Trump’s clampdown on USAID has forced trans clinics in India to shut down
Three clinics under the NGO Mitr, in Hyderabad, Kalyan, and Pune, supported by USAID, were forced to wind up after the agency froze funding under Trump’s policies. Thousands of trans individuals, who relied on these clinics for hormone therapy, mental healthcare, and medicines are now stranded.
For India’s transgender community, access to healthcare has been fraught with discrimination, stigma, and systemic neglect.
Exacerbating the crisis, in February this year, three clinics for the transgender community in the country were closed, following a stop-work order from the US Agency for International Development (USAID), disrupting support for thousands of trans people.
The Mitr Clinics located in Hyderabad, Kalyan, and Pune, launched with USAID funding in 2021, were providing hormone therapy guidance, mental health counselling, HIV and STI assistance, legal aid, and general medical care.
The funding freeze by USAID—a direct result of former President Donald Trump’s policies—has abruptly severed the lifeline that had been sustaining these services.
Left without safe spaces
Apart from medical facilities, the Mitr Clinics provided safe spaces for transgender individuals, many of whom had been rejected by their families, turned away from mainstream hospitals, or left untreated until their health issues became critical.
“For trans people, even finding a doctor who treats us with respect is a battle. So while transitioning is a big part of our work, we went beyond just that,” says Rachana Mudraboyina, trans activist and Founder of Mitr.
“Hormone replacement therapy has an impact on all the organs of the body, including cardiovascular system, liver functioning, and also the brain and mental health. And we provided a step-by-step guide through all these phaseschallenges,” she says.
To legally change one’s gender from male to female or vice versa, Indian law mandates that individuals undergo gender reassignment surgery. But it isn’t a straightforward process. Before undergoing this surgery, individuals typically go through a psychiatric evaluation to ensure informed consent and readiness for the procedure.
This requires a qualified mental health professional to assess the individual’s gender dysphoria, mental health status, and readiness for surgery, and a recommendation letter from the evaluating psychiatrist or psychologist, confirming that the individual has undergone the necessary assessments and is a suitable candidate for surgery.
However, without USAID’s financial backing, there is no way for Mitr to keep up with rising operational costs, staff salaries, rent, and medical supplies, says Mudraboyina.
With lack of awareness and the stigma that most trans patients, especially from the lower economic strata, face at government hospitals, their autonomy over their bodies and their lives invariably take a hit, she adds.
“When people came to the clinics, they felt safe. They could openly discuss their health concerns without fear or shame. That has now been taken away from them.”
The Mitr Clinics started with a focus on HIV prevention and treatment, as transgender individuals are among the most vulnerable to HIV in India. The scope of the clinics quickly expanded to include comprehensive healthcare services, including guidance on hormone replacement therapy, mental health counselling, general health screenings for diabetes, thyroid and cancer screenings, legal aid and advocacy for transgender rights, and employment and entrepreneurship support.
Now with Trump’s freeze on USAID, this entire support system has collapsed overnight. With the clinics now shut, transgender individuals in these cities have nowhere to go. Many of them will be forced to seek medical care at mainstream hospitals, where they are often met with hostility, refusal of treatment, or lack of knowledge on transgender health issues, says Mudraboyina.
“Many of our patients are terrified to go back to hospitals where they are misgendered, ridiculed, or denied care,” she says.
Ayesha Meera, a 26-year-old transwoman from Hyderabad, started hormone treatment in December 2022, with the help of Mitr. In six months she would have been ready for surgery but is now facing an unpredictable situation with the shutting down of the clinic.
“I avoided starting treatment for five years, because what I encountered at clinics and hospitals outside was an alarming level of misinformation, stigma and abuse,” says Meera.
“My psychiatrist behaved inappropriately with me, and after going through many screenings, the senior doctors would ask me very fundamental questions about my body. One of them asked me if I had a fallopian tube,” she adds.
Thousands of trans people who were benefitting from the free services at Mitr clinics now fear that they will be forced back into unsafe, exploitative conditions.
A struggle to keep services afloat
The sudden loss of funding has left USAID-supported NGOs scrambling for alternatives.
Mitr may have pulled down its shutters for now, but it is trying to stay afloat. The Telangana State AIDS Control Society has offered partial funding for it, but it is not enough to sustain the clinics at full capacity, says Mudraboyina.
“We are trying to find new donors, but everyone is hesitant now because transgender issues have become so politicised, even internationally,” she says.
“They tell us we don’t exist, that we can be erased by policy. But we refuse to disappear.”
Edited by Swetha Kannan
