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      Is social exclusion pushing the Pakistani Hijras (Transgenders) towards commercial sex work? a qualitative study

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          Abstract

          Background

          The Hijra is a distinct type of gender role in South Asia where men act like women. This group of people is socially excluded by the general community, in terms of attainment of an opportunity for a socially productive life. Often this sort of deprivation forces these individuals towards professions like sex trade, in pursuit of sustenance, which as a consequence places them as a key block in the puzzle of an impending generalized HIV epidemic in Pakistan.

          Methods

          This study is a qualitative study, which involved 8 in-depth interviews and four focus group discussions, conducted in Rawalpindi and Islamabad (Pakistan) from February to April 2012. The data was audio taped and transcribed. Key themes were identified and built upon. The respondents were contacted through a gate keeper Hijra who was a member of the hijra community. Multiple interview sessions were conducted with each respondent.

          Results

          Two key categories of the Hijras were identified as Khusrapan and Zananapan, during the in-depth interview sessions. This initial information paved way for the four focus group discussions. The data was presented using key themes which were identified. The study participants explained their life histories to us which made it obvious that they had been socially excluded at many stages of their lives from performing normal social functions. This lack of occupational and educational opportunities pushed them towards entering the risky business of selling sex.

          Conclusion

          The transgender community is socially excluded by the Pakistani society which is leading them to indulge in commercial sex and putting their lives at risk. Prudent measures are needed to form community based organizations managed and led by hijra community and addressing their social exclusion and risky behaviors.

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          Most cited references8

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          Living on the Extreme Margin: Social Exclusion of the Transgender Population (Hijra) in Bangladesh

          The transgender people (hijra), who claim to be neither male nor female, are socially excluded in Bangladesh. This paper describes social exclusion of hijra [The term is used in this abstract both in singular and plural sense] focusing on the pathway between exclusion and sexual health. In an ethnographic study, 50 in-depth interviews with hijra, 20 key-informant interviews, and 10 focus-group discussions (FGDs), along with extensive field observations, were conducted. The findings revealed that hijra are located at the extreme margin of exclusion having no sociopolitical space where a hijra can lead life of a human being with dignity. Their deprivations are grounded in non-recognition as a separate gendered human being beyond the male-female dichotomy. Being outside this norm has prevented them from positioning themselves in greater society with human potential and security. They are physically, verbally, and sexually abused. Extreme social exclusion diminishes self-esteem and sense of social responsibility. Before safer sex interventions can be effective in a broader scale, hijra need to be recognized as having a space on society's gender continuum. Hijra, as the citizens of Bangladesh and part of society's diversity, have gender, sexual and citizenship rights, that need to be protected.
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            The HIV epidemic in Pakistan.

            Pakistan's HIV epidemic is fully established and expanding among injection drug users (IDUs) of whom 20% are infected with HIV. Nascent epidemics are seen in some cities among Male sex workers and transgenders who form sexual contacts of IDUs. With involvement of sex workers, Pakistan appears to be following the "Asian Epidemic Model". On the other hand, nearly all patients in HIV clinics are expatriated migrant workers and their immediate relations. Almost all principle population subgroups have at least some cases of HIV in most cities. While universally known risk of HIV transmission are present among sex workers, IDUs, a sub-group of men from the general population and other groups, epidemics among male sex workers have preceded those among female sex workers suggesting local nuances in sex behaviors. Universal male circumcision and limited contact between sex workers and IDUs may have slowed the initial progress of the epidemic thus far although that will change as the numbers of HIV-infected IDUs and their sexual contacts grows. The government runs HIV prevention programs for IDUs and sex workers in many cities, but must enhance the levels of coverage and quality of services provided. The slow early progression has provided a window of opportunity; it must not be allowed to close.
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              Leaving sex work: barriers, facilitating factors and consequences for female sex workers in northern Thailand.

              Factors facilitating or inhibiting women's ability to leave sex work are still poorly characterized, and little is known about women's lives after they leave the profession. This paper presents findings from a qualitative study about factors affecting women's ability to leave sex work and influencing their lives after leaving. We interviewed 42 current and former female sex workers (FSWs) drawn from a cohort study of 500 FSWs in northern Thailand. All but one of the participants had quit sex work at least once. The majority experienced one or more quit-re-entry-quit cycles. Women's ability and decisions to leave sex work were determined primarily by four factors: economic situation, relationship with a steady partner, attitudes towards sex work and HIV/AIDS experience. Economic concerns, ranging from survival needs to materialistic desires, had the strongest influence. Most women perceived their risk for HIV infection to be lower after leaving sex work, but three of the 17 HIV-infected women acquired infection after having left, presumably from their steady partners. Prevention efforts should guide women as they transition out of commercial sex work. Interventions aimed at assisting women wanting to leave sex work need to address the role of economic factors.
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                Author and article information

                Journal
                BMC Int Health Hum Rights
                BMC Int Health Hum Rights
                BMC International Health and Human Rights
                BioMed Central
                1472-698X
                2012
                19 November 2012
                : 12
                : 32
                Affiliations
                [1 ]Shifa College of Medicine, Pitrus Bukhari Road, Sector H-8/4, Islamabad, Pakistan
                Article
                1472-698X-12-32
                10.1186/1472-698X-12-32
                3534382
                23163979
                73b04ede-955a-47bb-b279-e9a7a0ac0e53
                Copyright ©2012 Abdullah et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 May 2012
                : 15 November 2012
                Categories
                Research Article

                Health & Social care
                hijras,commercial sex work,social exclusion,hiv and pakistan
                Health & Social care
                hijras, commercial sex work, social exclusion, hiv and pakistan

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