The transgender community has been part of India’s social fabric for centuries, but decades of policy neglect pushed many into poverty and inadequate health care. 

The Supreme Court formally recognized trans people as a third gender in 2014, yet state-level services developed slowly. Telangana opened India’s first dedicated trans clinic, the Mitr Clinic, in 2021 with support from the U.S. Agency for International Development and Johns Hopkins University. Jharkhand State has now ordered all government hospitals and medical colleges to establish dedicated outpatient units for transgender patients.

People for Change, an LGBTQ organization, spent the past year mapping gaps in trans health care across Jharkhand. Its surveys of 100 trans residents in five districts found limited access to gender-affirming care, hormone therapy, dermatology, and mental-health services. The group followed this survey with a May 2025 consultation in Jamshedpur, an industrial town in Jharkhand, that brought together clinicians and community leaders to outline a feasible outpatient model. 

Those findings were presented to Health Minister Irfan Ansari in June, backed by input from allied organizations and more than 50 trans leaders. The process helped inform the state’s decision to introduce dedicated trans outpatient departments in all government hospitals and medical colleges.

People for Change, which played a central role in shaping the policy, noted that government hospitals in Jharkhand still face infrastructure and resource gaps. Even so, the group said the order reflects a clear policy commitment to creating dedicated trans health services.

If Jharkhand’s trans outpatient departments system functions as planned, it could become a regional model for states with comparable gaps in public health access. 

Government data from the 2011 Census — the latest official count to identify an “other” gender category — lists 13,463 trans residents in Jharkhand, alongside sizable populations in neighboring states: 40,827 in Bihar, 30,349 in West Bengal, 22,364 in Odisha, 18,489 in Chhattisgarh, and 137,465 in Uttar Pradesh. Though likely underreported, these figures underscore the scale of need across eastern and central India.

“The decision to start dedicated transgender OPDs (outpatient departments) is not just an administrative step — it is a statement of inclusion, a recognition that the transgender community deserves discrimination-free, dignified, and responsive healthcare. When the government takes such a deliberate step, it sets a tone for systemic change,” said Souvik Saha, founder of People for Change. “It creates an official entry point for transgender healthcare.”

“For the first time, transgender persons will have a recognized and respectful space within the public health system,” added Saha. “That itself is a major shift. It signals to doctors, nurses, and administrators that transgender health is a priority. This leads to sensitization, accountability, and the gradual improvement of attitudes within hospitals.”

Saha told the Washington Blade the policy is likely to trigger broader improvements, noting that once a service is formally notified, budget allocations, training, infrastructure, and staffing typically follow. He said the move could strengthen the system gradually, “step by step.”

“We are realistic: we know improvements won’t happen overnight. But we are also optimistic because the state has already shown genuine leadership and empathy by issuing this order,” said Saha. “And since Jharkhand is celebrating its 25th year of formation, this decision reflects the state’s intention to move towards greater equality and social justice.” 

“For the transgender community, this is not just a service — it is dignity. It is visibility. It is inclusion,” he added. “And with the government, civil society, and community working together, we believe this will lead to meaningful and lasting change in the years ahead.”

Saha told the Blade that the dedicated transgender outpatient will operate within existing government medical colleges and hospitals in Jharkhand and will be staffed by current medical and paramedical teams, with no separate funding required at this stage. He said the policy does not call for separate wards or beds, but for clearly designated outpatient spaces for trans patients. The service, he added, will be run by existing staff who will receive training and orientation as needed.

“At this moment, the specific operational details are still being discussed with the government of Jharkhand. However, what is clear is: the OPD will function as a dedicated space within the hospital, not limited to a specific day,” said Saha. “Transgender individuals will have access to focused, discrimination-free services through this dedicated space. The clinic will run through existing hospital systems, with linkages to psychiatry, dermatology, endocrinology, and other departments when required.”

“This structure allows the government to start services immediately without needing new construction, new staff positions, or separate budget lines,” he added. “It is a practical and efficient first step, making the service accessible while keeping the doors open for: future budget allocations, specialized staffing, expansions into gender-affirming services, and strengthened infrastructure. The government’s intent is very clear: to ensure dignified, equitable, and discrimination-free healthcare for the transgender community. This order is a strong beginning, and operational details will continue to evolve through collaborative discussions between the government, hospitals, and People for Change.”

Saha acknowledged that taboos, misinformation, and stereotypes about the trans community persist in Jharkhand and in many other states. However, Saha said there are encouraging models at which to look. 

He pointed to Kerala and Chhattisgarh, which have introduced sensitization programs and begun integrating trans-inclusive practices into their public health systems. These examples, he noted, show that when health departments invest in training and awareness, attitudes shift and services become more respectful and accessible.

