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by Jason Lee


Tagline: In this essay, Jason Lee explores the relationship between gender categories and health policy-making through the embodied experiences and political discourses of hijra, a transregional third gender identity in South Asia.


In recent decades, public health researchers have taken a greater interest in examining the health outcomes of gender-diverse communities in a global context. In particular, the growing body of literature on hijra, a transregional third gender identity across South Asia, represents a concerted effort in this regard. Though often regarded as individuals with feminine identities in male bodies, many hijras identify with a separate gender identity that deviates from being transgender female (Dutta and Roy 2014). Playing significant cultural and religious roles, hijras usually perform rituals and offer blessings at weddings and birth ceremonies (Nanda 1999). Commonly believed to possess the power to bless or curse families, hijras are often regarded with a mixture of respect and fear. Many also live together in organized communities called gharanas with lineages of gurus (teachers) and chelas (disciples) (Nanda 1999).

In addition to these common portrayals, hijras are also noted for exceeding national and religious boundaries, from hijras that worship Maya Ji, a Hindu goddess, in Muslim-majority Bangladesh to those who identify as Muslims in India. (Hossain 2018). Linguistically, hijra communities have also often been described as supranational due to their unique spoken languages, which include Ulti or “reverse language” in Bangladesh and West Bengal as well as Hijra Farsi in Pakistan and India (Hossain 2018, Awan and Sheeraz 2011).

Hijra as Resisting Colonial Erasure of Gender

Under British colonial rule, hijras were denigrated as “eunuchs” and criminalized under accusations of sodomy, kidnapping, and castration. Following the 1871 Criminal Tribes Act, local colonial police in the North-Western Provinces started collecting registries of hijras (Hinchy 2020). The police also banned hijras from performing or wearing feminine clothes, disrupted succession patterns, and removed children from hijra households. Undermining such efforts of elimination, some registered hijras would permanently migrate out of the region while others would wear a mix of masculine and feminine clothes to avoid incarceration (Hinchy 2020).

Colonial officials’ systematic attempts to eliminate the physical and cultural presence of hijras demonstrate how they not only regarded hijras as an immoral, ungovernable population but as a threat to colonial social order. With a key ideological focus on governing the bodies and sexualities of hijras, they portrayed hijras as a population incapable of bodily labor or self-discipline due to castration or impotence (Hinchy 2020). In this case, the police relied on feminine appearances and presentations as measures of one’s impotence. However, determining a “eunuch” based on visual appearance alone proved difficult as hijras often defied binary gender categories. As a result, colonial physicians were eventually called upon to diagnose impotence as part of the broader campaign to criminalize hijras (Hinchy 2020). 


Though no longer subjected to the same colonial laws, hijras today are still subjected to bureaucratic governance that dictates their bodies and gender expression. Examining the implications of the 2014 Rights of Transgender Persons Bill in India, some scholars have critiqued how the act of requiring hijras to register for official recognition strengthens the government’s powers in adjudicating gender categories (Bhattacharya and Ghosh 2020). In turn, requiring hijras to register under a government-sanctioned gender has caused hijras to be denied access to key services and resources (Dutta and Roy 2014). For instance, by refusing to adhere to stable gender categories of “male” “female,” or “other/transgender,” some hijras who applied for multiple identity cards have faced problems accessing healthcare services (Dutta and Roy 2014).


In addition, despite having laws and governmental policies that seemingly respect their gender identity, hijras continue to be discriminated against under biological determinist notions of disability. As part of a 2015 diversity initiative to hire hijra individuals as office assistants and clerks, the Ministry of Social Welfare in Bangladesh required candidates to undergo medical examinations to prove their status as hijras (Hossain 2017). Realizing that 11 out of the 12 candidates had male genitalia, the ministry and news outlets accused the candidates of being men who pretended to be hijras for the sake of employment (Hossain 2017). The government and media’s reaction, in this case, reflected a mainstream understanding of hijras as emasculated and disabled with genital birth defects. Rejecting such biological conceptualizations of an “authentic” hijra, hijra organizations have protested against such reductive identification methods that obscures their sociocultural roles (Hossain 2017).



