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New Indian medical curriculum excludes guidelines for transgender patients

WPATH has called for global authorities to suspend national commission

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India’s National Medical Commission has introduced an undergraduate curriculum that does not include protections for transgender individuals and people with disabilities.

The National Medical Commission on Aug. 31 released the Competency-Based Medical Education (CBME) Curriculum 2024, scheduled for implementation in the 2024-2025 academic year. The curriculum sparked controversy by introducing “sodomy and lesbianism” as unnatural sexual offenses in undergraduate programs, prompting two international organizations to threaten to seek the suspension of the National Medical Commission over the issue.

The International Council for Disability Inclusion in Medical Education and the World Professional Association for Transgender Health (WPATH) have called for global authorities to temporarily suspend the National Medical Commission’s recognition by global authorities. The two organizations claim the new curriculum violates exiting laws that protect the rights of people with disabilities and LGBTQ individuals.

The National Medical Commission reintroduced several regressive ideas regarding the LGBTQ community, with a complete omission of transgender rights that contradicts Supreme Court guidelines and previous regulations. Leaders from the disability and trans communities wrote a letter to Union Minister of Social Justice and Empowerment Virendra Kumar in which they criticized the curriculum.

The revised curriculum removed key disability competencies and critical components related to trans health. 

On Sept. 5, as India observed Teacher’s Day, the National Medical Commission temporarily withdrew the guidelines, only to reintroduce them on Sept. 12 without addressing the controversial sections. Terms, such as “dignity” and “transgender,” were notably absent from the 466-page document.

The revised curriculum allocates eight hours to sports but no longer mandates the previously required seven hours for disability training. It uses terms such as “gender identity disorders” and refers to intersex people as “abnormalities,” retaining language from earlier medical perspectives.

The revised curriculum no longer classifies sodomy and consensual same-sex sexual relations between women as “unnatural sexual offenses.” The earlier version, however, included descriptions cross-dressing as a form of sexual perversion. It also categorized a range of behaviors — including voyeurism, exhibitionism, sadism, and masochism — together with necrophagia (the consumption of the dead) and necrophilia (sexual attraction to corpses) under a single category.

The earlier version did not include LGBTQ-inclusive language.

The revised curriculum includes education on topics that include informed consent for sexual intercourse, the history of gender and sexuality-based identities, and the legal background surrounding the decriminalization of adultery and consensual same-sex relationships. It also introduces lessons on paraphilia and paraphilic disorders, covering a range of atypical sexual fantasies and behaviors.

The National Medical Commission has not provided a specific explanation for including outdated concepts in the curriculum. Senior officials have, however, attributed the changes to an unintentional oversight, stating it was an error that led to portions of the 2022 curriculum being mistakenly reintroduced.

The National Medical Commission in 2022 updated six modules in forensic medicine and psychiatry to reflect societal and legal changes. These amendments included the decriminalization of consensual same-sex relationships. They aimed to educate students on informed consent and, within psychiatry, to address the spectrum of gender and sexual orientations. 

The curriculum was designed to prepare students to manage issues, such as gender dysphoria, intersex conditions, and sexual dysfunctions. These changes were based on recommendations from an expert committee formed under a Madras High Court ruling in a case involving a lesbian couple whose parents opposed their relationship, leading to a police complaint about their alleged disappearance.

The Madras High Court ruling noted queerphobia was being incorporated into the education of future doctors. 

The 2022 changes were seen as essential for the daily practice of medical professionals, as misinformation about consensual same-sex sexual relationships could result in some patients receiving inadequate care and treatment.

While the revised curriculum released on Sept. 12 does not include references to trans rights, the Transgender Persons (Protection of Rights) Act of 2019 explicitly requires medical colleges to incorporate trans health and develop health manuals for gender confirmation surgeries. The revised curriculum, however, does not reflect current standards of inclusivity and care.

Ankit Bhuptani, an LGBTQ rights activist and founder of the Queer Hindu Alliance, during an interview with the Washington Blade expressed disappointment over the new curriculum.

“It is not just about the NALSA judgment, but also the current government has been very actively talking about trans rights throughout their policy and their various programs,” said Bhuptani. “So, it’s quite surprising that it was not included and the government should have been more mindful. I hope, they rectify the error that was done earlier in terms of lesbians and other elements which were problematic.”

