A Survey on the COVID-19 Awareness and Vaccination Acceptance/Hesitance Among the Transgender Population in Various Districts of Tamilnadu.

Introduction: Coronavirus Disease of 2019 (COVID-19) has been deemed as one of the biggest global health crisis. The pandemic has caused a landslide in governance, economics, health care systems, and the daily lifestyle of man for the past 2 years. One of the chief weapons installed by various governments worldwide was the rapid development of an efficient vaccine to combat the disease. This study aims to identify the awareness of COVID 19 and seeks to find the challenges faced by the community in vaccination. This study hypothesized the presence of a multifaceted issue among the transgender populations' hesitance to vaccination. The results from the study could be exploited by the policy makers of the government to provide policies that best alleviate the hesitance among the transgender population. Material and
Methods: This study is a cross sectional questionnaire based study. A total of 121 transgender people above the age of 18 years who were voluntarily willing for the study were included in the study, while excluding the male and female participants and those transgender participants who were unwilling for the study. Results and Discussion: A 100% response regarding COVID-19 awareness from the 121 participants showed exemplary reach to the population. With 76% of individuals being vaccinated, the acceptance of the vaccine and reach of the vaccine was high. COVID-19 awareness has reached the people from all walks of life. With little tweaks to the current policies, India could achieve absolute vaccination against the pandemic. Copyright:

INTRODUCTION

Transgender people are often faced with a disassociation between their gender identity and their assigned birth gender.[12] Gender minorities have universally suffered prejudice, social injustice, and radical violence as a result of their sexual orientation. The inclusive nature of the current generation has allowed these individuals to thrive and succeed in all walks of life. Besides, the government has laid all efforts in helping them live peacefully and at ease. However, the standard of living, their access to basic life amenities, and comforts still remains an uphill task in most parts of the world.[3]

The COVID-19 pandemic was and still will be one of the most dreadful pandemic of the modern era. The disease wreaked havoc sparing none.[45] The issues surrounding COVID-19 was varied and often affects the socially and economically weaker sections of the society, such as the sexual minorities especially the individuals who identify themselves as transgender.[67] Their access to health care has been a challenge in many foreign countries, as a result of deplorable policies.[8] They have been subject to violence and social injustice as a result of binary paternalistic policy influencers.[910] The only way to curb the pandemic was to stop its spread and find a cure. Various governing bodies invested in the research and development of a vaccine against the virus. This vaccine was instituted as a measure of prevention to limit the spread of the virus.[11] Besides vaccination, the government introduced various preventive measures in the form of social distancing, nationwide lockdown, use of face mask, and propagation of handwashing.[1213] The various measures taken against the virus could become a success only if it reaches the whole of the population indiscriminately. Beside this, population has been proved to possess a high level of psychological stress associated with COVID-19, thereby increasing their risk of COVID-19.[14151617] The survey was conducted to identify the awareness of COVID among the transgender people and to identify the manifestation of such awareness through enthusiastic acceptance of the COVID-19 vaccine.

MATERIAL AND METHODS

This study was a survey based on a questionnaire. The inclusion criteria for the study included transgender population above the age of 18 years who were voluntarily willing for the study and the exclusion criteria included the male and female participants and those transgender participants who were unwilling for the study. The study included a total of 121 willing participants. The questionnaire included a demographic section from question no. 1 through 4 yielding the name, age, and location of the participant of the survey. The next section of the questionnaire included three questions extracting the knowledge/awareness of the pandemic among the transgender population. The last section of the questionnaire, questions 8 through 12, proffers the aptitude and practice with relation to the COVID-19 vaccine. The questionnaire was printed in both English and the regional language Tamil. Appropriate measures were taken to ensure the sensitivity of the questions asked by pre-testing the questionnaire with two transgender members. The institutional ethical board clearance was attained before the start of the study. The responses were collected in person. The responses are recorded in printed format. The results are put through statistical parameters such as mean and the percentage of responses was calculated and tabulated for ease of interpretation.

RESULTS

Of the 121 population, all 121 participants belonged to different districts within Tamil Nadu [Figure 1]. The geographical distribution of the participants is given in Figure 1. The mean age of the participants was found to be 34.12 years. A phenomenal response was recorded in terms of COVID-19 awareness with a 100% of the population responding positively to the awareness-related questions. Furthermore, 76% (n = 92) of the population were vaccinated while 24% (n = 29) were not vaccinated. Of the 92 people who were vaccinated, 92.3% (n = 85) had the first dose and 7.6% (n = 7) had the second dose of vaccine. Those who received vaccination stated fever 58.7% (n = 54) to be the most common challenge associated with vaccination. Followed closely by body pain and hand pain 43.5% (n = 40). A few vaccinated responders claimed to have faced vomiting 13% (n = 12), headache 11.9% (n = 11), giddiness and tiredness 3.3% (n = 3), and stomach pain 1.1% (n = 1).