Similar to public health discourses of queer health in Euro-American contexts, a significant portion of public health research on hijras has focused on HIV/AIDS. Specifically, a heavy emphasis has been put on the “high risk” behaviors that hijras engage in that increase their likelihood of getting HIV. For instance, studies have highlighted how sex work, alcoholism, and substance abuse as risk factors among hijras (Altaf et al. 2012, Kumar et al. 2020). Regarded as a population that is “predisposed” to mental health problems, scholars have also aimed to uncover the vast pathways that underlie hijras’ social determinants of mental health. From adopting the minority stress model to implementing spatial analyses, these studies have shifted away from health behaviors toward examining the emotional, social, and structural impacts of widespread stigma, discrimination, and abuse towards hijras (Srivastava et al. 2020, Goyal et al. 2014, Sartaj et al. 2020, Bhattacharya and Ghosh 2020).

Throughout many public health studies of hijras, a common theme is how their increasing marginalization is conveyed as more or less inevitable. However, the rationales that undergird the designation of hijras as a necessarily “vulnerable” population correspond to or deviate from preexisting framings of queer public health literature. In similar ways, the lack of societal acceptance and discrimination leads to hijras being more vulnerable to engaging in risky health behaviors and having poorer mental health outcomes. Additionally, modernization and globalization are implicitly regarded as driving forces behind hijras’ marginalization as their traditional roles become increasingly obsolete. Inherent vulnerability, in this case, is assumed as a product of cultural stigma, discrimination, and abuse that has roots in British colonialism but continues to worsen in a postcolonial context. While some studies have critiqued how recent government policies have exacerbated the health of hijras as a “vulnerable” population, others have been less explicit in recognizing government accountability. The inconsistency in defining hijras as “vulnerable” can result in vagueness that obscures the power dynamics that contextualize the health behaviors and social determinants of health that various studies have identified (Katz et al. 2019).


While public health literature has strengthened the depiction of hijra as a vulnerable population, hijras face conflicting challenges when reclaiming their agency over how they are represented in political and public health discourses. Recognizing how “transgender” carries more weight in governmental and legal spheres domestically and globally, some hijra activists and NGOs have adopted “transgender” to garner support and resources even though the term might not fully represent their identities (Dutta and Roy 2014). On the other hand, some trans individuals have attempted to distance themselves from negative portrayals of hijras, even rejecting the identity of hijra altogether. In 2016, the #IamNotAHijra photo campaign in India featured several transwomen holding signs that underscored how they were not beggars or sex workers (Mount 2020). With individuals who emphasized their occupations and implicitly their class as their point of distinction from being hijra, the campaign was critiqued for reinforcing the stigmatization of hijras. (Mount 2020). Similarly, #ChangetheClap, a 2017 social media campaign in Pakistan that rendered the hijra clap from a gesture of identity to a sign of stigma, has received similar criticisms for its neoliberal undertones that centered around “respectable” images of transwomen (Pamment 2019). 


In other cases, seemingly positive media portrayals of hijras can often reiterate enduring prejudice. In May 2020, news outlets in Dhaka, Bangladesh started reporting how hijra communities are volunteering in marginalized communities through services such as delivering food and medications to driving sick patients to hospitals (Hossain 2022). As a community heavily impacted by COVID themselves, hijras’ acts of service were widely depicted by the media as opportunities for them to demonstrate how they are an integral part of mainstream society (Hossain 2022). At first glance, it might seem as if such portrayals signify a gradual acceptance of hijras. However, from being denigrated as carriers of COVID to being hailed as heroes, such shifts in framing as hijra did not dissipate but actually reinforced the prejudice directed at them (Hossain 2022). As opposed to rectifying the social attitudes and policy discourses that constitute their marginalization, hijras are instead required to put themselves at greater risk in order to be humanized as productive members of society (Hossain 2022).




From eunuch in colonial registries to transgender in current identity cards, government initiatives that aimed to criminalize or supposedly uplift hijras have both reduced them to disabled bodies in a gender binary system. Therefore, it is important to examine and rectify how recent policies and media reports have further entrenched biological deterministic ideologies of hijras under the guise of equity. While public health discourses have become more specific in highlighting the “risk factors” that underlie hijras’ vulnerability, the inherent assumptions of hijras’ “social determinants of health” as immutable can often erase accountability (Katz et al. 2019). As such, it is critical to parse out structural factors such as heterosexism and colonization and trace them to key governmental institutions and decision-makers. Additionally, the prevailing narrative of hijra as a “local” gender identity and transgender as a “global” gender identity has reinforced characterizations of hijras as increasingly vulnerable under globalization (Dutta and Roy 2014). In turn, such hierarchies of identities have also undergirded polarizing approaches to reclaiming agency, from the simultaneous adoption of hijra and transgender to the rejection of hijra in favor of transgender (Dutta and Roy 2014, Mount 2020). Deconstructing ontologies of hijra as a localized gender identity- in government policies, public health research, and queer activism–is therefore key to dismantling how public discourses have continued to restrict hijras’ bodies, identities, and expression.