Ankit Bhuptani (Photo courtesy of Ankit Bhuptani)

Bhuptani also told the Blade the current government is open to receiving suggestions from the LGBTQ community.

“The government has met a few community members already, and I was one of them,” noted Bhuptani. “After the meeting, we requested that the community need to be consulted for larger LGBTQ rights. They have given their email IDs publicly so that where general public can send suggestions. So, I hope the community members who are raising these issues, will reach out and take this ahead as well.”

Bhuptani said he plans to raise the issue with the government.

Ankush Kumar is a reporter who has covered many stories for Washington and Los Angeles Blades from Iran, India, and Singapore. He recently reported for the Daily Beast. He can be reached at [email protected]. He is on Twitter at @mohitkopinion. 

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India

Madras High Court says families are possible outside marriage

May 22 ruling could set important legal precedent in India

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Madras High Court in Chennai, India. (Photo by Eugene Ga/Bigstock)

In a significant moment for India’s LGBTQ community ahead of Pride month, the Madras High Court on May 22 affirmed people can form families outside of marriage.

The decision, handed down by Justices G.R. Swaminathan and V. Lakshminarayanan, emphasized “marriage is not the sole mode to found a family,” recognizing the concept of “chosen families” as a well-established principle in LGBTQ jurisprudence.

A two judge Madras High Court panel ordered the release of a 25-year-old lesbian woman who had been forcibly separated from her partner and subjected to harassment by her birth family. 

The Madras High Court sharply criticized the local police for their mishandling of the case, condemning their decision to force the woman back to her parents against her will. The two judges denounced the police’s “rank inaction” and insensitivity, emphasizing that government officials, particularly law enforcement, are obligated to respond swiftly and appropriately to complaints from LGBTQ people, ensuring their rights and safety are upheld.

The Madras High Court expressed unease with the term “queer,” noting its dictionary definitions as “strange” or “odd.” The judges questioned the appropriateness of the label in the context of describing LGBTQ identities, urging sensitivity in language to reflect the community’s dignity and rights.

“For a homosexual individual, their sexual orientation is natural and normal,” said the judges. “There is nothing strange about such inclinations. Why then should they be labeled queer?”

The Madras High Court judges observed that not all parents embrace their children’s identities, unfavorably comparing the detained woman’s mother to late-Justice Leila Seth, who publicly supported her son’s sexual orientation. The panel highlighted Seth’s acceptance as a model for familial understanding, underscoring the need for greater societal compassion toward LGBTQ people.

“The mother of the detenue is no Leila Seth,” said the court. “We understand her desire for her daughter to live a conventional heterosexual life, marry, and settle down. However, as an adult, the detenue is entitled to choose her own path.”

The Madras High Court emphasized the concept of “family” must be understood expansively, citing the Supreme Court marriage equality case and other precedents. These international guidelines affirm that all people, regardless of their sexual orientation or gender identity, are entitled to the full spectrum of human rights, reinforcing the court’s stance on recognizing chosen families within the LGBTQ community.

“While the Supriyo case may not have legalized marriage between same-sex couples, they can very well form a family,” the court said in its order. “The concept of ‘chosen family’ is now well settled and acknowledged in LGBTQIA+ jurisprudence. The petitioner and the detenue can very well constitute a family.”

The Madras High Court referenced Supriyo Chakraborty v. Union of India, which is the marriage equality case on which the Supreme Court ruled in 2023.

The Supreme Court in that ruling declined to extend marriage rights to same-sex couples, but recognized the rights of queer people to form families and urged the government to explore civil union protections, bolstering the court’s call for an expanded understanding of family.

The Madras High Court invoked landmark rulings, including NALSA v. Union of India (2014), which affirmed the right to self-identify as one’s gender, Navtej Singh Johar v. Union of India (2018), which decriminalized consensual same-sex sexual relations, and Shakti Vahini v. Union of India (2018), which upheld the right to marry by choice as a fundamental right. The two judges reaffirmed sexual orientation is an individual choice, falling within the ambit of personal liberty protected under Article 21 of the constitution.

Article 21 guarantees the right to life and personal liberty, stating no person shall be deprived of these rights except through lawful procedure. This fundamental right has been expansively interpreted by courts to encompass dignity, privacy, and autonomy, including protections for sexual orientation and other individual identities.