“In Jharkhand, People for Change has proposed a similar approach. We have formally recommended to the government that civil surgeons, chief medical officer, doctors, nurses, and other hospital staff be trained on gender sensitization and transgender health challenges. This includes understanding gender identity, psychological needs, respectful communication, medical protocols, and ways to ensure discrimination-free services,” said Saha. “The encouraging part is that these proposals are already being discussed in detail with the government of Jharkhand. The government has shown strong intent through the issuance of the transgender OPD order, and training health professionals is naturally the next crucial step.”

Saha noted that it remains unclear whether trans people will be recruited into government health roles, saying it is too early to make any definitive statement. He explained that recruitment requires separate processes, policies, and approvals, and the current order does not address new staffing or the creation of government positions.

A recent performance audit by the Comptroller and Auditor General of India, the constitutional authority responsible for auditing government spending and administration, outlined severe human-resource and medicine shortages across Jharkhand’s public health system. 

Tabled in the state assembly in February, the report found that about 61 percent of sanctioned posts for medical officers and specialists were vacant, along with more than half of all staff-nurse positions and roughly four-fifths of paramedic posts. The audit also documented acute shortages of essential drugs in the hospitals it reviewed, with stock gaps ranging from 65 to 95 percent during the 2020-2022 period. The findings highlight the systemic constraints that the new trans outpatients will have to navigate.

Saha acknowledged that drug shortages remain a serious issue in government hospitals and said the concern is valid. Even so, he added that he is approaching the new outpatient policy with hope and confidence.

“The government of Jharkhand has made a historic and intentional decision by opening dedicated transgender OPDs,” said Saha. “When a government takes such a strong step of recognition and inclusion, it also shows the readiness to understand the specific health challenges and medication needs of the transgender community.” 

“As more transgender persons start coming to the OPDs and their health requirements become clearer through proper documentation and reporting, we are confident that the state will make every effort to ensure that essential medicines are available for them,” he added.

Saha said People for Change is also seeking support outside the public system. The organization has begun briefing civic service groups — including Lions Club, Rotary Club and Inner Wheel, international volunteer organizations that run local welfare and health projects — on the outpatient order and the community’s needs. According to Saha, several of these groups have indicated they may help trans patients with medicines and other essentials when prescribed by a doctor.

“So the effort is two-fold: the government is creating an inclusive health system and will be informed of the community’s specific medicinal needs through the OPDs. People for Change and partners are strengthening the safety net to ensure that transgender persons are never left unsupported,” said Saha. “We truly believe that this collaborative approach will ensure that transgender individuals receive the medication and care they deserve — with dignity, consistency, and compassion.”

“Every hospital may take a slightly different amount of time depending on internal readiness, but overall: The foundational work is already underway, Hospitals have started preparing their designated OPD spaces, And coordination is happening at the level of civil surgeons, medical superintendents, and hospital management teams,” he added.

A same-sex couple on Aug. 14 petitioned the Bombay High Court to consider their challenge of provisions of India’s Income Tax Act that only exempt gifts between heterosexual spouses from taxation.

Section 56(2)(x) of the Income Tax Act states any money, property, or asset received without adequate consideration that exceeds 50,000 rupees ($570.96) is taxed as “income from other sources.”

An exception in the fifth provision exempts such gifts when received from “relatives,” a category that includes “spouses.” The law, however, does not provide a separate definition of the term “spouse.”

The petitioners have asked the court to declare the use of the term “spouse” in Section 56(2)(x) unconstitutional, arguing its application effectively excludes same-sex couples from the exemption.

The Bombay High Court has issued notice to the attorney general of India, the country’s top law officer, on the petition. 

The petitioners, represented by lawyers Dhruv Janssen-Sanghavi, Tejas Popat, Vishesh Malviya, Amandeep Mehta, and Aanchal Maheshwari, argue that denying them the exemption available to heterosexual spouses amounts to discrimination.

“While not entering into the merits at this stage,” observed Justices BP Colabawalla and Firdosh P. Pooniwalla on Aug. 14. “Since the constitutional validity is challenged, we issue notice to the attorney general of India returnable on Sept. 18, 2025. We also direct the registry to issue notice to Respondent No. 2, returnable on Sept. 18, 2025.”

The petitioners told the court that the current framework violates their fundamental rights under Articles 14, 15, and 21 of the Indian constitution, which guarantee equality under the law, prohibit discrimination on grounds including sex, and protect the right to life and personal liberty.

