Peshawar: Deewani, a homeless transgender woman, lived by a garbage bin in the old city. She was sleeping without a shirt, bare-chested and emaciated, on an old bed covered in a net to ward off mosquitoes. People gave her bed a wide berth, even as they piled garbage around her.

Nobody knew she was very sick and in need of immediate medical help. The fact that she was a transgender person was enough to keep everyone away from Deewani. She was abandoned by her own community when she was diagnosed with HIV/AIDS.

Deewani (Transgender) under treatment at HIV Centre, Hayatabad Medical Complex : Photo by News Lens Pakistan.

A media report brought Deewani to the attention of rights activists in Peshawar. They took her to the HIV Centre at Hayatabad Medical Complex where she died a week later from exposure and tuberculosis.

“The day she died, her pathology tests showed that she was HIV positive and had full blown tuberculosis,” Tauhid Zulfiqar, the hospital spokesperson, told News Lens Pakistan.
Before her death, Deewani told reporters that her transgender community had banished her from the living quarters she shared with other transgender persons because they feared she might transfer the disease to them.

Deewani’s death prompted debate about the HIV epidemic among the transgender community.

Qamar Naseem, an advisory member of the Trans Action Alliance of Khyber Pakhtunkhwa (KP) that works for  transgender rights, said more than 50 per cent of the transgender population in the province is HIV positive.

Citing Deewani’s case, he said poverty and deprivation forces trans-women to solicit sex even when diagnosed with HIV, for as little as PKR 30.
“If the government doesn’t stop people having sex with transgender, the disease will become an epidemic in KP,” said Naseem.

He said the government should examine the transgender population for HIV so that they could be treated.

“Transgender persons are reluctant to have HIV test for fear that they would be abandoned like Deewani by their own community if they test positive.”

Moreover, said Naseem, men do not use condoms during sex with transgender which results in spread of HIV/AIDS at an alarming rate. He said most of the sex-clients or the transgender themselves do not know about the the benefit of using condoms during sex.

According to Directorate General Monitoring and Evaluation’s report on the KP government’s enhanced HIV programme, a copy of which is available with News Lens, the population in the province shows an overall HIV prevalence rate of 27.2 per cent among injecting drug users, 5.2 per cent among transgender sex workers and 0.85 per cent among female sex workers.

The report says that a major reason for the spread of HIV spread is people injecting drugs and then having sex with transgender.

According to the report, the number of injecting drug users in district Peshawar is estimated at 1800, among which the HIV prevalence rate is more than 20 per cent.

A research study titled ‘Correlates and prevalence of HIV and sexually transmitted infections among transgender in Pakistan’ published in the Journal of Pakistan Medical Association reveals that 84 per cent of the transgender population in Pakistan sell sex four times to at least one client per week.

The study states that 94 per cent could identify a condom, but 42 per cent felt they never needed one. Only one per cent carried a condom but 56 per cent felt they could obtain one if needed. Sixty eight per cent had heard of HIV and associated risk reduction with condom use (69 per cent), avoidance of anal sex (73 per cent) or needle sharing (87 per cent).
The study’s findings said infrequent condom use, bisexual lifestyle, universal commercial sex, and dissociation between protective knowledge about HIV among hijras or transwomen were the factors behind HIV prevalence in Pakistan.

Naseem said the government should initiate awareness campaign for the transgender community to use condoms.

“Transgender people don’t have any means of earning except selling sex and performing during weddings,” he told News Lens.

Paro, a transgender who has started a boutique and given up dancing at parties, said the government should establish vocation centres for the transgender community.

“They will not be compelled to sell sex if they have other means of earning,” he told News Lens.

Dr. Idrees Afridi at the Hayatabad Medical Complex (HMC) said over 2000 HIV patients are  currently admitted in HMC’s HIV treatment centre.


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