Souvik Saha, an LGBTQ activist and founder of People for Change, a leading Indian advocacy group, described the Madras High Court’s recognition of chosen families as both a relief and a validation of the community’s lived realities.

“As the founder of Jamshedpur Queer Circle and someone who has worked closely with LGBTQ+ individuals navigating rejection, violence, and social isolation, for decades, queer, and trans persons in India have built nurturing ecosystems outside their biological families — often due to rejection, abuse, or lack of acceptance,” said Saha. “This concept of ‘chosen family’ is not new to us; it’s a survival mechanism, a source of healing, and a space where we find dignity, belonging, and love. The fact that the judiciary now formally acknowledges these relationships marks a progressive and humane shift in how family is legally and socially understood.”

Saha shared the story of S, a transgender man from Jamshedpur whose biological family disowned him at 17.

Finding refuge with a queer couple who became his guardians, S received emotional support, celebrated milestones like birthdays, and was guided through education and gender-affirming healthcare. “Isn’t that family?” asked Saha.

Saha told the Washington Blade the Madras High Court’s ruling sparks hope for legal reforms; particularly in securing adoption, inheritance, and caregiving rights for queer people. He said the decision affirms that queer lives are not deviant but diverse, vibrant, and capable of forming loving, responsible families. Most crucially, Saha noted, it sends a powerful message to queer youth in Jamshedpur and other smaller cities that their lives and relationships are valid and valued.

“This ruling is a step forward, but we must be honest. Legal rulings alone won’t change police behavior unless they are followed by systemic structural reforms,” said Saha. “Policing in India is still deeply patriarchal, casteist, and heteronormative. Many officers still view LGBTQ identities as criminal or immoral, even after Section 377 was struck down in 2018.”

Saha said mandatory sensitization programs in every police academy are needed to transform attitudes. He said the inclusion of queer rights in law enforcement curricula — beyond token workshops — are also important. Saha added the recruitment of LGBTQ liaison officers and the formation of compliant mechanisms at the district level is needed.

“This ruling is a strong message from the judiciary, but unless the Ministry of Home Affairs and state police departments institutionalize this into practice, change will remain slow and uneven,” said Saha.

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India’s ‘pink economy’ could bolster economic growth

LGBTQ purchasing power in country estimated to be $168 billion

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(Photo by Rahul Sapra via Bigstock)

The rollback of the U.S. Agency for International Development under the Trump-Vance administration represents a global setback for LGBTQ rights. A report from the Observer Research Foundation, a leading Indian think tank that advises the government on policy, however, highlights a unique opportunity for the country to rely less on overseas funding to promote LGBTQ inclusion and integrate the “pink economy” into its broader economic growth strategy, fostering a more inclusive and self-reliant framework.

The “pink economy,” defined as the purchasing power of the queer community, is valued globally at approximately $3.7 trillion. In India, this market is estimated at $168 billion, but remains largely untapped due to persistent stigma that obstructs economic inclusion for LGBTQ people.

The ORF report notes that, as a result, India’s LGBTQ community has relied heavily on international aid and funding, with Western narratives often shaping perceptions of queer identities.

Despite India’s efforts to advance LGBTQ rights — through recognizing a “third gender” in the 2011 Census, the Supreme Court’s 2018 decision to decriminalize consensual same-sex sexual relations by striking down Section 377, and the passage of the Transgender Persons (Protection of Rights) Act in 2019 — these measures have done little to meaningfully to elevate the social and economic status of the LGBTQ community.

India’s queer community constitutes roughly 18 percent of the global queer population. A 2025 study reveals it receives only 1 percent of global LGBTQ funding, despite heavy reliance on international donors.

The Against All Odds — Advancing Equity for India’s LGBTQIA+ Communities report reveals that, within India, only one of the nation’s top 50 donors explicitly funds queer causes, underscoring a significant gap in domestic philanthropy for the LGBTQIA+ community.

India’s Social Justice and Empowerment Ministry for the 2025-2026 fiscal year allocated $1.07 billion to support education, skilling, healthcare, and rehabilitation for marginalized groups. The ORF report, however, emphasizes this funding falls significantly short for the estimated 140 million-strong queer community, as it narrowly focuses on trans people, thereby limiting its impact on the broader LGBTQ community.

A 2014 World Bank report, the Economic Cost of Homophobia and The Exclusion of LGBT People: A Case Study of India, found that excluding the LGBTQ community from economic participation results in a GDP loss of between .1 and 1.7 percent, translating to an annual economic impact of $1.9 billion to $30.8 billion.