Figure 1

Geographical distribution of the sample

Among the 24% (n = 29) of the population who did not receive the vaccination, 48.3% (n = 14) chose the option “others (specify)” but were unwilling to specify the reason. A significant 31% (n = 9) were not interested in vaccination and only 13.8% (n = 4) and 6.8% (n = 2) claimed to fear the vaccine and have no faith in the vaccine, respectively. Those who did not have the vaccine stated that nothing could make it more comfortable 48.3% (n = 14) while 27.6% believed that more awareness regarding vaccine could help.

DISCUSSION

COVID-19 has afflicted increased levels of agony in all humans. For the gender minorities, however, these short comings was projected into blaring realities.[18] The study focused on the geographic expanse of Tamil Nadu. Tamil Nadu has been considered unanimously as a pioneer in promoting the social welfare of transgender population in India. It instituted the Tamil Nadu Transgender Welfare Board in 2008. With the introduction of the “aravani” card, the identity of the transgender people gets registered socially and delivering them a sense of acknowledgement.[19] A study into the reach of COVID-19 awareness and vaccination acceptance/hesitance could establish a model for the inclusion of such protocols to reach the transgenders all over the nation. Thereby nullifying the already existing exaggerated risk of contraction of the disease among trandgenders.[20]

COVID-19 awareness among the study population was probed using three questions in the questionnaire. The questions were drafted to understand the knowledge of the participant with regard to COVID-19 disease, its spread, and the various preventive protocols. Figure 2 shows the responses received for the questions regarding COVID-19 awareness. Every individual who participated in the study knew about the pandemic and its transmission. They have also followed stringently the SMS protocol of Soap, Mask and Social distancing. This was similar to previous studies showing a sum awareness of 98.0% on COVID-19 awareness.[21] The nature of the study with its sample involving a specific gender could testify the spread of awareness regarding COVID-19.

Figure 2

COVID-19 awareness among transgenders

COVID-19 vaccination was the most earnest effort taken by the world in unison to curb the spread of the virus. While the study was mostly restricted by geographical expanse and limited sample, it shows the crux of the trend in vaccination in Tamil Nadu. The multifaceted obstacles faced by the community in seeking medical care has been keenly observed by Thankachan A et al. (2020).[22] Although the overall vaccination pattern represented by transgender population in the world was significantly less, the study hailed a 76% acceptance of the vaccine. This proved a phenomenal success of the protocols in Tamil Nadu. The study engaged to explore the nature of reasons as to why a few of the population failed to vaccinate. Figure 3 provides the reason for failure to vaccinate. Besides, the remainder of the study population had expressed few alterations to the services with regard to vaccination which could motivate them to receive vaccination.

Figure 3

Factors preventing vaccination

The study has limitations such as restricted sample size, difficulty in generalizing the result, and non-probability sampling. The study limited itself by including members only of the transgender community while the other communities including the members of Lesbian, Gay, Bisexual, and Queer (LGBTQ) are not represented. The limited geography of the sample provided a clear insight of the Tamil Nadu state. However, a wider probation could yield in better understanding of the nature of the intervention required for the transgender community. A deeper probation into the entire geography of India and including all members of LGBTQ could result with policies being generated that best benefits the sexual minorities in India.

Ethical consideration

The ethics clearance number for this study is 2862/IEC/2021.

CONCLUSION

The study revealed the success of the colossal efforts laid by all forms of mass media to achieve the required levels of awareness among people belonging to all facets of the society. Overall, the vaccination of the transgender population achieved in the Tamil Nadu is highly commendable. A worldwide uptake of the policies and the health care welfare schemes for the gender minorities lead by Tamil Nadu as an example should help those transgender people in dire need. These steps in unison with public support may help to elucidate and mitigate the mean effects of the pandemic.

Future scope

The results can be used by governing bodies to modify policies regarding COVID-19. The study could also be altered to understand the COVID-19 related awareness and vaccination acceptance/hesitance among any population.

Abbreviations

SMS = Soap, Mask, Sanitise

LGBTQ = Lesbian, Gay, Bisexual, Transgender, Queer

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.