Veena Singh-048-091 - Review of Literature PDF

Chapter–2
Review of Literature
CHAPTER -2
REVIEW OF LITERATURE
2.1 Introduction
Review of literature is an analytical summary and evaluation of the present
state of facts and information in a peculiar area of research. During this process the
academic literature related to the selected topic have read, analysed, assessed and
precised. This process forms the basis and a source of secondary data for the ongoing
research. The review of related literature helps the researcher in selecting the relevant
variable for the present research, ascertaining the meaning and relationship among
variables and abstaining from any repetition of earlier work done.
The researcher critically analysed earlier research studies in the field of

TG/Hijras, their social status, education, health scenario, legal status as well as
empowerment with regard to know that how can education played a significant role
in upliftment of TG/Hijras. The researcher also investigates the research gaps found
in review of related literature which can be covered through further research.
The reviews are categorised into the following –

I. Studies related to the Socio-Economic Issues of the Transgender/Hijras
II. Studies related to the Education of the Transgender/Hijras
III. Studies related to the Health issues of the Transgender/Hijras
2.2 Studies Related to the Socio-Economic Issues of the

Transgender/ Hijras
The Transgender/Hijra community is completely shunned and not allowed to
mix in the mainstream society. They are destitute of several basic amenities like,
identity documents, education, social inclusion, security, and healthcare services.
The prominent studies concerning about the socio-economic issues of transgenders
are presented under this section.
Review of Literature 38
Roen (2001)1 weighed up the risk of racial marginalization from the

perspective of transgender theory and embodiment in New Zealand and found that it
was significant for transsexuals to keep traditional cultural values by countering
recognition with medical discussions on transsexuality. Study suggested to support
the struggle of transgenders to challenge medical constructions of transsexuality by
the activists for the wellbeing and development of transsexuals.
Laird, et. al (2003)2 examined the participatory assessment from perspective

of transgender research and found that the groups of transsexual and transvestite are
very dissimilar from each other. The study revealed that MTF transsexuals have
alcohol abuse, suicidal tendencies, anxious about gender. The FTM transsexuals
have apprehension about people’s views for them, suicidal tendencies and also
unhappy about body parts. Self hurt and hopelessness were also major issues for
MTFs and FTMs.
Mehra, R. (2005)3 explored the lives of hijras in Delhi and the causes of
their marginalization in society. Researcher contacted NAZ foundation for locating
hijras in the Delhi city and used case study and general group discussions for data
collection. Findings revealed their socio-cultural status, sexuality, identity, their
status as citizens. The study stated the need of various interventions i.e. legal, State,
media, and social work.
Polat, A., et. al. (2005)4 found that in Turkey gender nonconforming
persons discriminated and secluded from family and society. The findings show that
gender identity disorder was first noticed during puberty or pre-puberty. 1/3rd of
them felt accountable for it. While some attempted intimidation to modify the
condition while very few followed a encouraging approach. Most of the families
attempted to hide the condition from their direct surroundings and 1/3rd did not even
want to tell their nearest relations. 50% of the relatives informed through the mass
media and 1/3rd from doctors. Only 40.4% % of the families acknowledged the
transgender identity and accepted the SRS. Family member’s concern during
transgender person’s trans phase is significant for both the family and the anxious
transgender person.
Grossman, A. H. et. al. (2006)5 studied on 31% MTF transgender youth to

explore their gender uniqueness, gender expressions, gender untypicality and
reactions of their parents. Findings show that they experienced their peculiarity at
the age of 8 to 9 years and majority of them stated about parental abuse during their
early days.
Bryant, et al. (2008)6 administered an online survey of TG persons in

Australia and New Zealand. The findings show that majority of TG participants had
tried to amend their documents to show their gender identity. Some of them reported
denial of bank laboutoan and housing, physical abuse. Participants stated higher
rates of depression than the general population of Australia.
Khan, S. I. et al. (2009)7 found that Hijras of Bangladesh have no dignified

life. They faced tremendous oppression and abuse (physically, verbally, and
sexually) this causes low self- confidence and self worth in them. The study
suggested that Hijras should be recognised as another gender along with two gender
norm of society and their citizenship rights also guaranteed.
Roch, et. al. (2010)8 analysed the survey data of sixty transgender
respondents in Scotland and found that eighty percent of respondents had
experienced emotional, physical, or sexual abuse. Of these respondents, only sixty
percent labelled these behaviours as domestic violence. This research also focused to
discover some of the hurdles experienced by transgender persons facing domestic
abuse when obtaining domestic abuse services.
Govier, E. et al. (2010)9 studied the working of brain of sixty-eight

transwomen and twenty-six transmen by analyzing their performance with thirty-six
male and twenty-eight female controls on two indicators of cerebral lateralization:
dichotic listening and handedness. The findings show that the transwomen’s dichotic
pattern significantly similar to the control female pattern but the transmen’s dichotic
performance not significantly similar to the control male performance. There is
significantly more inclusive right-handers in both transwomen and transmen groups.
The neuroscience plays a significant function especially in the development of the

MtF trans-condition.
Loh, J. (2011)10 explored the religious practices among the Hijras of India.
The study found that the main focal point of academic research related to Hijras had
been theirsex or gender status The study noticed that in India the Hijras are
marginalized people in society.
Sivakami, et. al. (2011)11 conducted an interview on 120 transgenders of 20-

70 years old in Coimbatore to know their soci-economic status and nutritional status.
The study revealed that transgenders suffered from mental stress due to non
acceptance and humiliation from society.These mental conditions affected their food
intake routine. The common diseases known among transgenders are blood pressure,
high blood sugar and HIV/AIDS.
Kalra, G. (2011)12 studied the social-cultural aspects of hijra community.

