In Pakistan, transgender persons have long fought an uphill battle for dignity and equal rights. But for those living with HIV, the struggle deepens — pushing them into an even darker web of social stigma, economic exclusion, and health inequities. A new research study titled “Understanding the Impact of HIV Stigma on Transgender Persons Living with HIV in Khyber Pakhtunkhwa”, jointly conducted by Blue Veins and the National Commission for Human Rights (NCHR), sheds critical light on this crisis.

Despite progressive legal frameworks like the Transgender Persons (Protection of Rights) Act, 2018, transgender individuals in Khyber Pakhtunkhwa (KP) continue to face harsh discrimination in nearly every aspect of life. The research reveals alarming accounts of transgender persons living with HIV (PLHIV) being denied life-saving treatment, ridiculed openly by medical staff, and forced to endure humiliating delays at hospitals. The fear of being mistreated or publicly outed forces many to avoid healthcare altogether, resulting in poor adherence to treatment, advanced illness, and higher mortality rates.

This exclusion is not confined to the healthcare system. The research highlights the severe economic vulnerabilities transgender PLHIV face, as they are often rejected from formal employment and forced out of housing once their HIV status becomes known. Many are pushed into sex work and other high-risk survival strategies, further increasing their exposure to violence and health risks. Housing insecurity is widespread; landlords evict tenants, citing “reputation concerns” or “health risks,” leaving many with no choice but to live on the streets or in unsafe, unstable arrangements.

One of the most painful findings is that discrimination also comes from within their own circles. Traditionally, the Guru-Chela system has provided a social safety net for transgender persons in Pakistan, offering housing, protection, and economic support. However, transgender PLHIV often find themselves ostracized even by their Gurus and peers, who fear stigma and misinformation about HIV transmission. This internal community rejection compounds feelings of isolation and despair.

Mental health is a silent, devastating crisis among this group. Many respondents described battling severe depression, anxiety, and suicidal thoughts upon learning of their HIV diagnosis. Yet, gender-sensitive mental health support is virtually nonexistent. Without appropriate services, many turn inward, relying on personal faith or artistic expression as their only coping mechanisms, while others completely withdraw from social life.

Despite these challenges, the research also shines a light on extraordinary resilience. Many transgender PLHIV find strength through peer support networks and community activism, transforming their personal pain into collective advocacy for rights and inclusion. These small but powerful acts of resistance and solidarity underscore their determination to survive and thrive despite the odds.

The study calls for urgent, comprehensive reforms. It urges training for healthcare providers on gender-sensitive and stigma-free care, access to gender-affirming services, and the inclusion of transgender persons in social protection schemes like the Sehat Insaf Card. It also highlights the need for safe community spaces and accessible mental health services designed specifically for transgender persons.

This research sends a clear message: the fight against HIV stigma among transgender persons is not just a health issue — it is a deep human rights challenge. As Pakistan strives to uphold its commitments to equality and justice, it must prioritize the voices and rights of its most marginalized citizens. Transgender persons living with HIV in KP are not faceless statistics — they are individuals demanding dignity, equality, and the right to live without fear.

It is time to break the silence, confront prejudice, and ensure that no one is left behind.