“The Writ Petition is filed to declare and hold that the term ‘spouse’ appearing in the explanation to the fifth proviso to Section 56(2)(x) an unconstitutional inasmuch as it excludes the Petitioners from the scope and definition of the term ‘spouse.'” said the judges. “The declaration is also sought to extend the benefit of the fifth proviso to Section 56(2)(x) of the IT Act to the petitioners who are in a long-term, stable same-sex relationship.”

The judges, as an alternative noted the petition seeks an interpretation of the term “spouse” in Section 56(2)(x) that would extend the exemption to same-sex couples, whom the petitioners argue are in the same position as heterosexual couples presumed to be in a marriage.

The case is scheduled for hearing on Sept. 18, when the attorney general and the Indian government are expected to file their responses.

“Johar judgment of Sept. 6, 2018 gave us the right to love without fear,” said Harish Iyer, a prominent LGBTQ activist in India. “But what good is love if Lady Justice stays blindfolded to our families of choice — beyond gender boxes, beyond marriage certificates.”

Speaking to the Washington Blade, Iyer said the community’s legal journey has been a lifeline rather than a mere timeline, citing milestones such as the Naz Foundation ruling on decriminalization, the NALSA judgment on transgender rights, the Supreme Court’s decision in Navtej Singh Johar, and the affirmation in Puttaswamy that privacy is intrinsic to dignity. 

He stressed each ruling represented a moment of recognition and argued that rights for queer people are not passively granted but continuously upheld in courtrooms, newsrooms, boardrooms, and ballot boxes, requiring constant defense.

“Our fight for our rights is our lifelong resistance,” said Iyer. “Rights are not a given, they are a continuous defense — against erasure, against silence, against the comfort of forgetting. The Puttaswamy judgment reminded us that privacy is not a privilege, but a constitutional promise; and in that promise lives the freedom to love, to live, and to be.”

In response to a question about the impact on the community, Iyer told the Blade the struggle remains exhausting, with constant pressure weighing on both mental health and financial stability. At the same time, he noted a shift, with more voices speaking up and more people joining the fight. Iyer emphasized the Pride flag has been firmly raised and will not be lowered, underscoring the community’s resolve not to back down.

The Supreme Court, in its 2023 ruling that declined to extend marriage rights to same-sex couples, urged the government to create a committee to examine what measures could be taken to extend economic benefits currently available only to heterosexual couples. The court recommended the panel consider access to entitlements — joint bank accounts, pensions, succession rights, and health insurance — so queer couples are not excluded solely because their relationships lack legal recognition.

Ankit Bhupatani, a global DEI leader and LGBTQ activist, said the petition before the Bombay High Court is not only about taxation; but also about dignity, equality, and the need to dismantle systemic discrimination. He noted that this represents precisely the kind of legislative gap the Supreme Court had pointed out during the marriage equality hearing — heterosexual couples are protected while queer couples remain vulnerable.

“This reflects the gap between constitutional morality and statutory reforms. While the Supreme Court in Navtej Johar (2018) declared that LGBTQ persons are equal citizens, and in the marriage equality case acknowledged our hardships, the implementation of those declarations depends on proactive steps by the legislature and the executive. Unfortunately, successive governments have failed to do this work,” said Bhupatani. “It is unfair and exhausting for the community to repeatedly prove our humanity in courts just to access basic rights that heterosexual couples take for granted. Equality cannot be piecemeal; it must be comprehensive.”

Bhupatani further said that the impact is two-fold: emotional and material. 

On the one hand, such discriminatory laws send a message that same-sex love is “less than,” that same-sex relationships are legally invisible. This, he said, takes a toll on mental health and reinforces stigma in society. On the other hand, the financial burden is very real, as many queer couples face unfair taxation, denial of joint benefits, and lack of recognition in matters of property, pensions, and inheritance.

“These are not abstract issues, they affect whether couples can plan their future together, buy a home, or provide for one another in old age,” said Bhupatani. “When the law penalizes queer families, it perpetuates inequality and economic hardship. This case, therefore, is not just about taxes, it is about affirming that queer Indians deserve the same dignity, rights, and protections as anyone else under the constitution.”

A U.S. Agency for International Development funding freeze in January forced the closure of India’s Mitr Clinic, the country’s first transgender healthcare facility, disrupting critical services for a vulnerable population. 

Six months later, the clinic has reopened as Sabrang Clinic, reviving access to essential care for the transgender community.

Major Indian corporations, including some of the nation’s largest multinationals, stepped up with substantial financial support. Their backing has enabled Sabrang Clinic to resume its mission of delivering specialized, stigma-free medical services.