The ORF report underscores that social stigma restricts access to education and hinders opportunities for meaningful employment. 

A 2024 report, Fundamental Rights of Work Inclusion for LGBTQ in India, reveals that fewer than 6 percent of trans people are part of the formal workforce, with their presence in the public sector being nearly negligible. It further notes that, for daily survival, many trans people are forced into hostile environments or resort to street begging.

Thailand, with a marriage equality law that took effect in January, is widely recognized for its relative tolerance toward the LGBTQ community, fostering a vibrant queer culture in cities like Bangkok. The country actively promotes itself as a gay-friendly tourism destination, with businesses capitalizing on the “pink economy” through events, nightlife, and tailored travel services. A 2017 report highlighted Thailand as a leading hub for gay-friendly holidays, significantly bolstering its pink economy.

China stands out as a major player in the “pink economy,” valued at an estimated $300 billion annually in 2017, the largest in Asia, fueled by at least 70 million people. Despite government restrictions on queer content, businesses like Blued, a gay social networking app with 54 million users, and Taobao and other e-commerce platforms have tapped into the “pink market,” offering services such as same-sex wedding packages abroad.

Japan has made gradual strides in LGBTQ inclusion with Goldman Sachs, Panasonic, Rakuten and other companies implementing inclusive policies, such as same-sex partner benefits, since 2015. The Japan Business Federation in 2017 issued guidelines to promote LGBTQ-inclusive employment. Tokyo’s rising status as an LGBTQ-friendly city bolsters tourism and consumer markets tied to the “pink economy.” Japan’s tech and tourism sectors remain robust, despite the country’s modest economic growth, with “pink economy” initiatives driving urban economic vitality.

Anish Gawande, the first openly gay national spokesperson for India’s Nationalist Congress Party, told the Washington Blade that excluding the LGBTQ community carries a tangible financial cost. He emphasized India must soon recognize that marginalizing this group not only triggers a brain drain of top talent but also bars hundreds of thousands of highly capable individuals from driving the nation’s economic progress.

“I am a firm believer in a politics of care. If we only want LGBTQ+ inclusion for the sake of economic prosperity, there will never be true inclusion,” said Gawande. “What we must understand is that an embracing of diversity — across caste, class, religion, region, gender, and sexuality — is fundamental to ensuring that we build communities that listen to and learn from each other. By embracing diversity, which has been at the very heart of what it means to be Indian, we do not just prosper economically — but also build more resilient, more equal, and more harmonious societies.”

Kalki Subramaniam, a prominent LGBTQ activist and artist, told the Blade the issue transcends mere economic gain, emphasizing the vibrant spirit and unrecognized potential of LGBTQ people across India.

“We are here, we exist, and our contributions are invaluable. But the government is yet to recognize and fully tap it,” said Subramaniam. “If they are not listening, they will lose out, not just on money, but on the richness we bring to the fabric of India. This is not just an economic report, it is a heartbeat of a community yearning to be seen, to be accepted, and to be allowed to shine for the prosperity of our shared home.”

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Indian Supreme Court orders government to reconsider trans blood donor policy

Transgender people, MSM ineligible to donate under 2017 guidelines

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The Indian Supreme Court on May 14 ordered the central government to consult experts and address policies that label transgender people as “high-risk” blood donors, a designation rooted in assumptions rather than scientific evidence.

“Are we going to brand all transgender individuals as risky and stigmatize them?” said Justices Surya Kant and Nongmeikapam Kotiswar Singh. “You cannot say that all transgender individuals are indulging in sexual activity.”

These restrictions stem from guidelines that the National Blood Transfusion Services, under India’s Health and Family Welfare Ministry, issued on Oct. 11, 2017. The regulations categorize trans people, men who have sex with men, female sex workers, IV drug users, and those with multiple sexual partners as ineligible to donate blood due to presumed risks of HIV, Hepatitis B or C, and require clearance by a medical officer.

The justices considered a petition that contested the constitutional validity of Sections 12 and 51 of the guidelines.

Solicitor General Aishwarya Bhati, representing the central government, stated the rules, which the National Blood Transfusion Council’s panel of medical experts crafted, aimed to prioritize public health and safety without intending to stigmatize any group. The justices during the hearing noted barring trans people from donating blood reinforces their social exclusion, questioning whether these restrictions deepen existing societal biases.

