2021 SAATHII-Sahodaran study that screened 2,500 trans women for TB represents an important step in the fight against the disease
Tuberculosis (TB) is an uphill battle for most people in India, which is home to nearly a quarter of all cases recorded worldwide. The country also accounts for more than 17 percent of TB-related deaths globally, and bears the world’s highest burden for drug-resistant TB.
For LGBTQIA+ people, the ordeal is compounded by queerphobic stigma, lack of access to healthcare, and misinformation.
These problems are widely acknowledged, but data on their impact remains scarce. A study in Chennai, which examines the spread of TB among the city’s trans women, marks a crucial step forward. The draft report, shared exclusively with queerbeat ahead of its public release, indicates that the community faces an elevated risk of contracting the disease.
The study was initiated in 2021 by Solidarity and Action Against The HIV Infection in India (SAATHII), a healthcare-focused NGO that works with queer and trans communities in Chennai. It conducted the research in collaboration with Sahodaran, another Chennai-based queer rights NGO. Stop TB Partnership, an international alliance of NGOs, government institutes, and private companies working to fight the disease, supported the project.
Over 11 months, the SAATHII team verbally screened 2,534 trans women within the Greater Chennai Corporation. Of them, 1280 were sent for clinical diagnosis because they either had one or more TB symptoms and/or had risk factors such as diabetes, excessive smoking or excessive alcohol consumption. Among the trans women who were tested, eight were confirmed newly positive for TB, and another six had already been diagnosed and were on treatment, said L. Ramakrishnan, Vice President of SAATHII and a public health expert. That translates to 552 active TB cases among trans women per lakh population. For comparison, in 2021, the number of active TB cases across India stood at 312per lakh population. That means that there was a 1.76 times higher proportion of active TB in the trans women studied than in the Indian population as a whole, Ramakrishnan added.
The researchers also found that while 60 percent of the trans women covered in the study had heard of TB, only 41 percent were aware that it can be treated. And only 6.4 percent knew about the signs and symptoms of the disease.
The findings of the study point to the “need [for] a far larger study” on how TB affects queer and trans people in India, said Yogesh Jain, a public health physician from Sangwari, Chhattisgarh. Yogesh has worked with TB patients in rural areas of India for decades.
India’s TB crisis
TB is an air-borne disease that commonly affects the lungs. It can impact other parts of the body too, including the brain, spine, or kidneys. When left untreated, the disease can be fatal.
According to the World Health Organisation, India has the world’s highest incidence rate of TB. An incidence rate is the estimated number of new and relapse cases per 100,000 people in a given time period.
In 2020, the Indian government announced an ambitious plan to completely eradicate tuberculosis over the next five years. Significant progress has been made in that direction: the country’s TB incidence rate declined by 21 percent—from 237 cases per lakh population in 2015 to 187 per lakh in 2024. However, as 2025 draws to a close, three experts interviewed by queerbeat said that the target of eradicating TB by the end of the year would not be achieved.
This medical crisis has a direct bearing on India’s queer communities. The Indian government’s National Framework for a Gender-Responsive Approach to Tuberculosis identifies LGBTQIA+ people as a priority population that is particularly vulnerable to the disease. It points to “low education levels, discrimination in employment, poverty, and lack of access to safe housing and adequate nutrition” as some of the risk factors that elevate the chances of queer and trans persons contracting TB. The Framework also notes that “a high proportion of transgender persons are known to smoke, consume alcohol, and use drugs”—often as a means of coping with discrimination and marginalisation. These habits, according to the Framework, compound the threat they face from TB.
The Framework repeatedly acknowledges the “paucity of research on LGBTQIA++ identities’ vulnerability to TB outside of the HIV context and the need for this to be addressed.” The “HIV context” that the Framework refers to is the close link between TB and HIV.
At the height of the AIDS pandemic during the nineties, when patients with HIV began to die of TB, the two diseases came to be known as the “cursed duet,” health journalist Vidya Krishnan noted in a 2024 report published by The Caravan. HIV tends to weaken the immune system, making the body more vulnerable to other diseases. “People living with HIV are around twenty times as likely as others to contract tuberculosis,” she wrote.
The stigma around AIDS also extended to people diagnosed with TB, recalled D. Geetha, a 64-year-old nayak [leader] of a thirunangai [Tamil word for a trans woman] jamath [clan] in Chennai. Geetha has witnessed the struggles of the city’s trans community for the past four decades. Earlier, she said, “We knew TB only because it was linked to HIV and people were dying from it.” If someone contracted the infection, “they were isolated and people left them alone. It was very scary,” Geetha added.
Barriers to Testing
Typically, the first step towards addressing any public health concern is gathering data. “There is a huge lack of data on the queer community and TB,” said Anupama Srinivasan—Deputy Director at the Resource Group for Education and Advocacy for Community Health (REACH), a Chennai-based health non-profit that aims to create tuberculosis-free communities and advance equity in health.