Researcher found that this community followed strict hierarchy with large groups of
hijras from different areas forming different houses called gharanas. The awareness
about HIV/AIDS among TG community is increased among transgenders and
medical professionals but their psychological wellbeing is neglected.
Moumneh (2011)13 evaluated the level of transsexuals in the Middle East

and professed that there was a kind of moral terror over transgenders in the area
concerned. Study requested the policy makers to modify their way of thinking
towards transgenders to maintain principles of humanity in society.
Turell et al. (2012)14 found that transgender community members had a

vague awareness of intimate partner violence within their community, and a low
level of community’s readiness or motivation to address intimate partner violence.
This study recommends that there is a need to increase the awareness among
transgenders about intimate partner violence and readiness to address it.
Sharma, P. (2012)15 justified the demand of legal status of this powerless

and abandoned community of transgenders. Men and women of our country have
benefitted by numerous welfare schemes of the Indian government but the third sex
deprived of this because of their no legal status. The Indian constitution contains
certain prohibited grounds of discrimination such as race, caste, creed, sex, etc., but
not particularly contains sexual orientation.
Kisha, B. G. (2012)16 compared the correlation among attitude of youths and

attitude of adults towards transgender to recognize the major dissimilarity in the
research variables. Result of study shows positive attitude of the adults towards
transgender than the youth. Females have better attitude towards transgender than
males. There is no significant difference between college boys and college girls also
no significant difference between persons related with religions namely Christianity
and Hinduism.
Lenning, E. et. al. (2012)17 used narrative analysis to study the social,
economic and psychological challenges experienced by transgender persons and
their loved ones. The findings suggested that there should be awareness about the
interconnectedness of these problems for their empowerment and positive change in
lives.
Mrinalini, S . (2013)18 explored the social configuration, their perception
towards their effeminate character and their aspirations among transgender people in
four blocks of Villupuram district. The study revealed that about 1/3rd transgenders had
not undergone emasculation also not fascinated for it. All of the participants were
fairly contented and positive about their transgenderism. Majority of participants
reported that their transformation procedure occurred at pubescent stage and seldom
at adult stage. Most of them were aware that for achieving their aspirations it is
essential to collaborate and intermix with society.
Saveri, S. F. (2013)19 investigated the beginning of transgender movement

and different issues related that the o it. The findings show that main transgender
activists belong to urban areas and well educated with good English fluency are
privileged groups who guide other transgender people with broad-minded outlook
towards their empowerment. But the underprivileged transgenders belong to ruaral
areas, having low socio-economic status, illiterate or school drop-outs, linked with
aravani jamaat and are beneficiary of services from NGOs, CBOs and government
welfare policies. The state of Tamil Nadu has given citizenship to transgenders as
aravani and furnishing free sex reassignment surgery for them
Nanjundaswamy, S. (2014)20 found that male to female transsexuals in

Karnataka state subjected to persistent inequity in almost all fields of life, numerous
financial restrictions, various health threats, infringement of human rights.
Abbas, T. et al. (2014)21 conducted a research on social adjustment of

transgender in district Chiniot of Pakistan. The study highlighted their social,
cultural, political, psychological, individual life and the effect of factors i.e. age,
family type, family size and education on social adjustment. The result of research
showed that the high aged transgenders were more socially adjusted than low aged
transgenders, the highly educated transgeders more adjusted in society in
comparison to less educated and illiterate transgenders. High income respondents
were more socially adjusted than low income respondents. A great majority of
respondents wanted to get education and separate schools for transgenders.
Researchers suggested that government should take initiative to built special schools
SATs (social adjustment of transgender in schools).
Leelavathy. K. (2014)22 empahasized on the social, economical, legal and

political problems experienced by transgender people at their work place. This paper
proposed some schemes for such problems such as- reservation in appointments for
transgender, establishment of anti- discrimination policy and anti-sexual harassment
at place of work, 3 months maternity leave to those transgender who adopted child,
medical leaves for sex reassignment surgery, counselling for their mental tensions.
There is need of sensitization among society about transgender identity.
LGBT Weekly, (2014)23 analyzed local TG women’s legal and social

environment in Thailand. The report highlighted the limited education about
transgender women issues in schools. Most of the Thai TG women hide themselves
and also not revealed their gender on identity papers. TG women students faced
humiliation and abuses in schools despite the fact that Thailand’s law forbids
discrimination against citizens on any grounds. There are laws for relationships or
parenthood and laws on marriage only for heterosexual couples not for TG women.
Johnson, S. L. et. al. (2014)24 explored the experiences of parents of

transgender children. Due to insufficient knowledge they look for other well-
informed resources to improve knowledge on their children’s mental state during
trans phase and to help them. Parents try to find the suggestions of other parents of
transgender children, make efforts to aware the family and society on transgender
issues, work with health care providers for the appropriate concern of their child
besides this looking for support services for their child.
Kuvalanka, K. A. et al. (2014)25 interviewd five mothers of transgender

girls. Findings point out that these mothers also experienced their own
transformation from least knowledgeable to most knowledgeable about issues of
transgender children throughout observing the transition phase of their children
which also helped them in changing the outlook of family and society.
Sudha, M. (2015)26 found that thirty five percent of participants had felt
harsh transgender identity stigma, whereas forty nine percent of participants had felt
reasonable stigma. Only 44% of participants felt good quality of life (QOL), while
35% of participants reported very poor QOL. The QOL of participants depended on
their acceptance or non acceptance by their family members.
Athreye (2015)27 argued that transgender people constitute the marginalized

section of Indian society and face lots of legal, social as well as economic
difficulties. Their families avoid to accept their TG children, most of these children
have left their school because of ill treatment by peers as well as by teachers, have
very limited access to health services and public spaces. But some of the
transgenders have excelled in various fields despite many barriers.
Leonard, W. et. al. (2015)28 compared the psychological wellbeing of

