When prison felt safer: A case study of structural abandonment and transgender health in Pakistan

Background Transgender individuals globally face disproportionate exposure to violence, stigma, and institutional marginalization, all of which have significant implications for health and wellbeing. While carceral settings are widely documented as sites of harm for gender-diverse populations, emerging scholarship suggests that experiences of safety may be contextually shaped under conditions of chronic marginalization.Objective This study examines how structural abandonment shapes the health experiences and perceptions of safety of a transgender individual in Pakistan, producing a paradox in which incarceration is experienced as comparatively less threatening than life outside prison.Methods The study adopts a qualitative single-case design informed by the principles of Interpretative Phenomenological Analysis (IPA). Data were generated through an in-depth semi-structured interview and analyzed with a focus on idiographic meaning-making and lived experience.Results Findings indicate persistent exposure to harassment, violence, and institutional non-response outside prison contributes to heightened psychological distress, hypervigilance, and emotional exhaustion. In contrast, the controlled and predictable environment of prison is experienced as comparatively stabilizing. The concept of structural abandonment is developed inductively to describe a patterned condition of institutional absence, neglect, and under-protection shaping these experiences.Conclusions The perception of relative safety in prison is not interpreted as evidence of protection within carceral settings, but as an outcome of health-damaging structural conditions outside them. Structural abandonment operates not through overt repression but through institutional neglect, under-policing, and non-response, shaping conditions in which vulnerability is produced and normalized. As an analytically illustrative case, the study contributes to transgender health scholarship by demonstrating how safety operates as a key determinant of wellbeing in contexts of systemic marginalization in the Global South.