“Just think of something that such feeling does not come, and health standards are not compromised,” they said, granting the government time to address these concerns while maintaining medical safety.

The justices further observed that evolving times and emerging medical technologies offer solutions to screen blood donations for infections without excluding entire groups, allowing broader participation in civic programs.

Bhati said she would relay the court’s recommendations to medical experts for consideration. She explained that donated blood goes directly to blood banks, critical for thalassemia patients and other vulnerable groups who depend entirely on these supplies for their survival.

“As a group, transgenders are considered a high-risk group the world over, with certain exceptions,”Bhati told the justices. “There is a period within which infection has to be identified, and the risk window has to be carefully considered. Nobody can claim to have a fundamental right to donate blood. These guidelines must be seen from the perspective of public health as the idea is not to stigmatize anyone.”

The Washington Blade on Aug. 28, 2024, reported Shariff D. Rangnekar, a gay man from Delhi and director of the Rainbow Literature Festival, challenged the constitutionality of India’s blood donor rules, which bar trans people, MSM, female sex workers, and others from donating blood due to presumed health risks.  

The Supreme Court on July 30, 2024, agreed to hear Rangnekar’s petition that Ibad Mushtaq filed and lawyer Rohin Bhatt wrote. It questions the policy’s reliance on outdated stereotypes from the 1980s. Rangnekar notes the U.S., the U.K., Canada, and Israel are among the countries that have updated their blood donor policies. He urged India to adopt individualized risk assessments. 

South Asian countries have varying blood donation policies for trans people and gay men, with some avoiding blanket bans and others enforcing them. 

Equaldex notes Nepal allows MSM to donate blood without specific restrictions based on sexual orientation or gender identity, suggesting trans people and gay men face no categorical bans. Bangladesh also lacks a specific ban on such donors, although its policies remain ambiguous due to limited documentation.

Pakistan, Sri Lanka, and Malaysia ban MSM and trans people from donating blood, categorizing them as high-risk groups for HIV and other infections.

“It is not just LGBTQIA+ people whose blood can test positive for infections, it could be anybody. All blood that is transfused needs to be tested before transfusion,” said Harish Iyer, a prominent LGBTQ activist in India. “If that is not happening, we have much reason to worry. There is no test on fidelity, regardless of the sex, gender, or sexual orientation. There are open marriages and clandestine affairs that happen in every sexuality. The solution is to speak of safe sex practices and not to take anyone’s word and to test every packet of blood before transfusion.”

Iyer told the Blade that branding and banishing minorities by stereotyping them is an underlying cause of hate crimes. He highlighted that MSM and trans people for years have been seen as simply vectors of HIV, and not as people who lead happy, fulfilling lives. Iyer added the blood donor ban further accentuates this divide and further marginalizes the community.

Iyer said the government should enhance public awareness campaigns around safer sex practices and ensure that all blood undergoes rigorous testing before transfusion. Ankit Bhupatani, a global DEI leader and LGBTQ activist, told the Blade the justices’ directive represents a long-overdue recognition that India’s blood donation guidelines require scientific scrutiny rather than perpetuating stigma.

“By asking the government to seek expert opinion, the bench has opened a path toward evidence-based policy reform. The bench’s observation that labeling all transgender persons as ‘risky’ is troubling, shows judicial wisdom in identifying how these guidelines institutionalize prejudice,” said Bhupatani. “This intervention creates an opportunity to align our healthcare policies with constitutional values of equality and dignity while maintaining necessary medical safeguards.”

He said the 2017 guidelines are a form of structural discrimination.

“Such policies do not merely restrict access to a civic activity; they codify stigma into our healthcare system and reinforce harmful stereotypes about LGBT individuals,” said Bhupatani. “The international trend has indeed moved toward individual risk assessment rather than categorical exclusions. India’s policy remains anachronistic in its approach.” 

“The government absolutely should implement individualized medical screening based on specific behaviors rather than identity,” he added. “The current policy creates the paradoxical situation where a heterosexual person engaging in high-risk behaviors faces less scrutiny than a transgender person in a monogamous relationship. The selective application of supposed ‘public health concerns’ reveals that these guidelines are more informed by social prejudice than medical evidence. Rigorous individual screening would better protect our blood supply while eliminating discriminatory practices.”

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