LGBT and conventional communities. Also studied the variations in psychological
wellbeing and resilience amongst LGBT members. Findings showed that
psychological wellbeing enhanced with age for most of the gender identity and
sexual identity groups. Mental tension reduced with age among male to female
transgender, while in female to male transgender stayed steadily high in all age
groups. In all groups resilience raised with age. The psychological stress was closely
related to low socio-economic status of LGBT participants. Among LGBT
participants the rate of drug abuse was more than participants of general population.
Male to female transgender accessed more mental health services than female to
male transgender.
Seelman, K. L. (2015)29 studied that transgender persons generally

discriminated and experienced problems in obtaining domestic violence and rape
crisis services. The findings show that those transgender persons who have low
income, have psychosocial risk factors and who are not citizens of U.S. faced more
discrimination in above mentioned services. TGs with disabilities faced more
discrimination in domestic violence services.
Chettiar, A. (2016)30 explained socio-economic status of Hijras, their ill

treatment by police and health professionals in Greater Mumbai. The result of study
shows that about sixty percent of hijras belong to the middle class and about forty
percent belong to the upper-lower class. Majority of hijras suffered from AIDS,
experienced victimization by railway and traffic police. Hijras prefer to visit private
clinics instead of government hospitals because of the insensitivity of government
health professionals. Researcher emphasised on the need of reforming the guidelines
and curriculum in medical colleges by the Indian Medical Council (IMC) and Indian
Council for Medical Research (ICMR).
Oommen, M. A. (2016)31 differentiated between the term transgender and

intersex people. This article sketched out the different problems faced by
transgenders in India i.e. zero acceptances by their biological family, extreme
discrimination and harassment in getting education, medical facilities and their basic
rights. This study emphasised that the acceptance of transgenders by the Supreme
Court of India and redrafting of the Rights of Transgender Persons Bill, 2014 helped
this marginalized community to live with dignity.
Andrews, D. T.G. (2016)32 analyzed the dimensions of victimization of

transgender people that includes biological, psychological, sociological and legal
and also its effects on the permanent resident and migrant transgender people in
thoothukudi district. Findings show that there is no noteworthy difference between
the biological dimension of victimization and educational qualification of the
permanent resident transgender people and migrant transgender persons of
Thoothukudi district.
Barrett, B. J. et. al. (2016)33 examined the intimate partner violence (IPV)
within transgender community which is under researched than the IPV in GLB
persons. The study found the practical ,socio-political hurdles in conception of
awareness of IPV among transgender persons, incidences of IPV committed against
or by TG persons and misuse of trans terror as protection by perpetrators of IPV in
legal contexts. The study suggests to help TG survivors of IPV in comprehensive
and trans- friendly manner.
Riggs et al. (2016)34 assessed the effectiveness of workshops for enhancing

the capabilities of service providers to support those TG women who had faced
domestic violence and abuse (DVA) in South Australia. domestic violence workers,
from three different domestic violence service providers The result of study
demonstrated that after attending such workshops the domestic violence service
providers , exhibited high encouraging attitudes, more comfort, and higher
confidence in working with TG women. Hence such training workshops an services
are of utmost importance for TG women facing DVA.
Divan, V. et. al. (2016)35 explained that the United Nations Development
Programme (UNDP) furnished literature of transgender community’s human rights,
health issues, socio- economic issues and also mentioned solutions for these
problems. This document addressed to countries to take actions immediately to
tackle the infringement of human rights of TG persons, prevalence of HIV, poverty
and humiliation. Suggests to encourage social acceptance, superior health services,
impartiality and socio-economic development.
Sawant, N. S.(2017)36 stated that Indian government has taken various

welfare measures for the transgender people which include census, certification,
providing citizenship ID Cards, passports, housing facility, legal measures, police
reforms, legal and constitutional safeguards to prevent infringement of human rights
of the third gender persons and institutional mechanisms to address unambiguous
concerns of transgender people.
Virupaksha, G. et. al. (2018)37 studied the resilience among transgender

people. The results show very inferior resilience in TGs. There are various factors
related to better resilience as living with their biological families, advance education
and employment. Study suggested need of more focus on resilience and increasing
the factors associated with better resilience status.
Papazian, N. A. (2018)38 examined the domestic violence in the TG

population in Queensland and found some uncommon experiences of cruelty which
were not happened in fierce relationships of cisgender partners. These uncommon
issues associated with phases of transition and susceptibility to oppression and
individuality issues that appear with transitioning whilst in a relationship.
Naved, A. (2018)39 analysed the social inclusion and human rights of

transgender and hijra in India and Bangladesh and also compared their conditions in
both countries.
Garthe, R. C. et. al. (2018)40 explored that young transgender women

(YTW) subjected to unequal and different types of intimate partner violence (IPV)
than cisgender persons. The findings illustrated that the experiences of childhood
abuse as well as ill-treatment, bigotry, and exploitation due to their gender
orientations were high among YTW and these were linked to high vulnerability for
IPV among them. . The results of study will helpful for domestic violence service
providers and other health professionals to help young transgender women in coping
with IPV and other psychological problems.
Mishra, S. et. al. (2018)41 found that family of transgenders is accountable

for their marginalization, prejudice and omission because family discarded
transgender children. They have no rights of property, adoption and other basic
rights in India.
Ng, Sameeta, et. al.(2018)42 found the connection between socio-

demographic factors and subjective well-being among fifty transgender aged 18
years and above, in Manipur. The results show no significant connection between
the subjective well-being and socio demographic parameters like age, educational
qualification, profession, dwelling and outlook of family.
Konduru, D. et.al. (2018)43 defined the problems of transgender’s socio-

cultural elimination and addition , their growth and attitudes of society towards
them. Even after Supreme Court recognised transgender as third gender they still
face elimination from social, cultural, political and economic fields. Society should
have positive attitude towards them and accept them for giving dignified life.
2.3 Studies Related to the Education of the Transgender/Hijra

Review of various studies revealed poor educational level of
transgender/hijra community and barriers to access education because of
discrimination and victimization in educational institutes.
Harris (2005)44 identified that transgender students have faced verbal

harassment four times than other students due to their sexual orientation and gender
identity.
Beemyn, B. et. al. (2005)45 found that the educational institutions are now
starting to think about the requirements of transgender students but only some are
aware of how to recommend help to them. This article deal with issues and gives
recommendations for student relationships professionals.
Rye, et. al. (2007)46 emphasised on real life experiences for TG students
through inclusion of education. stated that perspective about transsexuals may be
changed into supportive and compassionate ones by inclusion of transgenders in

education hence other students can have real life experiences with transgenders.
Antoszewski, B. (2007)47 found that the female students have more

awareness and consideration for transsexuals than male students in Lodz college.
The perception of students was supportive regarding transsexual’s legal and surgical
sex change.
Macgillivray, et. al. (2008)48.stated that the fundamentals of educational

textbooks can depict LGBT content in such a way to support positive image of this
neglected community by follow these categorization - prejudice and pestering
against LGBT people, LGBT identities and experiences, historical background,
families, lawful issues, individual view point and resistance.
Greytak, E. et. al. (2009)49 investigated the experiences of transgender

