From the quick survey for community response for transgender and hijra by the Bandhu Social Welfare Society, we found that 100% of transgender communities know about coronavirus, 80% wash their hands, 47.5% wear masks, 21.3% use hand sanitizer, 15% use gloves, only 8.8% eat a balanced diet and shield themselves while sneezing, and even less, that is 2.5%, keep themselves clean ( https://www.bandhu-bd.org). Additionally, 71.3% of respondents knew that they need treatment if coronavirus infects someone, and 41.3% think they must be alone at home. Also, 26.3% of respondents call the government helpline for medical services, and 3.8% received help from the police.

A significant aspect of the pandemic response is initiatives that bridge the divide between vulnerable groups and the government. Common income-generating practices for disadvantaged communities have evaporated with the nation on lockdown. ⁷ A rapid perception survey ⁸ showed no food stored at home for 18% and 10% of urban and rural respondents respectively. Extended shutdowns and the added stress of the pandemic intensified desperation and hopelessness. ⁸ To counter the extreme economic and industrial fallout from the pandemic, Bangladesh has introduced an economic stimulus plan. The assistance package was inefficiently administered for the weakest. ⁸

During a crisis, many transgender people cannot get help because they are not publicly identified. From the Bandhu Social Welfare Society survey, 74% of the transgender respondents received packages of rice, pulses, oil, etc. and 14% faced gender discrimination while receiving the aid ( https://www.bandhu-bd.org). In addition, 61% of respondents needed food, 59% needed money, 20% needed a hand washing agent, 11% needed a face mask, 9% needed safe and secure work, and medicine, and finally, 8% needed personal protective equipment. They are experiencing financial difficulties due to a lack of or limited access to social protection. Due to lockdown, they do not have access to ensure shelter and proper sanitation. They cannot afford hand sanitizers and masks in this kind of crisis. The authorities seem to remain blind to the miseries of the hijra community. ⁴ According to a survey on the impact of COVID-19 on hijra or transgender communities, 82% of respondents had earned no money in two weeks, and 59% had received no assistance from aid programs or families ( innovision-bd.com). Members of the hijra community typically make money by requesting voluntary donations in return for their good wishes. ⁵ However, many of them have lost their income from alms collection, religious ritual engagement, sex work, and lockdowns, worsening their difficulties. ⁴

While several public and private organizations have provided support services and assistance programs to help financially vulnerable people, it is feared that such programs will not benefit transgender diverse people due to discrimination. However, a few citizen-led youth projects have supplied some relief to the hijra community. ^{4 , 9} The aim is to raise money through crowdfunding platforms, raise public awareness about the community’s plight, raise money to source basic food supplies, or facilitate direct bank transfers to beneficiaries. ⁷

The government, non-governmental organizations (NGOs), and voluntary organizations should work together to meet the needs of the hijra community, both socially and financially, to have proper access to their necessities during this pandemic.

The majority of transgender or hijras earned their money through street work and ritual work. They are working in informal workplaces, for example, as sex workers and in recreation. Hijras earn their livelihoods via a small range of available choices as they are still not socially accepted in daily employment. ⁵ The lockdown meant they had all the doors locked as they were viewed as unclean and virus carriers. Therefore, shops and homes declined to support them. ⁹ For sex workers, there were no customers. There is no community record of virus infections, but it is feared that social stigma has discouraged transgender people from obtaining medical care. ¹⁰

The poorest who survive on daily wage labor show that economic mortality overshadows health mortality. ^{3 , 11} In this pandemic, day-wage earners have struggled the most, but hijra people do not survive on a daily wage as they do get into jobs in the mainstream industries owing to their outdoor activities and lifestyle. ¹¹ Hijra groups have been accused as being carriers of the virus. Many hijra people are shunned by local elites and mosques and are left out of conventional support for relief ( https://www.dhakatribune.com).

Economic impact transcending to mental health impact

Marginalized societies around the world, including Bangladesh, are disproportionately affected by the COVID-19 crisis. ³ With inadequate access to basic resources, minority groups such as Biharis and transgender people live on the fringes of society with a 95% decrease in daily income of transgender people, 71% have borrowed money, and 81% have a decreased diet ( https://www.democracyspeaks.org/; https://www.bandhu-bd.org).

The average daily income of transgender people was Bangladesh taka (BDT) 296, and now it has dropped to BDT 14 ( https://www.bandhu-bd.org). In a study we found 51 transgender people were surveyed on the economic impact of the COVID-19 crisis on the population in Bangladesh ( innovision-bd.com). For the remaining crisis period, 100% of the respondents want food and monetary aid. During the economic slump, 86.36% need to postpone their loan payments due to low wages, 9.09% will borrow cash to repay a loan and 4.55% will sell their properties to repay a loan. Some are going to go to look for work, and some are going to start begging. A further 81% do not believe that funding from the government and individual private initiatives is going to continue ( innovision-bd.com).

By contrast, hijra community people were previously aided by NGOs and community groups, which stopped during the lockdown. The transgender community cannot go for health care, diagnosis of sexually transmitted infections (STIs), and other illnesses amid COVID-19 due to the extreme strain on the Bangladesh medical service during the pandemic. Furthermore, many people create discomfort for them when they visit health care facilities as they are feared and disliked by larger communities.

Hijras are more vulnerable to mental health issues, anxiety, and depression due to the various and intersecting forms of discrimination they face. The pandemic’s severe economic and health consequences and increased transphobia could exacerbate the situation. ⁸ Around 93% of hijra have anxiety due to uncertainty about food availability in the future, most survey respondents were psychologically anxious about money (94%) and food (68%), 16% endured mental abuse, but very few were exposed to physical torture and brutality ( https://www.bandhu-bd.org).

Discrimination, stigma, and fear causing transgender people not to pursue physical health care

Transgender people are viewed as having ill health and are seen as risky due to participation in sex work. ¹² They are apparent carriers of STIs. This results in social exclusion when they appear in public health services. In public or private hospitals and clinics, the doctors and the nurses sometimes feel uncomfortable treating hijra people. They are subject to violent acts from the staff, including physicians. ⁵

When it comes to medical services, this group of people is still disadvantaged and fails to gain access to our social system’s basic amenities due to discrimination. There is a distinction in fundamental health care. The medical infrastructure is still overburdened; testing and treatment for the transgender community are made more difficult by discrimination. Although the wards are divided into male-female categories, there is no center for transgender men and women. ¹⁰

Respondents from the hijra community alleged that they could not obtain medical health care due to discrimination, a lack of legal identity papers, and violations of patients’ rights in healthcare settings. Health care professionals fear and are stigmatized when it comes to accessing healthcare services, putting them at a higher risk of not being tested or monitored for COVID-19. ^{4 , 10}