TWO cases this year — that of a transgender person dying in a Peshawar hospital as healthcare providers deliberated over which ward to put her in; and of another who, after being diagnosed as HIV positive, was forced to live near a garbage dump until she died — highlight the insensitivity that prevails towards this marginalised community.
Exact numbers for Pakistan’s transgender population are not known. Media estimates range between 80,000 to 500,000, but this figures lack credibility given that the last national census was conducted in 1998 and did not account for a third gender.
While many civil society organisations have recently organised seminars and protests for the security of transgenders, they ignored the most important thing this community needs: access to healthcare.
Healthcare is a universal right, but across the world — particularly in Pakistan — transgender persons face barriers in accessing it. Nor am I referring exclusively to hormone and transition-related care; many face tremendous barriers when trying to access the healthcare system for common illnesses and injuries. In recent conversations with members of this community, they revealed that they often don’t access hospital services to avoid ridicule and discrimination.
The transgender community in Pakistan is underserved. They can’t access the education system; they can’t have regular jobs like those who identify themselves as either male or female. Their livelihoods often depend on dancing at weddings or as sex workers in the absence of other opportunities. Once they are over 45, many turn to begging. Due to the nature of their occupation, they are at high risk of contracting sexually transmitted diseases. The government, unfortunately, has ignored their plight.
The government has ignored the plight of this community.
The barriers to accessing healthcare are multilayered. Discrimination from medical staff is the biggest hurdle. The recent case in Peshawar should have been a catalyst for improving transgenders’ healthcare access, but few took that incident seriously. The transgender person was shot eight times. She lay on a stretcher. However, instead of arranging for emergency treatment, the hospital staff passed derogatory remarks and allegedly even propositioned sex to her and her friends. She eventually died.
While the case received media attention, even that did not galvanise the healthcare sector into making the necessary changes for the transgender community. There are thousands of others like her.
Then we witnessed another side to the problem. Diagnosed HIV positive, a transgender person was evicted from her residence by her colleagues and friends. Her plight threw light on another type of barrier: lack of knowledge within the community. HIV/AIDS is a taboo issue, and while no one wants to be infected certain professions increase the risks of contracting it.
Even though the entire community is vulnerable to this, they deserted a friend who contracted it. It shows the lack of knowledge and empathy towards peers. Had they known that HIV is not contagious like the flu, and that their support could have helped increase her lifespan, they might have opted to help. Had they known that there are specialised HIV treatment centres, they might have saved her life by getting her the healthcare she needed.
It will take decades to change societal attitudes towards transgender people. However, the government must take some short-term steps to ensure that they can access healthcare with confidence.
This requires a two-pronged strategy. The first step is administrative. The government needs to create ‘safe zones’ in hospitals for transgender people, places they can easily access without feeling discriminated against. The government should provide them free healthcare, and initiate outreach programmes for free HIV and hepatitis testing. It must also pass laws to punish those who ridicule them or discriminate against them.
The second step should involving giving information and raising awareness about transgender persons, both outside and within the community. Doctors and nurses must undergo courses to sensitise them to transgender rights to ensure that they are well equipped to treat transgender patients while respecting their gender identity.
Hospitals should provide introductory short courses about the anatomy and unique medical needs of transgender people. The government and NGOs should collaborate on community-based projects for raising awareness on safe sex and sexually transmitted diseases, and transgender persons should be provided resources to help them access healthcare in case they note any symptoms of HIV.
The most important steps towards improving access to healthcare for the transgender community lies in the acknowledgment of its members as a third gender in the yet to be conducted census. The inclusion of transgenders in the survey will enable policymakers to better assess the healthcare needs of this marginalised community.
The writer is a PhD scholar specialising in health communications.
Published in Dawn December 4th, 2016