students in non supportive school environment and effect of their exploitation on
academic performance, their involvement in school commune and make contact
with the resources. The study found that transgender students constantly suffered
more harassment and physical assault in schools and very high percentage of suicide
attempts in comparison to their non-transgender fellow students. The study suggests
that teachers and policymakers try to understand the peculiar experiences of
transgender students and execute strategies to make school safe and friendly for
LGBT students.
Rands, K. E. (2009)50 emphasized on the inclusion of transgender related

issues in teacher education, so that teachers can explain gender in more elaborated
ways and also discuss the presence and needs of transgender persons.
Toomy, et. al. (2010)51 reported that the school victimizaton of LGBT
students is strongly linked to mental health of young adult and risk for STDs and
HIV. The high rate of school victimization of LGBT caused high levels of
depression and suicidal tendencies. Verbal harassment can caused inferiority
complex, social avoidance and anxiety problem among LGBT.
Toomey et. al. (2011)52 investigated that awareness of Gay Straight

Alliances efficiency is increases the college level educational achievement and
decreases hopelessness and dependence on illegal substance. The existence of GSA
is linked with feeling of safe school atmosphere and also welfare of student, that
maintains into later life. The transgender persons can approach to GSAs or other TG
community based programs for problems during their coming out.
Singh, A. A. et. al. (2011)53 discovered the five common themes of

resilience in twenty one transgender persons, attained by semi- structured interviews
and Focus Group Discussion. These themes are a self-produced definition of self,
accepting self-respect, knowledge of ill treatment, association with a concerned
community and developing aspirations for forthcoming time. The study also
identified two variant themes i.e. social activism and as an optimistic role model for
other transgender people.
Kosciw, J.G. et. al. (2013)54 investigated the influence of negative climate
of school on achievement and the role of school-based supports which compensate
these influences, on LGBT individuals of secondary school in United States. The
result exhibited that exploitation amplified the lower academic achievements and
deflated self-worth, while school-based supports helped to lower the exploitation
and improve academic achievements.
Aragon, S. R. et al. (2013)55 highlighted the findings of a survey conducted

on students of high school to examine the relationship between victimization and the
academic outcomes of truancy, post- high school intentions and grades for lesbian,
gay, bisexual and transgender students and questioning of LGBTQ and non-LGBTQ
students. The results showed that LGBTQ students reported higher truancy, greater
intentions not to complete high school and lower intentions to join a four-year
college. Thus victimization is a very important factor responsible for the educational
disparities between LGBTQ and non- LGBTQ students.
Savage, T. A. et al. (2013)56 emphasised on the importance of school life in

every children’s lives. The school administration, teachers, school counsellors
should have acquainted with the issues and challenges experienced by lesbian, gay,
bisexual, transgender and queer students in school. It is their responsibility to make
and sustain safe, violence free and compassionate schools for LGBTQ students.
Payne, E. et al. (2014)57 revealed the experiences of elementary school

professionals with transgender children in elementary schools. The results show that
majority of participants stated their apprehensions of the transgender identity and
breach of two norms gender system, but this mental state restrains the probabilities
for schools to proclaim transgender identity.
Orr. (2015)58 studied that harassment and abuse in educational institutes had
negative effect on physical and mental health of TG or gender non-conformity
students. They faced biasness, discrimination at work place, housing discrimination,
felt uncomfortable in getting police assistance, physically assaulted in jails or
prisons and sexually assaulted, refusal of medical care facilities due to their
transgender or gender non-conforming status.
Snapp, S. D. et. al. (2015)59 studied the experiences of students about the
LGBTQ-inclusive curriculum. The results of study show that generally LGBTQ-
inclusive curriculum was included in social sciences and humanities subjects but
hardly ever connect values of societal justice learning, although circumstances for
decisive dialogue about exploitation frequently appeared. Few students gained
positive understanding from LGBTQ lessons and showed the ways such curriculum
exhibited their identities and formed a helpful school climate.
Asmy, V. S., et. al. (2015)60 examined the socio-economic status and hurdles
in education of the third gender community. Although having constitutional
guarantees this community deprived from their basic rights i.e. right to personal
liberty, dignity, right to education, empowerment, right against violence,
discrimination and exploitation. The study emphasised on the need for a progressive
environment to explore educational and employment opportunities. The efforts with
adequate fund support should be made to serve as a link to employment
opportunities. Banning the use of verbal abuse against TG community in media,

movies and television.
Abreu, R. L. et. al. (2016)61 described the circumstances of school bullying

of LGBTQ students and pointed out the laws and policies which restricting the
requisite care of LGBTQ students require to improve their school and mental
outcomes. This article explored the role and professional ethical responsibilities of
school counsellors in avoiding LGBTQ bullying and developing a safe school
climate. Lastly, the LGBT antibullying interventions which can be implemented by
school counsellors are scrutinized.
Dugan, J. P. et al (2016)62 furnished the basic knowledge about the

transgender students and their views, participation and educational consequences
related with college atmosphere. The TG student’s educational outcome, their
perceptions of safety and belongingness was very low in comparison to their peers
(non-transgender LGB and heterosexual). The experiences and requirement of TG
students are not similar to the LGB students. The MTF and intersex students are less
mentored by the faculty members due to the lack of knowledge about LGBT
individuals.
Peter, T. et al (2016)63 explored the relationship between suicidal tendency

and school climate among LGBTQ youth in Canadian school. The results show that
even small efforts to give more understanding to the issues of LGBTQ have
remarkable effect on the experiences and perceptions of LGBTQ youth which
results in the lowering the suicidal tendencies among them. The inclusive policies
for LGBTQ endeavoured to upgrade the school climate and lower the effects of
homophobia and transphobia in schools.
Jones, T. et. al. (2016)64 studied the school experiences of Australian

transgender and gender diverse students with specific thought of acknowledgment of
their gender identity in documents, experiences of teenage years and sexuality
education, dealing by school staff and peers. Findings show that proper language
used by school teachers can sustain security and academic performances of TG

