Asmat Shah Garwaki
In Swat, a 29-year-old transgender person living with HIV, who requested anonymity, confessed: “I will not seek treatment because I want to spread the disease to take revenge from the society.” This statement underlines the destructive cycle of stigma and negligence. Instead of finding compassion and care, many patients, especially vulnerable groups like transgenders are pushed to the margins, where frustration turns into hostility.
HIV/AIDS remains one of the most pressing public health challenges in Khyber Pakhtunkhwa. Beyond the disease itself, the stigma surrounding it has created layers of social exclusion, denial, and even dangerous attitudes among patients who feel rejected by society.
For transgender individuals, this stigma is often twofold: they face discrimination for their gender identity and again for their HIV status. Many are ostracized by their families from an early age, denied formal education, and excluded from mainstream employment. As a result, many turn to informal or high-risk means of livelihood, such as sex work, where exposure to HIV is significantly higher. However, when they are diagnosed, they often choose silence over seeking treatment due to fear of violence, police harassment, or being denied healthcare altogether.
Healthcare facilities in KP, though improving, still lack sensitivity training for staff dealing with transgender patients. Reports of humiliating treatment, misgendering, or outright denial of care are not uncommon. This drives many transgender people away from public health centers, compounding the risk not only to their own health but also to public safety. Their marginalization becomes a breeding ground for misinformation, untreated infections, and growing resentment, as reflected in the statement from Swat.
According to recent surveys, there are an estimated 30,000 potential HIV cases in the province. However, only about 9,000 patients are officially registered and receiving treatment at government facilities. This leaves tens of thousands untreated, posing serious health risks to both themselves and the wider community.
Data from the provincial HIV/AIDS control program reveals that the highest number of registered patients are concentrated in urban centers, particularly Peshawar. Hayatabad Medical Complex in Peshawar has 2,723 registered patients, while Lady Reading Hospital in Peshawar treats 2,082 patients. Khalifa Gul Nawaz Hospital in Bannu has 1,097 patients, DHQ Kohat reports 678 cases, Batkhela DHQ 471 cases, Ayub Teaching Hospital in Abbottabad 466 cases, Mufti Mehmood Memorial Hospital in D.I. Khan 448 patients, Saidu Hospital in Swat 385 patients, DHQ Mardan 337 cases, and Bacha Khan Medical Complex in Swabi 230 patients. Other districts, such as Bajaur (125), Miran Shah (122), and Parachinar (45), also report cases, though at smaller scales.
In terms of district-wide spread, Peshawar leads with 1,724 cases, followed by Bannu with 939, Swat with 437, and Mardan with 427. Among the merged districts, North Waziristan tops the list with 354 cases, followed by Khyber with 286 and Kurram with 224.
HIV/AIDS is not only a medical issue it is deeply tied to societal perceptions. Patients often hide their diagnosis out of fear of rejection, social discrimination, or even violence. This secrecy prevents them from seeking treatment, leading to further transmission.
For marginalized groups such as transgenders, the stigma is even harsher. Social exclusion, lack of family support, and limited economic opportunities push many into high-risk behaviors. When these individuals are denied acceptance and healthcare, some, like the transgender person in Swat, begin to see the disease as a weapon rather than an illness.
This emotional and social isolation leads to mental health issues such as depression, anxiety, and hopelessness all of which further reduce the likelihood of seeking treatment. In a society where transgender individuals are already criminalized or ridiculed, being HIV-positive can mean total abandonment. The lack of social safety nets, legal protection, and community-based healthcare for trans individuals only worsens their vulnerability.
Experts emphasize that the fight against HIV/AIDS cannot be won through medical interventions alone. Without addressing stigma, misinformation, and social attitudes, the number of untreated patients will continue to rise.
Public health campaigns must focus on raising awareness about prevention and treatment, destigmatizing HIV/AIDS by educating communities that it is a medical condition, not a moral failure. Healthcare services must be inclusive and accessible to marginalized groups, especially transgenders, ensuring that they receive not only treatment but also counseling and protection. Voluntary testing should be encouraged to identify hidden cases and begin treatment early, curbing the silent spread of the virus.
The spread of HIV/AIDS in KP is a warning that silence and stigma are as dangerous as the disease itself. If thousands remain untreated due to fear of discrimination, the epidemic will continue to grow. Society must learn to replace rejection with empathy, ensuring that patients see treatment not as a punishment, but as a path to life.
Only through awareness, acceptance, and care can the cycle of fear and revenge be broken.