But trans people are reluctant to get tested, in part because they fear ostracisation. “They usually do not come voluntarily for testing,” said S. Chitra, a Senior Treatment Supervisor at a Tuberculosis Unit run by the Greater Chennai Corporation. “Only when they get really sick do they come. Or if another community member brings them, like the Sahodaran [NGO] team members—they come because they trust them.”
The SAATHII-Sahodaran study focused on building this trust with the trans women they screened, according to Farzana, a member of the Sahodaran team. “When we go meet members of the community, we don’t immediately start with ‘oh you have TB,’” she said. “We go slowly, explain what we are doing and why. And the community knows Sahodaran and SAATHII. Those years of trust are important. People also saw us working during COVID and know that we are trying to help.”
Even when trans persons do get tested, systemic prejudices and limited understanding of trans identities can weaken the quality of the data gathered by the government, according to Ramakrishnan. He noted that government healthcare workers tend to misgender trans folks because they operate using a misleading understanding of who is transgender based on clothing and surgery status. “That makes the data unreliable,” he said.
The SAATHII-Sahodaran research team used the study findings to address this issue. “We partnered with the Tamil Nadu National TB Elimination Program to advocate for training of healthcare workers so we can avoid undercounting of trans women in TB data,” said Ramakrishnan.
Discrimination from Within
Trans women affected by TB face discrimination within the community too. Members of the research team from SAATHII and Sahodaran told queerbeatthat societal stigma has TB prevented many trans women from accessing testing facilities.
J. Bhagya, a 45-year-old trans woman and a sex worker who contracted TB in 2019, experienced this stigma first hand. “The others [in the jamath] did not allow me to mingle with them or be present when food was served,” she recalled. Bhagya was already HIV positive when she contracted TB. Since she was undergoing antiretroviral therapy (ART) for HIV, she said she found it extremely hard to cope with the TB medication. “TB alone is a big issue, but for a person with HIV it gets more severe,” she told queerbeat. “I felt very alone at that time.” According to Ramakrishnan, combining ART and TB medication increases the risk of adverse reactions and reduces the effectiveness of at least one antiretroviral drug, which is part of a three drug-combination that is typically administered.
Bhagya’s experience—of being ostracised by her chosen family when she was at her most vulnerable—isn’t an uncommon experience among people living with TB. A. Vennila, who runs a business selling clothes in Chennai, was diagnosed with HIV and TB in 2006. She was thrown out of the house she shared with four other trans women soon after, she told queerbeat. “It was humiliating and isolating. I have lived by myself since then,” she said.
It has been nearly 20 years since Vennila was diagnosed with and survived TB. She believes that the stigma around the disease has reduced since then because there are more survivors of TB now, who help others understand how the disease spreads and that it can be cured. “TB is not as prevalent as it used to be but there needs to be awareness.”
As a TB survivor herself, Bhagya now strives to increase awareness about the disease among people in the trans community. But she is often confronted with misconceptions and deep-rooted fears. “When I go to educate people they scold me,” she said. “Our community is associating TB with HIV and are scared that others will think they have HIV and so they will lose clients in the sex work trade.”
Bhagya believes government intervention is vital to tackle TB. She stressed on the need for public awareness programs that spread awareness about TB risk factors like in the case of HIV, when condom use was extensively promoted. She also argued that the stigma around the disease could be reduced by making screening mandatory for everybody.
Burden of Inequality
“TB is a disease of the most vulnerable,” Anupama told queerbeat. In her view, given the advancements in healthcare in today’s world, the only reason TB continues to exist is because of inequality, which is further exacerbated in the case of queer and trans communities.
Consider, for example, the increasingly common experience of extreme rains or heat due to climate change. For Chennai’s trans women, already marginalised in many ways, these events heighten the chances of contracting TB. “Natural disasters, like the floods that Chennai has experienced in the past, displace people into overcrowded living conditions where TB has a greater chance of spreading,” said Ramakrishnan.
Ramakrishnan echoed Bhagya on the need for the government to implement mass screening drives and preventative therapy for TB among trans populations. “Government healthcare workers need to be sensitised on queer issues. In the case of trans women, it should not matter what their attire or surgical status is, they should be classified correctly based on self-identification. The government also needs to test people for TB regardless of whether they have HIV or not,” he said.
He also added that preventive therapy should be offered to all household contacts of trans persons affected by TB.
Ramakrishnan believes the study represents a meaningful advance in the fight against TB within the trans community. “While our project has some limitations [in terms of the number of trans women tested], it was an important step because we now have actual data, we have numbers, and we hope that it will increase awareness about this issue,” he said.
First Published by Queerbeat on 21st November, 2025.