students.
Islam, M. A. (2016)65 has found in his study that the hijras of Bangladesh
have got the recognition as third gender but still they have no educational facilities.
The study suggested need to take instant steps to give equal opportunity in
education, medical facilities and employment. By giving reservations in government
jobs, making transgender friendly educational institutions can boost their upliftment.
The government, society and NGOS should give their full support to safe guard
transgender’s right to education.
Taylor, et al. (2016)66 found troublesome disparities related to inclusive

education of LGBTQ in thinking, awareness, and procedures of educators worked in
Canadian public school’s Kindergarten to Grade 12. T his study suggests to measure
these disparities by taking into account of emanating best procedures for inclusive
education of LGBTQ. Efforts should be made for positive school atmosphere for all
students, LGBTQ students and students with LGBTQ parents.
Swanson, K., & Gettinger, M. (2016)67 focused on the relationship among

three school-level supports for LGBT students and teacher’s awareness, attitudes,
and conduct regarding LGBT youth. The findings of this study show that teachers
stated more occurrences of involvment in activities to support LGBT students while
working in a school with an active GSA. Although recognized the necessity to help
LGBT youth, teachers may not always get involved on account of LGBT students.
Rajkumar. (2016)68 highlighted the need for a decisive researches and

educational tasks to create more data to recognize and aware of the problems related
to their life and assist in making strategies through research and educational tasks
that would carry an efficient and positive change in their lives.
Parveen and Chandra (2017)69 explored that there was a significant

difference among trainee teachers in their attitude towards transgender persons on
the basis of gender and also on the basis of educational qualification (UG and PG)
but there was no significant difference among trainee teachers in their attitude
towards transgender persons on the basis of locality.
Chandra, S. (2017)70 stated that addition of transgender children or

individuals in conventional education structure requires satisfactory learning
atmosphere or social acceptance. The study suggested teacher training programmes
should be updated by adding up issues related to transgender community in their
curriculum to sensitized the pre-service and in- service teachers in dealing of
transgender students in classes.
Raj,T. S. (2017)71 investigated that tansgenders were subjected to

discrimination both in their school lives and their depiction in textbooks. All
respondents reported about their social exclusion. Even the NCERT text books and
New Education Policy also continue to ignore TG children.
Ullman, J. (2017)72 investigated the statements of transgender and gender

diverse secondary students and revealed that the positiveness of teachers had
remarkable effect on gender diverse student’s feeling of attachment to their school
setting. The study emphasized the necessity of teachers to be erudite and
proclaiming of gender diversity.
Wells, K. (2018)73 investigated the experiences of three MTF transgender

teachers who had undergone transition in in 1980s, 1990s and 2000s, though
dynamically teaching within Canadian K–12 public schools. These TG teachers
evolved contradictory narratives to confront conventional discussions of trans
anonymity, stillness, humiliation, and horror.
Forhard-Dourlent, H. (2018)74 examined participation of transgender

students in decision-making processes at their school and reply of educators to the
requirements for acknowledgment by transgender students. There should be gender
neutral educational settings.
2.4 Studies Related to the Health of the Transgender/Hijras

The Transgender/Hijras are socially, educationally and economically
marginalized people. They have faced consistent discrimination also in health
sector.. Majority of them have HIV positive status with multiple health threats. They
are also deficient of medical facilities due to social non- acceptance. They have no
medical insurance and healthcare facilities. The notable studies concerning the
health issues of transgender/hijras are presented under the following headings.
Studies Related to the Psychosocial Disorders

Lombardi, E. (2001)75 stated that transgenders faced problems in obtaining
the health care services. The requirements of transgenders are different from other
members of society hence the relevant treatments and strategies are provided to
them. The study suggested that society should accept the transgender identities and
discrimination and refusal of services to transgender should not be tolerated. There
should be encouragement for researches related to TG health care, promotion of the
awareness about intersexed persons and rejected out the practice of surgeries on
intersex children and infants.
Couch, M. et. al. (2007)76 surveyed to examined the health and wellbeing of
transgender persons of Australia and Newzealand. Findings show higher rate of
depression in transgenders than depression present in the general Australian
population. All participants try to find recognition in the health care sector.
Winter, S. (2007)77 explored transphobia in seven countries and found that

transwomen diagnosed with mental disorder, not considered as women and must not
furnished with rights of women, non acceptance by family and teachers, by their
colleagues and involved in atypical sexual conduct.
Kim, et al (2007)78studied psychological status, health-related QOL in forty

FTM and MTF transgender persons. Study shows health-related QOL is remarkably
very low in participants in comparison to the Korean males and females. Female to
male transgender respondents are more unfriendly and fearful than male to female
transgender respondents. Sex reassignment surgery make better their quality of life
and stable mental level.
Kelleher, C. (2009)79 studied the psychological distress among LGBTQ

youth due to minority stress on them in Ireland. In this study the three factors of
minority stress i.e.sexual identity suffering, stigma awareness and heterosexist
experiences were measured. The findings show that the harsh societal surroundings
produced due to transgender identity-related stigma harmfully affects the welfare of
LGBTQ youth. This study is helpful for medical professionals and strategy makers
who concerned for the LGBTQ youth’s problems related to minority stress and will
help in the growth and modify the interventions to come within reach of LGBTQ
youth.
Riddle-Crilly (2009)80 explored that the alcohol, drugs and suicidal

tendencies not the identifiable causes to low self-esteem of LGBT persons but they
acted as problem increaser to the identifiable causes.
Mustanski, B. S.et. al. (2010)81 analyzed the relationship of race, gender,

and sexual orientation with mental disorders among two hundred forty six LGBT
youths aged 16 to 20 years. It was found that the transgenders had Post-Traumatic
Stress Disorder (PTSD), deep depression and attempted suicide at some point of
their lives. They had low self-esteem than biological males and females.
Nuttbrock, et. al. (2010)82 investigated the psychological effect of

interpersonal abuse and gender related abuse during five phases of life span of male
to female transgender people of New York City Metropolitan Area. Results show
that the effect of both types of abuses on the depression of the younger and older
participants was very powerful at their adolescent stage but in case of younger
participants it noticeably reduced in later phases of life and in case of older
participants it decreases slightly in later phases of their life. Both types of abuses
exerted not so strong influence on suicidal tendencies but more steadily noticed
during the life span of younger and older participants.
Ahuja, A. et al. (2015)83 analyzed the relationship between anti-LGBTQ

bullying and psychological sickness and recognized means to support these patients.
Study suggested that they should be informed about strategies to fight with this
bullying.
Scandurra, C. et. al. (2018)84 studied the effect of internalized transphobia

as a intervenor between anti-transgender discrimination and psychological health
and analyzing resilience as the personalized coping method mitigating this
connection on one hundred forty nine TGNC Italian persons. The result shows that
humiliation and hostility intervene the bond between anti-transgender discrimination
and despair whilst only while only hostility intervenes the bond between anti-
transgender discrimination and nervousness. Moreover, the indirect bond between
anti-transgender discrimination and nervousness through hostility based on small
and reasonable levels of resilience.
Discrimination in the health care services

