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Third gender people in Pakistan, most commonly known as khwaja sira, have experienced significant social and economic impacts, both from the COVID-19 pandemic and from the migration of Pashtun refugees, following the withdrawal of American troops in Afghanistan in August 2021. Prior to the pandemic, khwaja sira communities primarily earned their livelihood through the offering of blessings known as badhai; public performances of song and dance; panhandling; and sex work. However, all these modes of income generation have been further marginalized during the pandemic as the very nature of these activities poses some degree of infectious disease risk. Experiences of social marginalization within the community were exacerbated due to stay-at-home orders, limitations in movement and transportation, and restrictions on public gatherings.
Objective
We sought to explore the ways in which khwaja sira communities of Swat, a region within the northwestern province of Khyber Pakhtunkhwa, Pakistan, have been impacted by the ongoing COVID-19 pandemic, focusing primarily on social and economic implications.
Methods
We interviewed 45 khwaja sira in the language of Pashto on their experiences during the COVID-19 pandemic. Inclusion criteria for the study were: (1) self-identified as khwaja sira; (2) reside in Mingora, Swat; (3) proficient in speaking Pashto; and (4) over the age of 18. Interviews were digitally audio-recorded in Pashto and transcribed/translated into English. Data was collected between 2020 and 2021.
The theoretical framework of Minority Stress Theory was applied to analysis of the transcripts. After reviewing the transcripts, six evaluators—the principal investigator, two research assistants in Pakistan, and three U.S.-based research assistants—developed a codebook of themes. We engaged in an iterative process to redefine and group themes. Consensus was reached on all coding decisions, following discussions among the members of the research team.
Results
We identified two overarching themes and six subthemes related to the COVID-19 pandemic. The two overarching themes were financial insecurity and social vulnerability. Under the theme of financial insecurity, we identified three subthemes: (1) loss of income and financial stress; (2) risk from engagement in sex work; and (3) dependence of extended family members on khwaja sira’s income. Under the theme of social vulnerability, we identified three themes: (1) social isolation; (2) psychological distress and (3) the inability to access medical care. Narratives from each of these themes will be expounded in the presentation
Implications for Social Work Policy and Practice
Our findings have direct relevance for designing future public health policies and programs in the Swat region and throughout the Afghanistan-Pakistan border. Future engagement with Pashtun communities must acknowledge the unique vulnerabilities for infectious disease control in humanitarian crisis contexts.