The former Mitr Clinic on May 2 reopened as the Sabrang Clinic. YR Gaitonde Center for AIDS Research and Education, an HIV/AIDS service organization, manages the facility.

The Sabrang Clinic sparked controversy in the U.S. when U.S. Sen. John Kennedy (R-La.) in February denounced its USAID funding, arguing that American taxpayer dollars should not support trans healthcare initiatives abroad. President Donald Trump amplified the criticism, labeling the agency’s spending on such programs as “wasteful” and aligning with his administration’s broader push to curb federal support for gender-affirming care. White House press secretary Karoline Leavitt further fueled the debate, citing the clinic’s funding as part of a pattern of USAID’s “radical” expenditures, while House Speaker Mike Johnson (R-La.) echoed the sentiment, decrying similar international projects as misaligned with American priorities.

Elon Musk, who until May led the Department of Government Efficiency, added to the controversy surrounding the clinic. 

“That’s what American tax dollars were funding,” he said in a Feb. 28 X post. 

His remark, made before his departure from the Trump-Vance administration, spotlighted the clinic’s USAID support, intensifying debates over its role in delivering trans healthcare in India.

The Washington Blade on Feb. 27 detailed how the USAID funding freeze crippled Mitr Clinic’s operations, spotlighting the broader fallout for South Asian LGBTQ organizations. 

The Blade noted the clinic, a vital resource for trans healthcare in India, faced abrupt closure alongside groups in Nepal, Bangladesh, and Pakistan, as the freeze slashed support for programs addressing HIV/AIDS, mental health, and gender-based violence, leaving thousands without access to essential services.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID in 2021 launched Program ACCELERATE, spearheaded by the Johns Hopkins University School of Medicine, to establish Mitr Clinic in Hyderabad in Telangana State. As India’s first comprehensive healthcare center for the trans community, the facility offered tailored medical services, including HIV/AIDS treatment and mental health support, filling a critical gap in the region’s healthcare landscape.

Sabrang Clinic serves a critical role for India’s estimated one million trans people, a population facing a disproportionate HIV/AIDS burden. 

A 2019 Reuters report noted a 3.1 percent HIV prevalence among trans people, translating to roughly 31,000 individuals living with the virus, compared to the national adult rate of 0.26 percent. Similarly, a 2021 UNAIDS report cited a 3.8 percent prevalence, suggesting approximately 38,000 trans people with HIV/AIDS. 

Internal reports indicate the clinic since it opened in 2021 has served more than 3,000 patients. It has become a model of community-led care that fosters trust and addresses the unique health needs of trans people in Hyderabad.

When USAID funding cuts forced Sabrang Clinic’s closure, scores of people and LGBTQ community members in Hyderabad were left without access to reliable, stigma-free healthcare. Undaunted, the clinic’s trans-led team pivoted to virtual consultations and medication delivery, sustaining critical support for patients until corporate funding revived operations.

Tata Trusts, a philanthropic arm of India’s Tata conglomerate, in April pledged to fund the clinic for three years.

The Hindu, a leading Indian English-language newspaper, reported the trust committed approximately $18 per person a year to sustain the clinic’s operations. This contrasts with the earlier USAID program, which had provided about $23 per person each year.

Tata Trusts covers the salaries of Sabrang Clinic’s core medical staff, while its leadership positions are jointly funded by Tata and the clinic’s parent organization. The clinic is now pursuing partnerships with additional donors to expand its trans-focused healthcare services.

“We are elated to continue this service, as we have always believed that sexual minorities deserve respect and their right to self-expression,” said YRGCARE Chief Operating Officer A.K. Srikrishnan. “That’s why we launched Mitr Clinic under Project ACCELERATE in 2021, and it operated until January 2025. The Trump administration’s USAID funding withdrawal forced a shutdown, but we have no comment on that. Fortunately, with great vigor, we secured support from Tata Trusts to sustain Sabrang Clinic. The name change to Sabrang, also called ‘Help for All,’ was simply to reposition the brand, with no deeper logic attached.”

Srikrishnan told the Blade that YRGCARE will aim to raise additional crowdfunding and support if the current funding proves insufficient to maintain the same level of services at the clinic. Srikrishnan also thanked Tata Trusts for its support.

“We want to expand it throughout the country given the choice,” said Srikrishnan. “If someone were to tell us, ‘Can you run it across the country?’ we would certainly love to do it.” 

“Sexual minorities are a reality, and however much someone wishes them away, they exist and need to exist with the respect and rights they deserve,” added Srikrishnan. “We do not differentiate between local and foreign contributions; when we needed it most, Tata Trusts stepped in and helped. So we are certainly grateful to them.”