Altaf, Arshad, Aysha Zahidie, and Ajmal Agha. 2012. “Comparing Risk Factors of HIV among Hijra Sex Workers in Larkana and Other Cities of Pakistan: An Analytical Cross Sectional Study.” BMC Public Health 12 (1). doi:10.1186/1471-2458-12-279. 


Awan, Muhammad Safeer and Muhammad Sheeraz. 2011. “Queer but Language: A Sociolinguistic Study of Farsi,” in International Journal of Humanities and Social Science 1 (10), 127–135.


Bhattacharya, Shamayeta, and Debarchana Ghosh. 2020. “Studying Physical and Mental Health Status among Hijra, Kothi and Transgender Community in Kolkata, India.” Social Science & Medicine 265: 113412. 


Dutta, Aniruddha, and Raina Roy. 2014. “Decolonizing Transgender in India: Some Reflections.” TSQ: Transgender Studies Quarterly 1 (3): 320–37. 


Hossain, Adnan. 2018 “De-Indianizing Hijra.” TSQ: Transgender Studies Quarterly 5 (3): 321–31. 


Hossain, Adnan. 2022. “Metaphor of Contagion.” Essay. In Covid-19 Assemblages: Queer and Feminist Ethnographies from South Asia. Abingdon, Oxon: Routledge. 


Hossain, Adnan. 2017. “The Paradox of Recognition: Hijra, Third Gender and Sexual Rights in Bangladesh.” Culture, Health & Sexuality 19 (12): 1418–31.


Hinchy, Jessica. 2020. Governing Gender and Sexuality in Colonial India: The Hijra, c. 1850-1900. Cambridge: Cambridge University Press. 


Goyal, Shrigopal, Koushik Sinha Deb, Deeksha Elawadhi, and Nanaji Kaw. 2014. “Substance Abuse as a Way of Life in Marginalized Gender Identity Disorder: A Case Report with Review of Indian Literature.” Asian Journal of Psychiatry 12: 160–62. 


Katz, Amy S., Billie-Jo Hardy, Michelle Firestone, Aisha Lofters, and Melody E. Morton-Ninomiya. 2019. “Vagueness, Power and Public Health: Use of ‘Vulnerable‘ in Public Health Literature.” Critical Public Health 30 (5): 601–11 


Kumar, Pradeep, Shobini Rajan, Bhavna Sangal, Arvind Kumar, Shreena Ramanathan, and Savina Ammassari. 2020. “HIV/AIDS-Related Risk Behaviors, HIV Prevalence, and Determinants for HIV Prevalence among Hijra/Transgender People in India: Findings from the 2014–2015 Integrated Biological and Behavioural Surveillance.” Indian Journal of Public Health 64 (5): 53. 


Mount, Liz. 2020. “‘I Am Not a Hijra’: Class, Respectability, and the Emergence of the ‘New’ Transgender Woman in India.” Gender & Society 34 (4): 620–47.


Nanda, Serena. 1999. Neither Man nor Woman: The Hijras of India, 2nd ed. Belmont, CA: Wadsworth Pub. Co.


Pamment, Claire. 2019. “The Hijra Clap in Neoliberal Hands: Performing Trans Rights in Pakistan.” TDR/The Drama Review 63 (1) : 141–51.


Sartaj, Deepak, Vijay Krishnan, Ravindra Rao, Atul Ambekar, Neeraj Dhingra, and Pratap Sharan. 2020. “Mental Illnesses and Related Vulnerabilities in the Hijra Community: A Cross-Sectional Study from India.” International Journal of Social Psychiatry 67 (3): 290–97. 


Sequeira, Rovel. 2022. “Show and Tell: Life History and Hijra Activism in India.” Signs: Journal of Women in Culture and Society 47 (2): 451–74. 


Srivastava, Ankur, Murugesan Sivasubramanian, and Jeremy T. Goldbach. 2020. “Mental Health and Gender Transitioning among Hijra Individuals: A Qualitative Approach Using the Minority Stress Model.” Culture, Health & Sexuality 23 (6): 757–71.

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