In Khyber Pakhtunkhwa, transgender people living with HIV endure blame, beatings and lonely burials while society ignores the real drivers of the virus: stigma, not the disease itself, is killing them.

In the bustling plazas of Peshawar, where transgender performers once danced at weddings and festivals, fear now lingers heavier than the summer heat. Arif, known to friends as Wara, arrived from Quetta twelve years ago dreaming of a freer life. Months before his death at 27, he tested positive for HIV. Terrified of expulsion from the only home he had, he kept silent. When illness finally overwhelmed him, hospital staff offered little compassion. He died alone. Only a handful of transgender friends stood at his grave in a neglected Peshawar graveyard – no blood relatives, no prayers from the community that once celebrated him. “He left smiling on the fifth day of Eid,” recalled his friend Farzana. “Later I saw his lifeless body, turned blue.”

Wara’s story is not unique. Across Khyber Pakhtunkhwa (KP), transgender individuals are caught in a vicious cycle of stigma that proves more lethal than the virus they carry. Official figures from the Provincial AIDS Control Programme reveal a stark truth: out of 9,000 registered HIV patients in Khyber Pakhtunkhwa, only 197 – less than one per cent – are transgender. Men account for 60 per cent of cases, women 30 per cent. Yet society’s gaze remains fixed on the transgender community, blaming them for spreading the disease.

The Numbers Behind the Silence

Health officials confirm that early diagnosis and free government-supplied antiretroviral drugs can suppress HIV, allowing patients to live normal lives. But fear keeps many away from testing centres. Dr Tariq Hayat Taj, head of the Provincial AIDS Control Programme, notes that government teams now visit transgender residences for voluntary, confidential testing to protect privacy. Still, late diagnosis remains common. By the time patients reach hospitals, the disease has advanced, complicating treatment.

Violence compounds the crisis. In 2025 alone, 15 transgender individuals were killed in Khyber Pakhtunkhwa, with Peshawar, Mardan and Charsadda recording the highest numbers. Over the past decade, the toll has climbed to 157 deaths, according to Farzana Riaz, president of the Trans Action Alliance. Many killings are justified in the public mind by accusations of HIV transmission.

Lives Shattered by Fear

Deewani’s story echoes Wara’s tragedy. Expelled from Iqbal Plaza once her HIV status became known, she survived by collecting garbage until illness claimed her. Another 33-year-old transgender person was thrown out of a Peshawar rehabilitation centre after testing positive. Rejected by family and community alike, he died suffering on the roadside, according to field worker Ijaz Khan. A young patient who arrived at hospital with his father was publicly humiliated by staff who openly blamed him for contracting the virus.

Ijaz Khan, who has worked on the ground for 20 years, explains the cruel logic: “If a transgender person finds out they have AIDS, they hide it because they know clients will stop coming, they won’t be invited to dance events, and they may be expelled from their community.” The fear of abandonment extends beyond life. Farzana Riaz captures the dread many feel: “When they see their companions abandoned even after death, they see their own reflection in them. She wonders whether her father or brother would come for her after death, or if she would face the same fate.”

Voices Crying for Justice

Jamal, a transgender MPhil scholar and human rights activist known as Heer, challenges the dominant narrative with data. “If we are the ones spreading the disease, then why do people come to us to fulfil their desires? Why are they not held accountable? Does the virus exist only in transgender bodies?” Farzana Riaz echoes the frustration: “If we are the ones spreading the disease, then why do people come to us to fulfil their desires?”

Advocate Ayesha Khurshid points to Pakistan’s Constitution, which guarantees equal rights, yet hospitals lack dedicated transgender wards or even basic staff training on dignity and confidentiality. Patients report being stared at, whispered about, or denied respectful care.

Healthcare’s Blind Spot

The Provincial AIDS Control Programme offers free medicines and outreach, yet systemic gaps persist. Illegal clinics continue unsafe practices. Hospital staff, untrained in handling stigma-sensitive cases, sometimes breach confidentiality, accelerating social ostracism. Transgender individuals engaged in sex work or dance performances – often their only economic options – face heightened risk yet receive the least protection.

Field workers describe a community pushed to the margins: denied housing, jobs, and family support. When death comes, burials become battlegrounds. Many are interred in isolated plots, denied traditional rites, their graves unmarked and forgotten.

A Call for Compassion

Activists and health experts agree that change must begin with mindset. HIV must be treated as a medical condition, not a moral failing. Schools should teach accurate information about transmission rather than outdated myths. Hospital protocols need urgent reform: mandatory sensitivity training, private consultation rooms, and strict confidentiality rules. Government outreach teams have shown promise; expanding them could bring testing and treatment directly to those too afraid to seek it.

Activists say that there is a need for legal protections to move from paper to practice. Strict action against illegal practitioners and those who violate patient rights is essential. Most importantly, they say, society must confront its hypocrisy – blaming a tiny minority while the majority of cases occur elsewhere.

Wara’s friends still gather at his grave, offering quiet prayers the wider world denied him. Their message is simple: treat us as human beings first. Until stigma is buried alongside the dead, the virus will continue claiming lives that could have been saved. In Khyber Pakhtunkhwa, the fight against HIV is not just medical – it is a battle for dignity, justice and the right to live, and die, without shame.

Names of people living with HIV have been changed to protect their privacy.