A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people's health in India

Abstract

Amid incremental progress in establishing an enabling legal and policy environment for lesbian, gay, bisexual, transgender and queer-identified people, and people with intersex variations (LGBTQI+) in India, evidence gaps on LGBTQI+ health are of increasing concern. To that end, we conducted a scoping review to map and synthesize the current evidence base, identify research gaps, and provide recommendations for future research. We conducted a scoping review using the Joanna Briggs Institute methodology. We systematically searched 14 databases to identify peer-reviewed journal articles published in English language between January 1, 2010 and November 20, 2021, that reported empirical qualitative, quantitative or mixed methods data on LGBTQI+ people's health in India. Out of 3,003 results in total, we identified 177 eligible articles; 62% used quantitative, 31% qualitative, and 7% mixed methods. The majority (55%) focused on gay and other men who have sex with men (MSM), 16% transgender women, and 14% both of these populations; 4% focused on lesbian and bisexual women, and 2% on transmasculine people. Overall, studies reported high HIV and sexually transmitted infection prevalence; multilevel risk factors for HIV; high levels of mental health burden linked to stigma, discrimination and violence victimization; and non-availability of gender-affirmative medical services in government hospitals. Few longitudinal studies and intervention studies were identified. Overall, LGBTQI+ health research in India needs to move beyond the predominant focus on HIV, and gay men/MSM and transgender women, to include mental health and non-communicable diseases, and individuals across the LGBTQI+ spectrum. Future research should build on largely descriptive studies to include explanatory and intervention studies, beyond urban to rural sites, and examine healthcare and service needs among LGBTQI+ people across the life course. Dedicated funding and training for junior investigators conducting LGBTQI+ health research is crucial to building a comprehensive evidence base to inform health policies and programs.

Competing Interest Statement

Peter A. Newman serves on the Editorial Board for PLOS Global Public Health. All other authors declared no conflict of interest.

Funding Statement

This review was supported by the Social Sciences and Humanities Research Council of Canada (Partnership Grant, 895-2019-1020 [MFARR-Asia] PI: Newman). Dr. Venkatesan Chakrapani was supported in part by the DBT/Wellcome Trust India Alliance Senior Fellowship (IA/CPHS/16/1/502667).

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Data Availability

All data underlying our findings are reported in the manuscript.

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