An ethnographic pilot study: impacts of stigma on health and wellbeing of transgender females in Nepal

This ethnographic study explores the effects of stigma on the health and welfare of transgender women in Nepal with an emphasis on how societal, institutional, and internalized forms of stigma influence transgender women's lived experiences. Even with Nepal's gradual legal acknowledgement of a third gender, transgender people nevertheless face discrimination and exclusion in important domains like healthcare, work, housing, and education. The study draws upon qualitative data collected through field immersion and semi-structured interviews with five self-identified transgender women residing in Kathmandu. Thematic analysis reveals that stigma operates through three interconnected domains: social stigma—manifesting as family rejection and public discrimination; structural stigma—evident in healthcare, education, and employment discrimination; and self stigma—expressed as shame, self-isolation, and psychological distress. These combined marginalization experiences create major obstacles to receiving the right medical care, which frequently results in untreated mental health issues, increased susceptibility to HIV, and a lower standard of living. In addition, participants reported using advocacy networks, moving to an urban area for anonymity, and hiding their gender identification as coping mechanisms. This study provides policy-relevant insights for national and regional human rights frameworks and adds to the localized knowledge on transgender health. For transgender women in Nepal to achieve their right to health and dignity, stigma must be addressed in all of its social, structural, and psychological facets. The results highlight the urgent necessity of developing transgender-inclusive, gender-affirming healthcare services in Nepal as well as disaggregated policies that distinguish amongst LGBTIQ subgroups.