Transgender community at high risk of hiv 


Peshawar: Transgender woman Paro, 24, has been performing at weddings for nearly 12 years. Dancing at festive occasions is the only job she could find when her family threw her out for being transgender. It was also the only job she had the skill for when she left her home in Mansehra in Pakistan’s conservative northwest and moved to the provincial capital Peshawar to live with the transgender community.

Like most Hijras – a one-word-fits-all appellation widely used for cross-dressers, transsexuals, eunuchs, hermaphrodites, and transvestites in South Asia – Paro could dance. Peshawar’s Hijra community became Paro’s family. The community is tight-knit in the face of widespread discrimination.

Paro was trained by a transgender guru, a guardian-teacher who “imparts singing, dancing and other skills to his chelas [young disciples] to enable them to earn their own living,” according to a study by LEAD Pakistan, a non-profit organisation that works with young leaders.

Singing and dancing at weddings, birth celebrations and other auspicious occasions, begging for alms and sex work are the Hijras’ main sources of income, according to LEAD Pakistan.

Paro described herself to News Lens Pakistan as a “professional wedding dancer”.

Prostitution is common among members of the transgender community, Paro said. High rates of prostitution expose the community to HIV/AIDS. But Paro’s knowledge of the disease is scant.

“I have heard it’s a serious disease that kills,” she said, adding that she does not know how it is transferred between people.

Paro said that every member of her community has a permanent boyfriend with whom they are in a “continuous physical relationship”. They are not necessarily monogamous relationships.

“If the boyfriend fulfils her economic and social needs, she sticks to him; but if not, then she is compelled to have sexual relations with many others for survival,” Paro told News Lens.

“None of them use condoms for safe sex. Either the customer or the boyfriend refuses to use it. The transgender community has little knowledge to make use of condoms necessary for sexual relations or sex work,” she said.

According to Blue Veins, a non-government organization that works on sexual and gender-based violence in Khyber Pakhtunkhwa province, there are 1,800 transgender people are registered as residing in Peshawar.

Nearly a third of people living with HIV in Pakistan are injectable drug users, Qamar Naseem, who founded Blue Veins, told News Lens. Transgender people make up the second largest group, said Naseem, citing data from the National AIDS Control Program.

“Just over five per cent of AIDS patients across Pakistan come from the transgender community,” Naseem said. Male sex workers make up 1 per cent, while female sex workers constitute 0.6 per cent.

Migrants deported from Gulf countries are a major source of HIV transmission in Pakistan, Naseem added.

“The religious sections of our society remain in denial of extra-marital relations or male sex with males even, though Khyber Pakhtunkhwa is vulnerable to HIV/AIDS due to the prevalence of homosexuality,” Naseem said.

“Most men don’t use condoms. To them it is only a contraceptive, and if they are going to have sexual intercourse with a same sex person, then there is no need to use condom. Transgender people, male sex workers, female sex workers and their customers are also of the view that using a condom minimizes pleasure.”

“Ignorance about HIV/AIDS, and the fact that transgender have no professional skills to earn a livelihood, means they keep quiet despite infection,” Naseem said.

Naseem said the younger members of the transgender community use condoms but the older generation avoid it.

Paro, however, said transgender sex workers never use condoms because their customers don’t like it.

She said nobody had approached her or other members of her community to educate them about HIV/AIDS.

While ignorance and commercial considerations keep high risk groups from testing and revealing their HIV/AIDS status, access is another challenge. There are only two treatment centres for a province of 29.9 million people, with an estimated 16,000 people living with HIV/AIDS.

Around 2,600 patients are registered at the two treatment centres, in Peshawar and Kohat, said Dr. Attaullah Khan, Assistant Director of Public Health and Deputy Programme Manager HIV/AIDS for Khyber Pakhtunkhwa province.

“This is just tip of the iceberg. The rest of the population living with the disease remains hidden because of the prevailing stigma attach to it,” Khan told News Lens Pakistan.

According to Dr Khan, 70 per cent of those infected in KP are Pakistani migrant workers who have been deported home from Gulf states where they were working. Some 72 per cent of the total number of people living with HIV/AIDS in Khyber Pakhtunkhwa are men.

Subhan Ali, Site Manager for the Community and Home Based Care Centre of Khwendo Kor, a women’s rights organization in Khyber Pakhtunkhwa and FATA, said seven transgender persons with HIV infection had registered with his organisation for home care. These patients visited Peshawar to collect medicine, have psychotherapy and access other facilities offered under the project, Ali said.

“We only work with high risk groups like female sex workers, male sex workers, transgender people, injectable drug users and migrants,” Ali told News Lens Pakistan.

“They are exposed to HIV infection and can be a primary source of transmission to many others. We hold counselling sessions with these groups and they agree to be screened for the virus on site after they are convinced that it is for their safety and health.”

Ali said the transgender community were particularly vulnerable to sexually transmitted diseases.

“They are hospitable and kind-hearted, but society’s behaviour pushes them to social isolation where they are reluctant even to share their personal pain and experiences,” he said.


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