"We Are Alike but Also Different": Braiding Transgender Political Sensibilities into Health Initiatives in Kolkata, India

Background and Purpose: Public health initiatives have often engaged with transgender communities in India exclusively in the context of health risk: as either “at-risk” or “risky” populations in the spread of a pandemic like HIV. Postcolonial political theorists in India and critical health scholars have questioned the propensity of this orientation to simplify community needs to categories of risk identified through statistical surveillance strategies. They argue that these efforts atomize the complicated needs of a community into disease-focused basic survival factors, ignoring the full tapestry of a community’s dynamic processes, thereby exacerbating marginalization. This critique raises an important question for transgender communities in India: do public health initiatives seeking to protect them against a pandemic like HIV support their survival, or consign them further to the margins? Addressing this question, this research examines how transgender sex workers (TSW) in Kolkata, India, engaged with HIV-focused public health initiatives, to resist such simplification, establishing a social movement that brought community rights to the fore. Specifically, we examine the manner in which TSW engaged with the Sonagachi Project (SP), a globally renowned initiative that has been designated by the United Nations and the World Health Organization as the gold standard for community-based HIV interventions with sex workers.

Methods: We conducted a mixed methods study from 2015 to 2025, utilizing semi-structured qualitative interviews with LGBTQ sex workers (n=35), focus groups (n=10), and ethnographies of multiple public events organized by SP. A grounded theory approach with sensitizing concepts from postcolonial and critical health theories was utilized to code and analyze the data.

Results: TSW strategically engaged with SP to simultaneously align with, distinguish from, and resist SP’s initial health focus, and its eventual focus on sex work rights. Specifically, TSW: 1) aligned with SP’s HIV initiatives initially, to emerge into visibility as transgender sex workers, 2) braided transgender sex work identity into the “sex work is work” collective identity emerging from the expansion of SP, and 3) eventually resisted normative health and sex work identity by carving out separate collectives and mobilizational efforts focusing on transgender rights.

Conclusions and Implications: We describe an emergent conceptual framework that draws on and expands notions from health social movement and postcolonial political theory. We argue that health initiatives create political opportunities for marginalized communities to complicate health-focused goals, while energizing the next phase of mobilization against normative sex work collectivities, eventually foregrounding transgender needs and identities. We discuss the implications of the results and the framework for collective empowerment-based social work engagement with TSW in India. Specifically, our results emphasize the need to understand the life-course of a community’s mobilization as it engages with HIV health initiatives, while paying close attention to, and aligning with the mobilization efforts of intersecting communities such as TSW.