Intended for healthcare professionals

Rapid response to:


Police violence and sexual risk among female and transvestite sex workers in Serbia: qualitative study

BMJ 2008; 337 doi: (Published 30 July 2008) Cite this as: BMJ 2008;337:a811

Rapid Response:

Transvestites in South Asia: fall from grace

Hijras(transvestites) in South Asia identify themselves as female
though most are born biologically as males, maintaining social status as a
‘third sex’. Hijra identity is unique to the Subcontinent and has no
Western equivalent. Hijras once enjoyed an exalted status as devotees of
the Mother Goddess Bahuchara Mata[1]. They were patrons of fertility,
counselors to kings and bodyguards to queens. Nowadays, in a society where
they seem to have no place, most find employment only as prostitutes.

In Pakistan, an Islamic country where homosexuality is strictly
forbidden, Hijras are recognized as one of the major vulnerable groups
with regards to HIV/AIDS[2]. In one of study conducted on this
marginalized group, 80% admitted they had never used a condom; 79% of
Hijras had heard of AIDS, but beyond that, 42% did not know how it was
transmitted[3]. This shocking lack of knowledge, lack of protection,
coupled with their promiscuous behavior puts a serious risk on these
destitute transvestites on top of their status as social outcasts. They
are frequently beaten up by police for even carrying condoms –something
that is a crime in Pakistan[4]. Such is their sense of shame and
humiliation that some Hijras interviewed said they did not wear condoms
because HIV was divine punishment for their immoral activities[4].

Discrimination against those who trespass gender boundaries occur
around the world. However, when state and religion refuse to support them,
such groups are driven underground and further away from public health
interventions. Better health for transvestites must start with accepting
them as part of mainstream society. For violence to end, neglect must go

1. Bakshi S. A comparative analysis of hijras and drag queens: the
subversive possibilities and limits of parading effeminacy and negotiating
masculinity. J Homosex. 2004;46(3-4):211-23.

2. Rai MA, Warraich HJ, Ali SH, Nerurkar VR. HIV/AIDS in Pakistan: the
battle begins. Retrovirology. 2007;4:22.

3. Baqi S, Shah SA, Baig MA, Mujeeb SA, Memon A. Seroprevalence of HIV,
HBV, and syphilis and associated risk behaviours in male transvestites
(Hijras) in Karachi, Pakistan. Int J STD AIDS. 1999 May;10(5):300-4.

4. Rajabali A, Khan S, Warraich HJ, Khanani MR, Ali SH. HIV and
homosexuality in Pakistan. Lancet Infect Dis. 2008 Aug;8(8):511-5.

Competing interests:
None declared

Competing interests: No competing interests

11 September 2008
Haider J Warraich
Final Year Medical Student
Medical College, Aga Khan University, Karachi, Pakistan. PO BOX 34800