“No place for someone like me to speak”: political exclusion, prison governance, and sexual violence against transgender inmates in Pakistan

Background Transgender individuals experience disproportionate health, safety, and human rights violations within carceral systems globally, yet empirical evidence from the Global South, particularly Pakistan, remains scarce. In Pakistan’s prisons, entrenched structural stigma, political exclusion, and governance failures intersect to intensify sexual violence, psychological distress, and HIV vulnerability among transgender inmates. The invisibility of this population within legal, judicial, and health institutions further compounds these risks, underscoring the need for context-sensitive qualitative inquiry.Aim The aim of this study was to explore how political exclusion and prison governance shape experiences of sexual violence, mental distress, and HIV-related vulnerability among transgender prisoners in Karachi, while documenting their perceptions of legal, judicial, and health systems during incarceration.Methods A qualitative research design grounded in interpretivist philosophy was employed, using phenomenologically informed reflexive thematic analysis. In-depth, semi-structured interviews were conducted with 18 formerly incarcerated transgender individuals recruited through community-based organizations.Results Data were analyzed following Braun and Clarke’s six-phase framework, with reflexivity, audit trails, and peer debriefing used to enhance trustworthiness. Four interrelated themes emerged: (1) political exclusion as structured silencing within prison governance; (2) sexual violence as a predictable consequence of powerlessness and fear of retaliation; (3) psychological distress and HIV vulnerability as outcomes of institutional neglect and governance failure; and (4) deep institutional distrust and legal disenfranchisement across judicial and health systems. These themes reveal how governance failures translate into embodied harm.Conclusion The study concludes that transgender prisoners’ health vulnerabilities are structurally produced rather than incidental. Policy reforms must move beyond symbolic legal recognition to implement gender-affirming prison governance, trauma-informed healthcare, and accountable reporting mechanisms. Centering transgender voices is essential for ethical, effective carceral and public health reform in Pakistan.