The brief summarizes various issues faced by the Hijra and the transgender women community, and highlights the close links between this exclusion and vulnerability to HIV and other health risks. The document also outlines a range of recommendations to address other forms of exclusion faced by the community.

Asian countries have centuries-old histories of existence of gender-variant males - who in present times would have been labelled as 'transgender women'. India is no exception. Kama Sutra provides vivid description of sexual life of people with 'third nature' (Tritiya Prakriti).

In India, people with a wide range of transgender-related identities, cultures, or experiences exist - including Hijras, Aravanis, Kothis, Jogtas/Jogappas, and Shiv-Shakthis (See glossary). Often these people have been part of the broader culture and treated with great respect, at least in the past, although some are still accorded particular respect even in the present.

The term 'transgender people' is generally used to describe those who transgress social gender norms. Transgender is often used as an umbrella term to signify individuals who defy rigid, binary gender constructions, and who express or present a breaking and/or blurring of culturally prevalent stereotypical gender roles. Transgender people may live full- or part-time in the gender role 'opposite' to their biological sex.

In contemporary usage, “transgender” has become an umbrella term that is used to describe a wide range of identities and experiences, including but not limited to: pre-operative, post-operative and non-operative transsexual people (who strongly identify with the gender opposite to their biological sex); male and female 'cross-dressers' (sometimes referred to as “transvestites”, “drag queens”, or “drag kings”); and men and women, regardless of sexual orientation, whose appearance or characteristics are perceived to be genderatypical.

A male-to-female transgender person is referred to as 'transgender woman' and a female-to-male transgender person, as 'transgender man'.

The terms 'transgender' or 'transgender populations/people', used in this brief, while more encompassing than transgender women, are used to refer to transwomen given this brief's focus. Sometimes, for brevity, the abbreviation 'TG' is used to denote transgender women.

Until recently, HIV programs in India included transgender women under the epidemiological and behavioural term - 'men who have sex with men' (MSM), although many transgender people did not want to be included under that term. In addition to respecting the preferred term to be used by the transgender women, it is increasingly recognised that transgender people have unique needs and concerns, and that it is better to view them as a separate group that is not under the rubric of 'MSM'.

Even the umbrella term 'transgender' may hide the complexity and diversity of the various subgroups of gender-variant people in India and may hinder development of subgroup-specific HIV prevention and care interventions, and policies. For example, some Hijra activists may prefer others calling them 'Hijras' and not to subsume Hijras under the broader category 'transgender'. One reason for this is that they feel Hijras have a long history, culture and tradition in India, which would not be evident or which might be overlooked when using the catch-all term 'transgender'. Though some Hijra activists may also identify as 'transgender' for outsiders or in the global platform, they prefer the label 'transgender women' to be applied to those transgender women who are not part of the Hijra communities. However, some other Hijra/Aravani (Hijras in Tamil Nadu) activists may identify as both 'Hijras/Aravanis' and 'transgender woman.

Transgender people face multiple forms of oppression. The focus of this brief is to summarize the various issues faced by Hijras and transgender women by using the social exclusion framework, and highlight the relation between this exclusion and vulnerability to HIV and other health risks.