Social Determinants of Sexual Health Among Sexual and Gender Diverse People in South Asia: Lessons Learned from India, Bangladesh, Nepal, and Pakistan

Sexual and gender diverse people (SGDP) bear a disproportionate burden of and vulnerability to human immunodeficiency virus (HIV), sexually transmitted infections (STIs), and risks of mental health problems worldwide including countries in South Asia such as Bangladesh, India, Nepal, and Pakistan. Despite recent advances in LGBTQ rights in several South Asian countries, the expression of sexual and gender identity and behavior different from local hetero- and cis-normative expectations remains taboo in South Asian culture. This is reinforced by structural and societal values and norms. As a result, SGD people continue to face multiple oppression-related stressors that are a source of distress. SGD people's experiences and health outcomes across their lifespans can be understood through an intersectional lens. Stigma, discrimination, marginalization, and trauma experienced being in disadvantaged and marginalized status add to minority stress which drives poor health outcomes among SGDP across South Asia (SA). Both the intersectionality and minority stress models may further explain the role of individual-level coping and community-level responses in reaction to oppressive experiences. Based on the authors’ work, in collaboration with the community-based partners in India, Bangladesh, Pakistan, and Nepal, this chapter describes culturally relevant social determinants which affect sexual health among SGDP in South Asia. We elaborate on the socio-cultural and structural factors that act as catalysts in reinforcing historical stigma and discrimination and its health sequelae for SGDP in Bangladesh, India, Pakistan, and Nepal.