Peshawar: Paro, a transwoman, has been performing at weddings for nearly 12 years. For Paro, 24, dancing at festive occasions is the only job she could find when her family turned her out for being transgender. It was also the only job she had the skill for when she left her home in Mansehra and moved to 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.

Away from home and family, her community became Paro’s family. Transgender in Pakistan are a tightly knit community, brought together by dependency on each other’s support in the face of widespread discrimination against them. Trained by a transgender guru or a guardian-teacher who “imparts singing, dancing and other skills to his chelas [young disciples] to enable them to earn their own living, the chelas are expected to turn their earnings to the guru, who uses this money for maintaining the household,” says “The Third Sex: On the Fringes of Society”, a study by LEAD Pakistan, non-profit that seeks to integrate sustainable development concerns within professional work of young leaders. “Their major sources of income include singing and dancing on marriages, birth celebrations and other auspicious occasions, begging for alms and sex work.”

While Paro describes herself a “professional wedding dancer”, she told News Lens Pakistan that prostitution is common among members of the transgender community, exposing them to the risk HIV/AIDS.

“Is social exclusion pushing the Pakistani Hijras (Transgenders) towards commercial sex work?”, a qualitative study on BMC International Health and Human Rights – an open access journal publishing original peer-reviewed research articles in relation to health and disease in developing and transitional countries – says about Hijras in Pakistan:

This group of people is socially excluded by the general community, in terms of attainment of an opportunity for a socially productive life. Often this sort of deprivation forces these individuals towards professions like sex trade, in pursuit of sustenance, which as a consequence places them as a key block in the puzzle of an impending generalized HIV epidemic in Pakistan.”

Another paper in the Journal of Pakistan Medical Association, ‘The HIV Epidemic in Pakistan’ says, “The HIV epidemic in Pakistan is well established and expanding among injection drug users and their sexual contacts including male and transgender sex works forming the core of the epidemic.”

Asked if she knew about HIV/AIDS, Paro said, “I have heard it’s a serious disease that kills.” And does she know how the disease is transferred from person to person? “No, I really don’t know.”

When it was explained to Paro that sex work put transgender among the high risk groups for HIV/AIDS, Paro said that every member of her community had a permanent boyfriend that they were in a “continuous physical relationship” with.

“If her 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 condom for safe sex – either the customer or the boyfriend refuses to use it or the transgender community has little knowledge to make use of condom necessary for sexual relations or sex work.”

According to Blue Veins, a non-government organization that works on sexual and gender based violence in KP, there are 1800 registered transgender living in Peshawar but their total strength is somewhere close to 5000. Qamar Naseem, who founded Blue Veins, told News Lens Pakistan that HIV/AIDS prevalence among the transgender over the last decade ranges between low and high rates.

“According to the national AIDS control programme figures for 2015, there are three high risk groups in Pakistan,” said Naseem. “27.2 percent of them are Injectable Drug Users (IDU) living with HIV/ AIDS. This is followed by transgender with 5.2 percent of the total AIDS patients across Pakistan coming from that community. One percent is the ratio of patients who are identified as male sex workers or MSW. ”

Naseem said that female sex workers (FSW) constitute 0.6 percent of the People living with HIV (PLHIV). He said migrants deported from Gulf countries were a major source of HIV transmission in Pakistan.

“The religious sections of our society remains in denial of extra-marital relations or male sex with male (MSM) even though Khyber Pakhtunkhwa is vulnerable to HIV/AIDS due to prevalence of homosexuality,” says Naseem. “Most men don’t use condom. To them it is only a contraceptive and if they are going to have sexual intercourse with same sex then there is no need to use condom. Transgender, male sex workers, female sex workers and their customers are also of the view that using condom minimizes pleasure. He said 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 the young among the transgender community used condom but the older generation avoided it. However, Paro said the transgender sex workers never used condoms because their customers did not like it. She said those who want to be tested for HIV/AIDS were afraid of the disease and its social and economic implications for them.

“One of my friends told me that she was supposed to visit Peshawar Hayatabad Medical Complex Family Care Center where patients are tested and treated for HIV/AIDS,” said Paro. “She had to travel from Kohat on public transport. She said she faced harassment every step of the journey and at the hospital entrance. How could the community show willingness to be screened and treated then?”

She said nobody had approached her or other members of her community to educate them about HIV/AIDS.  About the news that four transgender persons in Mansehra were tested positive for HIV/AIDS, Paro said they were diagnosed with HIV but their names were not made public as it would undermine their commercial work. In March 2016, district president of the Shemale Association for Mansehra, Ms Maria Khan, revealed in a news conference that four of the infected persons belonged to Mansehra. She said some of these HIV positive persons were being treated at the Hayatabad Medical Complex in Peshawar while others could not continue treatment due to limited resources.

According to Qamar Naseem a transgender named Gul Hhotai was gang rapped a few years back by twelve men. “If she was someone with HIV/AIDS, you could imagine how quick the infection would be transmitted to these men and others who came in sexual contact with them.”

While ignorance and commercial considerations keep high risk groups from testing and revealing their HIV/AIDS status, the fact that for a province of 29.9 million people there only two treatment centers in Peshawar and Kohat makes it hard for everyone to access treatment.

“There are 2600 patients registered in these two centres while the estimated number of people living with HIV/AIDS in KP is around 16000 according to UNIADS,” said Dr. Attaullah Khan, Assistant Director Public Health and Deputy Programme Manager HIV/AIDS Khyber Pakhtunkhwa. “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.”

According to Dr. Khan, among the known HIV cases, 70 percent of those infected in KP are migrants workers deported from Gulf States. In 2014, 4 out of 28 prisoners in Central Prison Peshawar were found HIV positive. The registered PLHIV in KP, according to Dr. Khan, were 72 percent men, 23 percent women while 05 percent children.

Subhan Ali, Site Manager for Community and Home Based Care Center of Khwendo Kor, a women rights organization working in Khyber Pakhtunkhwa and FATA, told News Lens Pakistan that they had registered seven transgender persons with HIV infection. These patients, he said, visited Peshawar to collect medicine, have psychotherapy and access other facilities offered under the project.

“We only work with high risk groups like female sex workers, male sex workers, transgender, injectable drug users (IDUs) and migrants,” said Ali. “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 were most vulnerable to sexually transmitted diseases. “They are hospitable and kind-hearted but the society’s behavior pushes them to social isolation where they are reluctant even to share their personal pain and experiences.”



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