alternate sources of income through skill building and project activities, so that the sex worker can cut down on the number of encounters or partners for economic reasons alone. However, this is a slow process.

Working with sex workers in India, especially in places like Tamil Nadu, is not easy. They are hidden groups here, and most of the time the immediate family or their neighbors are not aware of her work. However through building up confidence, through peer networks and through other “secondary” groups such as auto drivers or brokers, NGOs manage to identify sex workers.

Testing for HIV is always a voluntary process as there is a huge stigma surrounding those who are found positive. Although sex workers are high-risk groups no one has the right to force anyone to undergo HIV testing. In fact, HIV spreads to the general population not because of sex workers alone, but because of the clients who transmit the infection to their wives and children. Sex workers are encouraged to test for HIV now, due to the free availability of ART, but no one is forced.

As an organization, TAI’s scope is for prevention of STDs/HIV/AIDS and improving the quality of life of the community. In an effort to reduce the vulnerability, TAI provides legal help for those sex workers who face violence or need legal remedy, provided it is within law. In the case of activities such as soliciting, that are illegal, TAI does not provide any assistance. In the long run, to asset their rights, sex workers need to collectivize and speak for themselves.