Health disparities and socioeconomic challenges faced by the Khawaja Sira (intersex and gender-diverse) community in Islamabad, Pakistan: A descriptive cross-sectional study

Enishwa Ali and Mariam Ashraf

PLOS Global Public Health, 2026, vol. 6, issue 7, 1-17

Abstract: In Pakistan, gender-diverse and intersex individuals locally identified as Khawaja Sira face systemic exclusion, social stigma, and limited access to essential health services. Despite the 2018 Transgender Persons (Protection of Rights) Act, empirical evidence on their health conditions and socio-economic realities remains limited. This study assesses the physical and mental health status, healthcare access, and socio-economic challenges of the Khawaja Sira community in Islamabad. A descriptive cross-sectional study recruited 91 self-identified Khawaja Sira individuals in Islamabad through snowball sampling initiated via community leaders (“Gurus”). Data were collected using structured questionnaires incorporating the Hopkins Symptom Checklist (HSCL-25; Cronbach’s α = 0.92) for mental health and the Health Protective Behaviour Scale (HPBS; α = 0.89). Descriptive statistics were analyzed using SPSS Version 19. Recruitment through community gatekeepers likely introduced network bias, potentially limiting representativeness. Within the sample, the mean HSCL-25 score was 2.1 (SD = 0.6), with 68% of participants exceeding the clinical cut-off of 1.75 for significant psychological distress. Common physical conditions included hypertension (20%), diabetes (9%), and asthma (7%). Only 25% reported regular health check-ups, and 73% lacked awareness of blood sugar levels. Tobacco use was reported by 57% of participants. Unemployment affected 34% of the sample, and 66% reported insufficient income for basic expenses. Nearly half (45%) felt uncomfortable or unsafe in healthcare settings, citing stigma and discrimination. This exploratory study documents substantial health inequities and socio-economic challenges among Khawaja Sira individuals recruited in Islamabad, with findings that warrant further investigation in more representative samples. Findings suggest urgent need for culturally competent healthcare services, mental health support, and inclusive social protection policies.

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pgph00:0005798

DOI: 10.1371/journal.pgph.0005798

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