The transgender/ Hijra community expressed the negligence, harassment and
denial of health care services in health sector towards them.
Gupta, R. (2004)85 explored the main reasons linked with marginalization of

transsexuals from health and welfare spheres as traditional gender norms of society,
poor economic conditions, unemployment, discrimination and their vulnerable lives.
Reddy, G. (2005)86 argued that public health sector’s incompetence to

understand the different needs of MSM and Hijras decreases the productiveness of
prevention programmes for STDs and HIV/AIDS. This paper suggested to rectify
the inequity in health care services.
Grossman, A. H. et. al. (2006)87 used three focus groups to explore factors
that affect the experiences of transgender youth of age 15 to 21years. Majority of
participants were aware about their transgenderism at their adolescent stage and
were subjected to harshness for their gender unusual behaviours, as well as
uncertainty among their gender identity and sexual orientation. Participants stated
about their susceptibility in health services as deficiency in of secure environments,
meagre access to physical health services, insufficient resources to tackle their

psychological problems, and inconsistency in care taking by their own families and
society.
Coleman, E. et. al. (2011)88 explained effectiveness of the Standards of Care

(SOC) in giving medical assistance for medical professionals to help transsexual,
transgender, and gender nonconforming people with secure and efficient ways to
attaining long-lasting individual ease with their gender to escalate their physical
health, mental health, and self-contententment.
Chapman, et al. (2012)89 explored the experiences of eleven LGT families

accessing health care for their children in Australia. The health care providers have
limited knowledge about lesbian, gay, transgender families and their needs hence
they show stigma towards them. This study suggested that health resources should
be compassionate and inclusive for LGT families.
Studies Related to Sex Reassignment Surgery (SRS)

Lawrence (2003)90 stated about transsexual’s enhanced QOL after sex
reassignment surgery. The regret is linked with the unsatisfactory physical and
functional results of SRS.
Yuksel, S. et al. (2007)91 showed that female to male transgender

respondents who had undergone hormone therapy better having QOL in comparison
to those who had not undergone hormone therapy. Both had normal psychological
level, better quality of life and stable mental level.
Kumta, et. al. (2008)92 studied on the men who have sex with men (MSM)
and male to female (MTF) transgender in Mumbai. The findings show that high
prevalence of HIV, and sexually transmitted diseases in transgenders may due to
painful anal sex and self medication. The wives of MSM also infected with STIs.
This study suggested that there is need to pay attention on education and preventive
measures for MSM and TGs.
Parola, et al, (2009)93 evaluated the influence of reassignment surgery on

opinions of female to male and male to female transgender patients. The findings
showed that female to male patients had reported more enhanced social,
occupational and cordial life in comparison to male to female patients. The quality
of life of reassigned transgenders did not affected by personality factors.
Ainsworth and Spiegel (2010)94 investigated the self-reported quality of life

of MTF transgender persons and the effect of facial feminization and gender
reassignment surgery on the QOL. The general female population and transwomen
who had gender reassignment surgery (GRS), facial feminization surgery (FFS) or
both had better mental health related QOL in comparison to TG women who had not
taken GRS and FFS.
George, A. et al. (2015)95 emphasised that quality of life shows that majority
of the transgender participants (45%) perceived that they have a good quality of life.
Thirty five percent of the participants perceived their quality of life as neither poor
nor good, about 13.3% of the participants perceived a very good quality of life and
about 3.3% of the participants perceived their quality of life as poor and very poor.
Sixty two percent of the respondents had reported that they are satisfied with their
health. Seventeen percent of them said that they are neither satisfied nor dissatisfied
with their health.
HIV/ AIDS
Nemato,T. et al.(1999)96 studied the interrelationships between HIV risk
behaviours and social and cognitive factors among MTF in comparison with
homosexual or bisexual males and heterosexual females. Results show that MTFs
involved in more perilous conducts than the other categories in terms of the number
of sex partners, prostitution and having a stable sex partner who administered drugs.
Clements-Nolle, et al. (2001)97 investigated that HIV prevalence and risk

behaviours were less in Female to Male Transgenders (FTM) in comparison to the
Female to Male Transgenders (MTF). MTF had more mental stress than FTM but
equal percentage of both had attempted suicide.
Operario, D. et al. (2005)98 showed that the full time TG sex workers and
drug (methamphetamine) users having more risk behaviours than the casual sex
workers and non-methamphetamine users. The susceptibility to HIV/AIDS raised by
the combination of sex work and drug abuse. The study showed that under the effect
of alcohol and drugs the participants more involved in sex work with customers
rather than private partners. The study recommends the proper treatment for
substance abuse should be provided to this neglected group.
Nemoto, T. (2016)99 studied twenty four male-to-female transgender sex

workers in Bangkok. Findings show that kathoey sex workers subjected to perilous
situations in various sex work venues. Study recommends that HIV prevention
programs for kathoey should focus on the significance of their monetary safety and
its connection with social help and gender transition within a cultural and work-
atmosphere particular frame.
Teh, Y.K.( 2008)100 showed that the main causes of HIV prevalence in
transgenders are as no deep knowledge of HIV/AIDS, unprotected sex, absence of
HIV prevention policies. Authorities harassed the maknyah population for their sex
work activities.
Meier, et. al (2011)101 focused on understanding the positive factors

