Exploring the sexual health seeking behaviors of hijra community in Dhaka: a qualitative study

Abstract

Introduction Hijra people in Bangladesh are stigmatized in various aspects of their lives including the healthcare system. This study aimed to explore the sexual health service seeking behavior of Hijra people in Dhaka city, along with its influencing factors. Method This study followed a qualitative approach to explore sexual health seeking behavior of Hijra people in Dhaka. Using snow-ball sampling technique, in-depth interviews were conducted with 26 Hijra people. To achieve an overview on the sexual health seeking behavior of the Hijra community, key informant interviews were conducted with 4 Hijra community leaders and 1 program personnel of a Hijra based NGO. The interviews were conducted in Bangla, translated verbatim in English and coded by using both inductive and deductive approaches. Selected interview responses were clustered and arranged according to themes and sub-themes in a data matrix for interpretation. Findings The criminalization of sex-reassignment surgeries in Bangladesh compels the Hijra people to take unmonitored risky surgeries from unqualified doctors in Bangladesh. The information on these illegal surgeons are kept secret by the Hijra people. Despite having knowledge on safe sex practices, many Hijra people were not consistently following these measures due to reasons like their personal preferences, and unwillingness of customers of Hijra sex workers to wear condoms. For sexual health services like supply of condoms, testing and treatment of STIs, most preferred facility by Hijra people is NGO based health facilities, followed by government hospitals. The negative experience they face in government hospitals often divert them to seek services from informal health service providers like local pharmacies and homeopathic doctors. Conclusion Legalization of sex-reassignment surgeries for Hijra people, establishing designated health facilities for them and sensitizing health service providers on Hijra people will improve sexual health status of Hijra people in Bangladesh.