The study estimated a TB burden of 552 cases per 100,000 trans women, significantly higher than the national average for the general population.
Published Dec 01, 2025 | 6:00 AM ⚊ Updated Dec 01, 2025 | 6:56 PM
Tuberculosis. (iStock)
Synopsis: A recent community-based study in Chennai showed that transgender women are disproportionately at risk. In a population that is largely invisible in official health data, the findings underscore an urgent need for targeted interventions.
Tuberculosis (TB) continues to silently affect vulnerable populations in India. A recent community-based study in Chennai showed that transgender women are disproportionately at risk.
The research revealed a health crisis compounded by the lack of awareness, social marginalisation, and structural barriers that prevent early diagnosis and treatment.
In a population that is largely invisible in official health data, the findings underscore an urgent need for targeted interventions.
In India, which carries the world’s highest burden of TB, these findings highlight how systemic inequalities amplify the threat for already marginalised communities.
In 2024, approximately 10.7 million people worldwide were diagnosed with tuberculosis, according to the World Health Organisation (WHO) Global Tuberculosis Report 2025. In the same year, India accounted for 25 percent of all new TB cases globally, representing the highest national burden of the disease.
The latest notification data highlights the uneven distribution of cases across states. According to Ni-kshay data, Uttar Pradesh reports the highest number of TB notifications at 6.36 lakh, far ahead of other states, followed by Maharashtra (2.02 lakh) and Bihar (1.93 lakh).
Tamil Nadu reported 83,921 TB notifications, placing it ninth in the country. While the state does not fall in the highest-burden tier, it still contributes a substantial share to India’s overall caseload.
This becomes important in light of emerging evidence and community insights showing how social factors continue to shape TB risk and access to care in the state. These gaps highlight why Tamil Nadu’s TB response must look beyond clinical treatment and address the social vulnerabilities that heighten exposure and delay diagnosis.
The study, originally published in Queerbeat , initiated in 2021, was led by Solidarity and Action Against the HIV Infection in India (SAATHII), a Chennai-based NGO working with queer and transgender communities, in collaboration with Sahodaran, a local queer rights organisation, and supported by the Stop TB Partnership, an international alliance of NGOs, government institutes, and private companies fighting tuberculosis.
The team screened 2,534 trans women across the Greater Chennai Corporation over 11 months beginning in 2021. Outreach teams conducted verbal symptom checks and assessed risk factors such as diabetes, smoking, and alcohol consumption to identify individuals for clinical testing.
A total of 1,280 were referred for diagnostic confirmation, resulting in eight newly confirmed TB cases and six individuals already undergoing treatment.
Based on these findings, the study estimated a TB burden of 552 cases per 100,000 trans women, significantly higher than the national average for the general population.
Awareness of TB among participants was strikingly low. While 60 percent had heard of the disease, only 41 percent knew it could be treated, and just 6.4 percent were able to identify its symptoms. The study also documented high prevalence of risk factors, including smoking, alcohol use, diabetes, and overcrowded or shared housing — conditions that increase susceptibility to TB and complicate treatment outcomes.
Few trans women voluntarily sought care at government facilities, often because of fear of discrimination or previous negative experiences. The study also highlighted systemic gaps: misgendering and inaccurate data collection in official health records limit visibility and hinder targeted interventions for trans populations.
While the SAATHII–Sahodaran study highlighted a high burden of TB among trans women in Chennai, local activists say that direct experience with the disease is rare.
“I’ve not seen many in the community suffering from tuberculosis, or maybe they are afraid to talk about their status if they have TB,” said Rose Venkatesan, an LGBTQ activist.
“Tuberculosis is a scary word; the disease itself carries the risk of people fearing you if you have it, and they want to keep away from you. They don’t want to share their room with you or utensils with you.” She added that while the stigma is not as severe as HIV or AIDS, “It does have its own level of stigma attached to those in the community who suffer from it.”
Living conditions and occupational routines further increase vulnerability. “Many in the community live in closed quarters, in tight living spaces, in shared accommodations, in insufficiently ventilated spaces,” Rose explained. Seasonal floods and heavy rains also pose a threat, as “these places easily get watery and muddy, and waterborne and airborne diseases coming out of mosquitoes are likely to spread faster.”
She added that fear of social exclusion affects healthcare-seeking behaviour. “If someone in the community gets sick with tuberculosis, they have to be really, really hush about it because they don’t want to be discriminated against by their own friends.”
“They don’t want to be avoided living with, avoided being friends with, for the fear of being discriminated against for having TB,” Rose said. This fear can lead some in the community to avoid visiting doctors, even though timely treatment is essential for recovery.
Despite these challenges, Rose noted that government healthcare access in Chennai is generally adequate. “I don’t think access to healthcare in Chennai, in the government setting, for tuberculosis is a problem at all for the community. The services are available and are not very discriminatory; in my opinion, they are fine.”
She emphasised that the main hurdles are social rather than structural: stigma, fear of disclosure, and precarious living conditions that heighten the risk of illness.
Her insights underscore that addressing TB in the community requires not only medical interventions but also social support, awareness, and safe living environments.
The study went beyond documenting risk to propose actionable solutions. It called for larger, multi-city studies to understand TB among trans populations nationwide. Researchers emphasised the importance of community-led screening, noting that most participants were reached only through proactive outreach by NGOs, rather than visiting clinics voluntarily.
Sensitisation of healthcare staff is another key recommendation; to ensure respectful treatment, accurate gender identification, and improved access to TB services.
Other suggestions include routine preventive therapy for household and community contacts, integration with HIV care due to the higher susceptibility of people living with HIV, and targeted health education to improve knowledge of TB symptoms and treatment.
Even though the study highlighted that addressing TB among trans women requires structural interventions and medical support, activists stress that social changes — reducing stigma, fostering acceptance, and encouraging open discussion — are equally vital to ensure the community seeks timely care.
By providing the first systematic evidence of TB prevalence in Chennai’s trans community, the study lays the groundwork for policies and programs that can improve both detection and treatment for this vulnerable group.
(Edited by Muhammed Fazil.)