associated to gender assertion treatments. They examined the relationship of
hormone replacement therapy, specifically testosterone, in relation to various mental
health outcomes in an Internet based sampling of more than 400 self-identified
female-to-male transsexuals.
Mikalson et al, (2011)102 carried a study to determine racial or ethnic

differences in social support and exposure to violence, transphobia and explored
correlates of depression among MTF transgender women with a history of sex work.
About 3/4 th of the participants expressed ever having suicidal tendency, sixty four
expressed suicide attempts. About 50% of the respondents expressed being
physically assaulted and thirty four percent expressed being raped before age of
18yrs. Non acceptance from their own family caused discomfort and lack of security
in public places. Social supports, transphobia, suicidal tendency, levels of income,

level of education were significantly and independently correlated with depression.
Chakrapani, et.al. (2011)103 analysed the obstacles to free antiretroviral

treatment availability among kothi (MSM) and aravanis in Chennai. The findings
exposed that the primary individual-level barrier was closely related to the family or
social and health care system. Study recommended a national policy to deal with
obstacles to antiretroviral treatment availability at family/social, health care system,
and individual levels for aravanis, kothis, other subgroups of MSM and other
marginalized groups.
Sahastrabuddhe, et.al. (2012)104 identified the prevalence of HIV and

sexually transmitted infections (STI) in Hijras. Males involved in sexual relationship
with TGs identified as risk group for STIs and HIV.
Bhagabati, K. (2012)105 conducted a qualitative descriptive study on

transgender community to discover the vulnerabilities to SITs and HIV/AIDS. The
findings of the present study show that denial, isolation and unfriendliness
experienced by hijras since birth which leads them to self exclusion. According to
SEKN model of social exclusion TG/Hijras are excluded socially, culturally,
politically and economically. Researcher suggested to promoting safe sex among
TGs and try to bring them in mainstream society.
Sharma, G. (2013)106 studied the clinical features, co-morbidities, quality of

life and socio-economic status of thirty five HIV positive male to female transgeder
( 17 pre ART and 18 on ART) of age group 22 years to 50 years. The participants
were assessed for clinical features subjected to the testing of syphilis by using
VDRL titres and TPHA test. The findings revealed that urban 42.8% belong to
upper middle class and 57.2% belong to lower middle class. All participants’s main
source of income was begging and among them thirty one percent indulged in
commercial sex work. Most of them were illiterate and alcohol addiction was
common in them. The social domain achieved minimum because very few of the
participants revealed their HIV positive stage within the community, some had not
because of the fear of prejudice due to HIV status. The poorer social and physical
domain of quality of life is also due to alcohol addiction. The literacy status had no
significant correlation with quality of life because despite their literacy level all of
them had same source of income i.e. begging and prostitution.
Kosenko, (2013)107 studied the health care of one hundred fifty two TG
adults In United States of America. The findings show six themes - gender
insensitiveness, discomfort, refusal of services, substandard care, verbal abuse, and
forced sex. These findings might be useful for health care sector for enhancement of
gender sensitivity among health professionals.
Budge, et al, (2013)108 studied the facilitative and avoidant coping as

mediator between distress and transition status of two hundred twenty six TG
women. The social support which has given within their community to the
transgender women acts as a shield against their mental stress. The rate of
depression was fifty one percent and anxiety was forty percent. The findings of
Structural Equation Modelling (SEM) show that transgender persons who are in the
initial stages of transition will use various coping strategies in comparison to those
who are in later stages of transition.
Reisner, et al. (2013)109 examined the high vulnerability to HIV in

transgender persons and the findings revealed that the middle income countries had
eighteen percent of HIV prevalence and in high income countries had twenty two
percent. The main factors to increase the HIV prevalence are violence,
discrimination, lack of education, unemployment, unhygienic living and very little
access to health care services.
Bianchi et al, (2014)110 explored prostitution among internally displaced

male and transgender female sex workers in Bogotá, Colombia. The study included
twelve displaced individuals who were TG women involved in prostitution. The
result of study showed that most of the respondents started sex work immediately
after displacement due to lack of money and social support. The vulnerability for
HIV was much more due to less awareness about HIV infection and unprotected sex.
Singh, Y. et al. (2014)111 investigated the opportunity to contact and utilize

the gender transition services by transgender persons in the private and public
hospitals in seven cities of India. The findings exposed negligible transition services
in public hospitals. Hence transgenders prefer incompetent doctors for castration.
Due to the unwillingness among competent doctors to recommend hormone therapy
forced them to take hormones by their own. Results show the necessity to provide
free or low-priced gender transition services in public hospitals, making effective
strategies for gender transition.
Roche, et. al. (2014)112 revealed that nurses show stigma and negative
attitude towards TG sex workers in health care centres lead to poor health status of
this community. The study highlighted insufficiency of literature that investigates
stigmatisation of TG community by the nurse.
Sheikh, S. et al. (2016)113 conferred the results of the Global Fund-supported

Pehchan programme. This program has contributed a lot to the cause of transgender
people, including their need based health, HIV and also covering mental, social and
legal aspects. Joint concerns by larger groups have tremendously improved the self
image of transgender people leading to satisfaction in their special needs.
Ducheny, K. et al. (2017)114 stated that the care of older transgender and
gender nonconforming (TGNC) people increased within last few years but there is
deficiency of extensive researches and the approach to risk-free confirmatory
services. The TGNC older adults are at peril due to their inferior standard of living
and the partiality of health sector. The main objective is the development of all-
round collaborative care that reinforce and defend the older TGNC, also raise their
views to the present- day organization of care.
Agosto, S. et al,(2017)115 described that the rate of substance use is much

more higher in TG community than the heterosexuals. The causing factors of this
substance use in Transgender and Gender Nonconforming(TGNC) older adults are
their loneliness, rejection from society, prejudicial treatment, guilt,violence and
physical health. There is a need to analyse the ability of TGNC older adults to adjust
33
properly in adverse conditions and their strength toplay a very important role in
recovery/ healing and therapy of substance use disorders.
KJ, Salas-Espinoza. et al. (2017)116 revealed that the risk and vulnerabilities
among male to female (MTF) transgender persons for HIV is less researched in
comparison to male having sex with male(MSM).This study was conducted on 100
MTF transgender persons in Tijuana, Mexico to resolved their characterstics,
behaviors and HIV dominance. Various factors analysed as substance use,sex
behaviors,stigma and sociodemographics. The result showed that the twenty two
percent of MTF tested HIV positive which were much more than other vulnerable
persons of key population.
Defreyne, J, et. al (2018)117 studied on FTM and MTF to explore the link
between testosterone level and aggression and function of psychopathology and
social help in them. The result shows that testosterone therapy is not related to low
level of aggression in MTF and high level of aggression in FTM while other
psychological or social factors give rise to self- reported aggression in them.
Review of research shows that while awareness and acceptance of

