OUR social and political structures have sent the transgender population to Coventry. Anathema and misconception have never been in short supply. Yet another instance of exclusion occurred on Sunday, when Sindh’s health secretary and medical superintendent of Civil Hospital Karachi were sent notices by the Sindh High Court on a petition filed against the non-provision of treatment for HIV-positive trans persons. The three petitioners required urgent medical intervention, including hip replacement surgery, chronic kidney infection treatment, etc. But they were turned away by the hospital due to their HIV status — a gloomy reminder of a Peshawar trans person in 2016, who was sentenced to a life at a garbage dump after being diagnosed as HIV positive.

While healthcare is a fundamental right globally, in Pakistan, the trans community battles multiple barriers to access it. Uneducated, jobless and abandoned, they are often forced into sex work, drug peddling, human trafficking and begging. These livelihoods make them vulnerable to exploitation and sexually transmitted diseases. A shift in societal sanctions may be decades away, therefore the government must look at short-term measures to ensure well-being. Hospital staff must be sensitised and educated about trans people, their identity and special medical needs; they must be given separate wards and have access to free HIV testing. If addressing susceptibility, stigma and inequity is not a goal, we will end up treading water. And an HIV upsurge is not a risk worth taking. For this reason, a vital measure that assures welfare is the recognition of a third gender, visible in the population count to guarantee right to protection, employment, healthcare and education. Although it’s hard to be precise about transgender numbers in Pakistan, the recent digital census reveals a near 35pc fall in their population in Sindh. It defies reason that this community has shrunk in the midst of a population explosion. We hope this is an oversight and not a trans health alert.

Published in Dawn, June 7th, 2023