Bangalore, India Cite this as: BMJ 2021;375:n2548 http://dx.doi.org/10.1136/bmj.n2548 Published: 18 October 2021 LGBT+: Indian medical institutions are asked to amend textbooks with unscientific content Priti Salian Medical institutions in India should not teach from books that contain content that discriminates against LGBT+ people, the Indian National Medical Commission (NMC) has said. The NMC—India’s regulatory body for medical education and practice—published an advisory1 that medical education should not be taught in a way that is perceived to be derogatory, discriminatory, or insulting to the LGBT+ community. The commission also said that medical institutions should not approve textbooks until they are amended to remove all discriminatory content after noting that some contain derogatory comments and unscientific information about virginity. In July 2018, the Indian Psychiatric Society said that homosexuality is not a disease, but a normal variant of sexuality.2 Two months later, India decriminalised same sex relationships.3 But a recent case in the Madras High Court observed that students in India’s 554 medical colleges are still studying a homophobic curriculum, and called for changes. Solidarity and Action Against HIV Infection in India (SAATHII),4 a Chennai-based non-governmental organisation working on public health, studied 16 textbooks for gaps and misrepresentations across the specialties of psychiatry, gynaecology, paediatrics, urology, forensics, dermatology and venereology, and endocrinology. The organisation’s research found a forensic medicine and toxicology textbook that refers to lesbians as “mental degenerates or those who suffer from nymphomania.” It further describes nymphomania as “excessive sexual desire, urge, or drive in a woman.” “Some of such women may turn lesbianists,” it says. In a gynaecology textbook, homosexuality, transvestism, and transsexuality were considered abnormal sexual behaviours. And a psychiatry textbook still lists homosexuality among sexual disorders, while another states that transsexuals may have a high degree of concomitant psychiatric disorders. L Ramakrishnan, a public health professional and vice president of SAATHI, who was part of the team that reviewed textbooks over a four year period, said, “One of the key problems is that many of these textbooks are reprinted versions of material published several decades ago and were not updated even when a new Bachelor of Medicine, Bachelor of Surgery curriculum was framed in 2019.” Earlier this year, when a case of a lesbian couple complaining of police harassment was presented in the Madras High Court in Chennai, Ramakrishnan represented the community’s views to the chief justice of the constitutional court Anand Venkatesh.5 Before giving a verdict on the case, Venkatesh spoke with a the bmj | BMJ 2021;375:n2548 | doi: 10.1136/bmj.n2548 psychotherapist and other community members and learnt about the prescription of antidepressants for the conversion of LGBT+ people, cases of doctors who refused surgical procedures for transmen, and how the medical health system is hostile towards the community partly because of the curriculum. Venkatesh’s verdict sought to remove discriminatory and inaccurate portrayals of people who are LGBT+ and included an order to the NMC for necessary changes to the curriculum.6 Sameera Jahagirdar, an Indian transwoman who works as an intensive care specialist in the NHS, was one of the three members of the team who studied the textbooks. She welcomed the NMC’s advisory but cautioned that the lack of an action plan meant that institutions may be slow to act. This work should not be taken as a burden by institutions, as “it is a human rights matter and amendment of what is wrong,” Jahagirdar said. The next move would be for institutions to fill gaps about topics such as child psychosexual development and conflicts related to sexual orientation. In another project,7 transgender doctor Aqsa Shaikh’s team is working to create trans-affirmative competencies for the medical curriculum. “Since the advisory has been published pursuant to a high court order, it is legally binding on all authorities,” said Amritananda Chakravorty, an advocate based in Delhi. The 2018 Supreme Court ruling against Section 377 prohibits discrimination against LGBT+ people and advocates their equality and inclusion. The 2019 Transgender Persons (Protection of Rights) Act8 makes it mandatory for governments to take measures for “review of medical curriculum and research for doctors to address their transgender specific health issues.” “Both these laws together with the Madras High Court order provide a decent body of jurisprudence for medical institutions to act on the curriculum,” Chakravorty said. 1 NMC’s advisory. www.nmc.org.in/MCIRest/open/getDocument?path=/Documents/Public/Portal/LatestNews/Advisory.pdf. 2 Indian Psychiatric Society’s position statement. https://indianpsychiatricsociety.org/ips-position-statement-regarding-lgbtq. 3 Constitutionality of Section 377 IPC. www.scobserver.in/court-case/section377-case/plain-english-short-summary-of-judgement. 4 SAATHII. www.saathii.org. 5 Unlearn and relearn: meet the team who helped Justice Anand Venkatesh. 2021. www.dtnext.in/News/TopNews/2021/06/13005210/1300590/Unlearn-And-Relearn-Meet-the-team-who-helped-Justice-.vpf. 6 Verdict. 2021. http://orinam.net/content/wp-content/uploads/2021/09/Sushma_Orders_Aug31_2021.pdf. 7 Community-based development of trans-affirmative health education in India. https://sangath.in/transcaremeded. 8 The 2019 Transgender Persons (Protection of Rights) Act. https://prsindia.org/billtrack/the-transgender-persons-protection-of-rights-bill-2019. 1 BMJ: first published as 10.1136/bmj.n2548 on 18 October 2021. 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