transgender/hijra people has been slowly increasing in past few years, but there is
still need of efforts to give them equity and a dignified life. The available literature
has revealed their high status and position in the past, their experiences of
stigmatization and discrimination in society and hurdles in accessing basic amenities
and health services. Many of them have a low self esteem and inferiority complex
because of their tormented childhood. Psychosocial element increases the
vulnerability to HIV risk in this community. Victimization in school makes them
scared of negative assessment and causes social anxiety. Studies have explored the
elements related to QOL in transgender/hijras especially after SRS. Majority of
researches are on the transgeder/Hijra people’s historical evolution, socio-economic
status and health issues of but there is very few researches on the education, their
psychosocial issues and empowerment of this marginalized community. Mostly the
available researches on empowerment have centralized on the empowerment of cis
gender and women, but the empowerment of Transgender/Hijras has been neglected.
It is significant to understand the literature on social exclusion, domestic violence

and violence in educational institutions of lesbian, gay, bisexual and transgender but
the experiences of transgender people are moderately dissimilar than the experiences
of cis gender people (lesbian, gay and bisexuals).
Hence the present study aims at exploring the level of education, challenges
in accessing the education, empowerment of Transgender/Hijra people and the
influence of education in empowerment of this most unempowered community.
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Chapter–2

The researcher critically analysed earlier research studies in the field of

The reviews are categorised into the following –

2.2 Studies Related to the Socio-Economic Issues of the

Roen (2001)1 weighed up the risk of racial marginalization from the

Laird, et. al (2003)2 examined the participatory assessment from perspective

Grossman, A. H. et. al. (2006)5 studied on 31% MTF transgender youth to

Bryant, et al. (2008)6 administered an online survey of TG persons in

Khan, S. I. et al. (2009)7 found that Hijras of Bangladesh have no dignified

Govier, E. et al. (2010)9 studied the working of brain of sixty-eight

The neuroscience plays a significant function especially in the development of the

Sivakami, et. al. (2011)11 conducted an interview on 120 transgenders of 20-

Kalra, G. (2011)12 studied the social-cultural aspects of hijra community.

Moumneh (2011)13 evaluated the level of transsexuals in the Middle East

Turell et al. (2012)14 found that transgender community members had a

Sharma, P. (2012)15 justified the demand of legal status of this powerless

Kisha, B. G. (2012)16 compared the correlation among attitude of youths and

Saveri, S. F. (2013)19 investigated the beginning of transgender movement

Nanjundaswamy, S. (2014)20 found that male to female transsexuals in

Abbas, T. et al. (2014)21 conducted a research on social adjustment of

Leelavathy. K. (2014)22 empahasized on the social, economical, legal and

LGBT Weekly, (2014)23 analyzed local TG women’s legal and social

Johnson, S. L. et. al. (2014)24 explored the experiences of parents of

Kuvalanka, K. A. et al. (2014)25 interviewd five mothers of transgender

Athreye (2015)27 argued that transgender people constitute the marginalized

Leonard, W. et. al. (2015)28 compared the psychological wellbeing of

Seelman, K. L. (2015)29 studied that transgender persons generally

Chettiar, A. (2016)30 explained socio-economic status of Hijras, their ill

Oommen, M. A. (2016)31 differentiated between the term transgender and

Andrews, D. T.G. (2016)32 analyzed the dimensions of victimization of

Riggs et al. (2016)34 assessed the effectiveness of workshops for enhancing

Sawant, N. S.(2017)36 stated that Indian government has taken various

Virupaksha, G. et. al. (2018)37 studied the resilience among transgender

Papazian, N. A. (2018)38 examined the domestic violence in the TG

Naved, A. (2018)39 analysed the social inclusion and human rights of

Garthe, R. C. et. al. (2018)40 explored that young transgender women

Mishra, S. et. al. (2018)41 found that family of transgenders is accountable

Ng, Sameeta, et. al.(2018)42 found the connection between socio-

Konduru, D. et.al. (2018)43 defined the problems of transgender’s socio-

2.3 Studies Related to the Education of the Transgender/Hijra

Harris (2005)44 identified that transgender students have faced verbal

changed into supportive and compassionate ones by inclusion of transgenders in

Antoszewski, B. (2007)47 found that the female students have more

Macgillivray, et. al. (2008)48.stated that the fundamentals of educational

Greytak, E. et. al. (2009)49 investigated the experiences of transgender

Rands, K. E. (2009)50 emphasized on the inclusion of transgender related

Toomey et. al. (2011)52 investigated that awareness of Gay Straight

Singh, A. A. et. al. (2011)53 discovered the five common themes of

Aragon, S. R. et al. (2013)55 highlighted the findings of a survey conducted

Savage, T. A. et al. (2013)56 emphasised on the importance of school life in

Payne, E. et al. (2014)57 revealed the experiences of elementary school

opportunities. Banning the use of verbal abuse against TG community in media,

Abreu, R. L. et. al. (2016)61 described the circumstances of school bullying

Dugan, J. P. et al (2016)62 furnished the basic knowledge about the

Peter, T. et al (2016)63 explored the relationship between suicidal tendency

Jones, T. et. al. (2016)64 studied the school experiences of Australian

used by school teachers can sustain security and academic performances of TG

Taylor, et al. (2016)66 found troublesome disparities related to inclusive

Swanson, K., & Gettinger, M. (2016)67 focused on the relationship among

Rajkumar. (2016)68 highlighted the need for a decisive researches and

Parveen and Chandra (2017)69 explored that there was a significant

Chandra, S. (2017)70 stated that addition of transgender children or

Raj,T. S. (2017)71 investigated that tansgenders were subjected to