In Khyber Pakhtunkhwa, the rising number of HIV cases has exposed deep cracks in the province’s public health and social protection systems, but stigma and silence remain among the most powerful drivers of the crisis. According to recent official figures, an estimated 40,000 people are currently living with HIV in KP, with 15 to 20 new infections being detected every day. Yet only a fraction of these individuals are formally registered for treatment, largely because fear of discrimination continues to deter people from testing and disclosure. Within this already alarming situation, gender-diverse communities, particularly transgender persons, face a disproportionate and often invisible burden.
HIV stigma intersects with gender identity
For transgender persons in KP, HIV is rarely understood as a medical condition alone. Instead, an HIV diagnosis is commonly viewed through the lens of perceived sexual identity. HIV status is wrongly assumed to confirm social stereotypes that associate transgender identities exclusively with sex work or “immoral” behavior. This harmful linkage between HIV and gender diversity deepens stigma and reinforces moral judgment, turning a health issue into a perceived character flaw. As a result, transgender persons living with the disease are subjected to layered discrimination first for their gender identity, and again for their health status.
Social exclusion and fear delay treatment
This stigma has tangible consequences. Many transgender persons report being rejected by families, excluded from housing, denied employment, or harassed in public spaces once their HIV status becomes known or even suspected. The fear of being labeled both transgender and HIV-positive forces many to hide symptoms, avoid testing, or delay treatment. In a province where social acceptance of gender diversity is already fragile, HIV becomes an additional source of vulnerability, pushing individuals further into isolation and psychological distress.
Healthcare settings reinforce HIV-related discrimination
Healthcare settings, which should offer safety and confidentiality, often replicate the same stigma found in wider society. Transgender persons living with Human Immunodeficiency Viruses in KP have shared experiences of humiliation, insensitive questioning, breach of confidentiality, and refusal or delay of care. Instead of receiving support, they are frequently subjected to moral policing and intrusive scrutiny unrelated to their medical needs. Such experiences erode trust in health institutions, making continued engagement with life-saving antiretroviral treatment difficult. For many, the fear of discrimination in hospitals outweighs the fear of the disease itself.
Limited services for transgender persons living with the disease
Despite growing recognition of the crisis, services that directly address stigma remain severely limited. While the provincial government provides free HIV treatment to registered patients, there are very few health facilities equipped to offer gender-affirming, stigma-free care for transgender persons. Counseling services are scarce, healthcare workers often lack training on gender diversity, and community-based outreach is uneven across districts. Programs tend to focus on testing numbers and treatment supply, while the social barriers that prevent access fear, shame, and discrimination are insufficiently addressed.
Cultural silence sustains myths
Cultural silence around sexuality and gender diversity further compounds the problem. Public discourse in KP rarely engages openly with HIV, particularly when it intersects with transgender identities. This silence allows myths to persist: that Human Immunodeficiency Viruses only affects certain “immoral” groups, that it is always linked to sexual behavior, or that people living with HIV are to blame for their condition. Such narratives obscure the reality that unsafe medical practices, lack of regulation, and systemic neglect also drive transmission, and they justify continued exclusion of those most affected.
Structural inequality deepens vulnerability
Structural inequalities intensify these risks. Many transgender persons in KP face barriers to education, formal employment, and social protection, pushing them into informal and precarious livelihoods. When HIV enters this context, vulnerability multiplies. Without stable income, secure housing, or family support, adhering to lifelong treatment becomes extremely challenging, even when medicines are available. The result is not only poorer health outcomes for individuals but also an increased risk of ongoing transmission.
Legal gaps leave people living with disease unprotected
Although policymakers increasingly acknowledge the need to address HIV stigma and protect key populations, legislative action remains pending. Despite years of advocacy and documented evidence of discrimination, comprehensive legislation specifically addressing stigma, discrimination, and access to rights for people living with HIV, particularly gender-diverse individuals, has yet to be enacted in the province. This legal vacuum leaves transgender persons living with HIV without clear protections against discrimination in healthcare, employment, housing, and public services, reinforcing their marginalization.
Ending the disease requires confronting stigma
Addressing HIV in Khyber Pakhtunkhwa, therefore, requires more than expanding testing and treatment infrastructure. It demands confronting stigma as a central public health issue. This includes investing in stigma-reduction programs, training healthcare workers on confidentiality and gender sensitivity, strengthening community-led services, and ensuring meaningful participation of transgender persons in policy design. Ending silence, challenging harmful narratives, and translating recognition into concrete legal and institutional reforms are essential steps if KP is to respond to HIV with dignity, equity, and justice for all.
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