Encapsulating the burden and social determinants of self-reported general health problems among a specific sub-group of transgender women in Dhaka, Bangladesh: a mixed-methods study.

Abstract

Background: In Bangladesh and other resource-constrained settings, a sub-group of transgender women (predominantly known as hijra in South Asia) encounter systemic marginalization, which unfairly predisposes them to health disadvantages. Although studies are beginning to illuminate the emerging burden of various communicable and non-communicable diseases, the global scholarship has predominantly confined these marginalized people within HIV/STI research framework. Our study explored the burden of diverse self-reported health problems and their underlying contexts among hijra in Dhaka, Bangladesh.

Methods: A mixed-methods cross-sectional study was conducted among 483 hijra. The quantitative component applied systematic sampling approaches from eight drop-in centers. Moreover, in-depth interviews and focus group discussions were convened with hijra and key-informant interviews with hijra leaders known as hijra guru, DIC staff, and public health experts. Qualitative findings were manually analyzed using the social determinants of health framework and equity lenses, within the domain of thematic analysis.

Results: Hijra living in Dhaka, Bangladesh reported heightened levels of general health ailments, exacerbated by the stigma, socio-economic marginalization, and limited healthcare access. Findings reflected high health burdens (58.4% with at least one ailment in the past year); self-reported mental health concerns (61.3%), anal conditions (55.7%), cold/cough (51.1%), asthma (41.5%), hypertension (33.3%), and diabetes (24.8%). Qualitative findings linked these health ailments to various contexts underpinned by structural inequities and social determinants, e.g. mental health concerns were linked to educational and familial exclusion, infectious diseases were exacerbated by poor living conditions, and non-communicable diseases were perpetuated by food insecurities and hormone intake linked to occupational risks.

Conclusion: Findings demonstrated the burden and variegated contexts of general health problems among hijra. However, these problems are often buried beneath the HIV paradigm. Their health problems were linked to structural inequities, marginalization, and healthcare constraints, and these inequities need to be addressed to ensure their health and wellbeing. Solely biomedical and public health frameworks may not suffice for hijra, rather we need to move towards a comprehensive equity-oriented approach.