Objectives: To distinguish between three distinct groups of male and transgender sex workers in Pakistan and to demonstrate how members of these stigmatised groups need to be engaged in the research process to go beyond stated norms of behaviour.
Methods: A peer ethnography study was undertaken in a major city in Pakistan. 15 male and 15 transgender sex workers were trained as peer researchers to each interview three peers in their network. Analysis was based on interviews with peer researchers as well as observation of dynamics during training and analysis workshops.
Results: The research process revealed that, within the epidemiological category of biological males who sell sex, there are three sociologically different sexual identities: khusras (transgender), khotkis (feminised males) and banthas (mainstream male identity). Both khusras and khotkis are organised in strong social structures based on a shared identity. While these networks provide emotional and material support, they also come with rigid group norms based on expected “feminine” behaviours. In everyday reality, sex workers showed fluidity in both behaviour and identity according to the situational context, transgressing both wider societal and group norms. The informal observational component in peer ethnography was crucial for the accurate interpretation of interview data. Participant accounts of behaviour and relationships are shaped by the research contexts including who interviews them, at what stage of familiarity and who may overhear the conversation.
Conclusions: To avoid imposing a “false clarity” on categorisation of identity and assumed behaviour, it is necessary to go beyond verbal accounts to document the fluidity of everyday reality.
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Funding: UK Department for International Development (DFID).
Competing interests: None.
Ethics approval: Ethics approval was obtained from HOPE in Pakistan and from the ethics committee at the London School of Hygiene and Tropical Medicine. Informed consent was obtained twice from the peer researchers, once during the training workshop and again when they were invited for in-depth interview and were asked permission for the interview to be taped. The peer researchers were trained to obtain verbal consent from the peers they interviewed, but carried no forms as this could potentially put them at risk.
Contributions: MC contributed to the design of the study, observed the training, interviews and analysis workshops, contributed to analysis and interpretation of the data and is lead author on the paper. AAQ was the main trainer and facilitator of the workshops with peer researchers, did the in-depth interviews with male sex worker peer researchers, contributed to analysis and interpretation of the data and to paper writing. SM contributed to the design of the study, analysis and interpretation of the data and to paper writing. NR assisted with study implementation and contributed to paper writing. AR contributed to analysis and interpretation of the data and to paper writing. BR trained the trainers in peer ethnography methodology and contributed to paper writing. RKV contributed to interviewing of peer researchers, analysis and interpretation of the data and to paper writing. HR was responsible for recruitment of peer researchers and coordinating supervision of the field work and logistics of workshops. N-i-R coordinated the workshops and interviews with peer researchers, did the in-depth interviews with transgender sex worker peer researchers, contributed to analysis and interpretation of the data and to paper writing.
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