"I Would Prefer to be Dead Than to Live This Life This Way": Lived Experiences of Stigma and Discrimination Against Khwaja Sira in Swat, Pakistan

Background and Purpose. Khwaja sira is the term most commonly used to identify third gender people in Pakistan, a population estimated to number approximately 1.5 million people. Following British colonization of South Asia and the subsequent criminalization of gender-nonbinary identities, khwaja sira have had limited educational opportunities, which have also influenced their work and financial options. Due to their identification as third gender people, khwaja sira have historically been subjected to pervasive experiences of stigma and discrimination. Due to a history of strict gender roles and several decades of social and political instability with neighboring Afghanistan, the northwestern Swat Valley, located in the Malakand region of Khyber Pakhtunkhwa, Pakistan, provides a unique sociocultural context for the study of gender-nonconformity stigma. The objective of this study was to better understand the experiences of gender-nonconformity stigma of khwaja sira in various social contexts, including within their families, in accessing health care, and within education and work contexts. The theoretical framework that guides the present study is Minority Stress Theory (MST). One of the central tenets of MST is that sexual and gender minorities are at increased risk for psychosocial stress due to their stigmatization in a heterosexist society (Meyer, 2003).

Methods. We recruited 45 khwaja sira in Mingora, Swat, Khyber Pakhtunkhwa, Pakistan to participate in in-depth qualitative interviews. Participants were provided a financial incentive of 500 PKR (approximately $2.50 USD at the time of study completion). Inclusion criteria for the study were: (1) self-identification as khwaja sira; (2) residence in Mingora, Swat; (3) proficient in speaking Pashto; and (4) over the age of 18 years. Interviews were collected in Mingora between 2019 and 2021 in the office spaces of partnering NGOs or in other private settings. Open-ended questions were utilized to elicit descriptions of lived experiences of khwaja sira. All interviews were digitally audio recorded, then subsequently translated and transcribed directly from Pashto into English. Transcripts of the interviews were analyzed using thematic content analysis on the software program, Dedoose.

Results. Applying MST, we identified three main themes regarding the experiences of stigma and discrimination experienced by khwaja sira in Swat, Pakistan: internalized stigma, perceived stigma, and enacted stigma. Under the theme of internalized stigma, we identified the following subtheme: feelings of shame and embarrassment. Under the theme of perceived stigma, we identified the following three subthemes: (1) perceived stigma regarding lack of employability; (2) perceived stigma regarding engagement in sex work; and (3) perceived stigma against one’s family for being associated with khwaja sira. Under the theme of enacted stigma, we identified the following four subthemes: (1) exclusion from families; (2) exclusion from students and teachers; (3) exclusion from religious spaces; and (4) exclusion from health care.

Conclusions and Implications. Analyzing experiences of gender-nonconformity stigma through the constructs of MST can help to better understand how khwaja sira are treated in various social contexts. Findings may inform future social intervention and community practice engagements with khwaja sira communities.