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Sanitation encompasses all conditions relating to public health - especially sewage disposal and access to clean drinking water.

Due to associated losses in productivity caused by sickness, increased healthcare costs and increased mortality, India recorded a loss of 5.2% of its GDP to poor sanitation in 2015.

Last month, India's candidate for Mr Gay World pageant in South Africa reportedly withdrew from the competition and went into hiding after he and his family received homophobic abuse and threats.

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“But the current government is unlikely to act on it any time soon and their recent decision to vote with Russia for blocking benefits to gay staffers was a testimony to the same.

They could have at least abstained, but they didn’t.”Homophobia on the rise As the law pushed LGBTs further into their closets, abuse is rampant on the roads and even inside the best public institutions such as the University of Delhi where a gay student was beaten up in a car and then thrown out in the night, with no redressal available since the university has repealed its anti-harassment ordinance.“A man called me gay like it’s an abuse and spat on my face,” said Iyer, while speaking about the shades of acceptance for the LGBTs varying from one place to another.

As tremendous as the economic losses are, the on-ground, human consequences of poor sanitation are grim - about one in 10 deaths, according to the World Bank.

Poor sanitation contributes to about 10% of the world’s disease burden and is linked to even those diseases that may not present any correlation at first.

Back and forth The gay community in India feels that the situation has only become worse after the Supreme Court ruling of December 2013 which declined to repeal Section 377 of the Indian Penal Code dating back to 1860, and put the ball in government’s court.“Section 377 is a big round football being used to play with the lives of people of this country,” said Harish Iyer, a gay rights activist who expressed no surprise at the findings of the survey.

“The government was poking the Supreme Court for a long time and then the Supreme Court kicked it back to them.”Iyer said the homophobia in the country continues to rise in the absence of legal protection to the community and that the only way to move forward is to have a conversation with those who consider homo-sexuaity to be "unnatural".“We have seen homophobia resulting in broken marriages, cheating, elopement and even deaths,” Iyer said.Improved sanitation can also help reduce prevalence of neglected tropical diseases.Though not a cause of high mortality rate, NTDs impair physical and cognitive development, contribute to mother and child illness and death and affect overall productivity.Diarrhoeal diseases, the most well-known consequence of poor sanitation, are the third largest cause of child mortality in India.They are also linked to undernutrition and stunting in children - 38% of Indian children exhibit stunted growth.Improving toilet access and access to clean drinking water can significantly boost disease control programmes for diarrhoea, NTDs and other correlated conditions.


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