CHENNAI: Has Tamil Nadu been successful in its battle against HIV/AIDS ? Yes and no.

The state recorded a marked decline in incidence of HIV infection and deaths from AIDS between 2009 and 2013 among both men and women. However, in what is both a pointer to the vulnerability of the third gender and an indictment of a failure in social inclusiveness, the mortality rate of HIV-positive transgenders in the state increased by more than 1,600% over the same period.

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Tamil Nadu State Aids Control Society (TNSACS) statistics, sourced by TOI through an RTI petition, show that 1,537 men and 814 women died of HIV/AIDS-related causes in 2009. Effective intervention by the state led to a decline in the numbers to 1,323 male and 595 female HIV/AIDS deaths in 2013, a fall of 18.42%.

Tamil Nadu — one of the four worst HIV/AIDS affected states along with Andhra Pradesh, Karnataka and Maharashtra — recorded only seven transgender deaths in 2009. The number climbed exponentially to 113 in 2013.

If this does not appear to be strikingly high number, consider that the latest census statistics put the number of transgenders in the country at 4.9 lakh out of a total population in excess of 120 crore. That is 0.04% of the general population. By comparison, the HIV/AIDS mortality rate for transgenders by population in Tamil Nadu is 5.56%.

Also, activists say, the actual numbers could be far higher because transgender deaths are hugely underreported.

"Social stigma prevents the reporting of transgender deaths," says A J Hariharan, founder of NGO Indian Community Welfare Organisation , which works for the welfare of the sex workers and transgenders. According to the TNSACS data, the number of HIV-positive cases in the state dropped from 25,572 in 2009 to 17,055 in 2013, with the number of HIV-infected males decreasing from 14,835 to 9,868 and women from 10,665 to 7,127 over the same period.

The figures raise several disconcerting questions. Have Tamil Nadu's highly acclaimed efforts to stem the spread of the disease not been an unqualified success? Is social inclusiveness a myth when it comes to transgenders despite several government initiatives to bring the community into the mainstream?

Tamil Nadu was the first state to create a special welfare board for transgenders and provide them land, pension and separate ration cards. The Election Commission in 2009 created a separate entry for transgenders on voter lists. But transgenders say the welfare board has ceased to function.

"It was after Tamil Nadu that other states like Maharashtra set up welfare board for transgenders. But unfortunately the board for all purposes does not exist," says R Jeeva, founder of NGO Transgender Rights Association and a former member of the welfare board.

Other officials say lack of awareness is probably the main cause for the rise in deaths of transgenders. "The increase in deaths of HIV-positive transgenders is a concern. It is most likely linked to unsafe sex," said Dr Vijaya Raman, deputy director of Tamil Nadu AIDS Initiative (TAI).

But transgenders say they have little choice in the matter. Latha S, a 30-year-old transgender says she's a prostitute by compulsion and not by choice. While that may be true of most women and men who sell sex for money, individuals of the third gender — stigmatised, ridiculed and shunned — have far fewer chances of opting out of the profession than others.

Latha says she did not have an education and no one would give her a job. "I have been in the profession ever since I discovered I was a transgender and joined the community," she says. "Once I left home there was no one to educate me or help me get employed."

Her job, Latha says, involves violence from drunks and rowdies. "Customers often do not pay and policemen harass us and force us to pay a large chunk of what we earn for protection," she says.

"I hate being a prostitute but I don't know what else to do," she says. What is worst, she says, is the vulnerability that she and other transgenders face and the constant fear it engenders.

Transgenders usually leave home when they are around 16 years old, says A J Hariharan, the founder secretary of Indian Community Welfare Organisation (ICWO), an NGO that works for the welfare of the homeless, sex workers and transgenders. "They join other transgenders and are pushed into begging and prostitution," he says. "Lack of basic education means they are unable to get jobs and the stigma attached to them means even manual labour is not an option."

Hariharan says companies could, as part of their corporate social responsibility programmes, look to help transgenders. "That would be empowering for members of the community because it would involve acceptance of the fact that transgenders are part of society and bring them into the mainstream, apart from giving them a livelihood," he says.

But the discrimination that transgenders face leaves them with little optimism that they could win acceptance and integrate with society. "Social acceptance? I don't know if that is possible," says transgender Raji Sekar, 25. "We can't even take a house on rent because few landlords would want transgenders as tenants."

"I did not wish to be transgender," she says. "I was born this way and that is what people should realise for society to accept us," she says.

Her companion Ambika M, has bruises on her face and hands. She says a group of men beat her up a few days ago. "We face intolerance all the time, so nobody cares about our safety," she says. "Not a day goes by without a transgender being beaten up by customers or drunkards."