Transgender persons living with HIV in KP are fighting two epidemics at once: the virus itself and the relentless stigma that surrounds it.
M۔ Irshadullah
When Aaliya learned she was HIV-positive in 2023, she didn’t tell anyone. “If I saidshe recalls quietly, “I would lose my family, my community, my home. Maybe even my life.”
For months she avoided clinics and kept her illness secret, hoping it would somehow fade away. When her health worsened, she finally went to a hospital in Peshawar. There, her worst fears came true, a nurse announced her HIV status within earshot of others. The whispers that followed pushed her out of the ward that day, never to return.
Aaliya’s story is not rare. Across Khyber Pakhtunkhwa, transgender persons living with HIV are fighting two epidemics at once, the virus itself, and the relentless stigma that surrounds it. In Pakistan, HIV remains a concentrated epidemic, largely confined to key populations. Yet within those groups, transgender persons are among the most vulnerable.
According to the National AIDS Control Program, over 78,734 HIV cases are registered nationwide. In Khyber Pakhtunkhwa alone, more than 8,300 people are living with the virus, including 197 transgender individuals as of June 2025. These figures barely tell the full story. Many transgender people never get tested, fearing exposure, humiliation, or outright refusal of care.
A 2024 HIV Stigma Index Study 2.0 carried out by Association for People Living with HIV revealed that 16 percent of transgender respondents had been denied healthcare services because of their HIV status ; the highest rate among any group surveyed.
In a province where both gender identity and sexuality are often moralized, HIV is seen not just as an illness but as a mark of shame.For most transgender people in Khyber Pakhtunkhwa, life is already lived on the margins. Rejected by families at a young age, many find shelter in deras; communal homes led by senior gurus. Economic survival often depends on informal work such as performing, begging, or sex work, which brings exposure to health risks but few protections.
When HIV enters this fragile equation, it deepens the cycle of isolation. “I have seen friends thrown out of their dera after they tested positive,” says Rizwana, a community leader from Mardan. “People believe it’s a punishment for sin. Even other transgender people start to avoid you, as if the disease is contagious through touch.” Without family support, acceptance, or steady income, many transgender persons with HIV in KP end up homeless or trapped in exploitative living conditions.
Silence becomes their only form of survival.The provincial government has made some efforts to improve care. Hospitals in Khyber Pakhtunkhwa have been directed to establish designated rooms for transgender patients ; a symbolic step toward inclusive healthcare. But implementation remains uneven. Some hospitals lack trained staff, others breach confidentiality, and in many districts the initiative exists only on paper.
“There’s no privacy. Even your name can expose you,” says a healthcare worker from an ART centre in Peshawar. Fear of being identified drives many to travel outside the province for treatment or to rely on private clinics they can hardly afford. Others simply stop taking medication, choosing secrecy over safety.
Cultural and religious sensitivities further complicate the situation. In a deeply conservative society, conversations about gender identity or sexual health remain taboo. Religious rhetoric often portrays HIV as divine punishment, reinforcing guilt and self-blame. Yet some local clerics are cautiously pushing back. “Islam teaches compassion and care for the sick, not rejection,” says a faith leader from Charsadda who has participated in awareness sessions with civil society groups. “We must fight the disease, not the person.”
These rare but powerful voices hint at the possibility of change, though progress remains fragile and inconsistent. Beyond the physical challenges, the mental health toll is enormous. The fear of exposure or rejection drives many transgender persons with HIV into depression and anxiety. “The stress is worse than the illness,” explains a counselor at an ART centre in Peshawar.
“They hide their medicine, avoid friends, even stop attending community events.” The emotional isolation created by stigma often leads to treatment interruption, which weakens the immune system and increases the risk of further transmission.
Still, there are rays of hope. Community-based organizations such as Blue Veins and TransAction Alliance are bridging the gap between health services and the transgender community. Through peer-navigator programs, transgender outreach workers accompany their peers to clinics, helping ensure confidentiality and emotional support.
Digital initiatives like Sehat Dost, supported by UNDP, helps vulnerable people access stigma and discrimination free HIV services, providing both preventive and post-exposure treatment and education to encourage healthy behaviours. However, these efforts remain limited in reach and sustainability, especially in rural and conservative areas where stigma is most entrenched.
Experts agree that real change will only come when the Transgender Persons (Protection of Rights) Act 2018 is fully implemented; guaranteeing equal access to healthcare, identity documentation, and social protection. But political controversies and court challenges have slowed progress. Until the law translates into lived reality, transgender people living with HIV will continue to face exclusion from systems meant to protect them.
The HIV epidemic among transgender persons in Khyber Pakhtunkhwa is not simply a health issue; it is a test of Pakistan’s international commitments especially the sustainable development goals. The province’s recent health reforms, combined with its visible transgender movement, offer a chance to lead by example. But the journey demands more than policies, it requires empathy.
Hospitals must enforce confidentiality and train their staff in respectful care. Religious leaders and educators must help dismantle myths and moral judgments. Most of all, transgender voices must be centered in policy, not silenced by fear. In Khyber Pakhtunkhwa’s fight against HIV for transgender persons, respect may be the strongest medicine of all.