The recent announcement by Khyber Pakhtunkhwa (KP) province that government hospitals will now have a dedicated ward for treating transgender patients is being welcomed by trans activists in the province as a notable step towards providing dignified access to appropriate care for this highly marginalised community.
A room of one’s own
On April 1, Khyber Pakhtunkhwa provincial chief minister Ali Amin Gandapure issued instructions to the provincial health department to reserve a separate ward for transgender people in all hospitals in the district.
The announcement was widely acclaimed by the transgender community and its civil society organisations, for whom this is a turning point in the fight against the stigma and discrimination that hinder their access to specialist health services.
“Access to the best healthcare services was a dream for the transgender community, which faced multiple challenges: harassment, discrimination, denial of care and rejection by both male and female-only hospitals,” says Katrina Khan, a transgender rights activist and organizer of professional trainings focused on transgender empowerment.
Transgender people deserve the same level of health care and access to treatment as others, Katrina emphasizes.
A ward reserved for the transgender community in a public sector hospital in Khyber Pakhtunkhwa province.
Photo Credit: Adeel Saeed
More expensive and less good
Katrina shares a personal anecdote that, for most Pakistanis, would not even be worth mentioning. Suffering from headache and fever, she had recently visited Lady Reading Hospital (LRH), the largest teaching hospital in Kuala Lumpur province. For her, it was a significant event: previously, she would have avoided going to the public facility and opted for a private clinic, for reasons of privacy.
“Access to the best health services was a dream for the transgender community, which faced multiple difficulties: harassment, discrimination, refusal of care and rejection by hospital services reserved for men as well as those reserved for women.”
– Katrina Khan, transgender rights activist
This privacy came at a cost. “In private clinics, we had to pay astronomical sums for consultations on minor health problems, while in public sector hospitals, examinations are completely free. This news is a financial relief, given the price hikes currently affecting our country,” she adds.
“Peace of mind”
“The decision [du gouvernement] “It has given us confidence that we can safely go to public sector hospitals for treatment,” said Farzana Riaz, president of the Khyber Pakhtunkhwa chapter of TransAction Alliance.
Until now, Riaz says, transgender people have typically only gone to hospital when they are seriously ill – often after experiencing violence. “Since 2015, about 100 transgender people have been victims of violent attacks in Khyber Pakhtunkhwa, most of them after altercations with male friends, about 10% after honour killings, and several after refusal of friendship,” she says.
Even in these serious cases, they faced jeers, insults and violations of their right to privacy, she adds.
Farzana acknowledges that this new policy guarantees them a space where they feel safe, but she hopes above all that it will encourage health professionals who disrespect them to change their attitude.
When it comes to addressing the healthcare needs of transgender people, the road ahead is agonizingly long. Farzana recounted the heartbreaking case of Alisha, a transgender rights activist who died in 2017 in a Peshawar hospital because her treatment was delayed because doctors didn’t know which ward to transfer her to—the men’s or the women’s ward.
“If there had been a separate room at that time where Alisha could have been treated immediately, she could have been saved,” Farzana says, her voice choking.
As evidence of transgender people’s lack of trust in the health system, only seven members of their community were registered in the health insurance system. Sehat Insaf Carda flagship initiative of the Khyber Pakhtunkhwa government, which provides free medical care to residents of the province, at a cost of Rs 1 million (USD 3,597) per year.
“Raising the level of health”
Young Omang, a consortium of Pakistani civil society organizations focused on youth sexual and reproductive health rights, called the announcement “groundbreaking,” and said in a statement that the move would help facilitate access to comprehensive health care services for all, especially the vulnerable transgender community.
“This decisive action will significantly improve the health and social status of the transgender community in Khyber Pakhtunkhwa province,” commented Qamar Naseem, a renowned transgender rights advocate and author of a report on the gaps in public health policy towards sexual and gender minorities in Pakistan.
In the report, which is based on interviews with 240 transgender and intersex people, Qamar Naseem finds that health workers are not treating transgender people with the respect they deserve and that they need training. He recommends that the Ministry of Health take steps to address the social and institutional stigma that breeds fear and prevents sexual and gender minorities from accessing health care.
Inclusive diagnostics to better combat diseases
As Heer Jamal, a transgender woman and advocate for the rights of members of her community, observed, fear of stigmatization by medical personnel makes transgender people reluctant to visit medical facilities, limiting their access to diagnostic tests for serious diseases such as HIV/AIDS and COVID-19.
Heer Jamal is currently working on transgender health under the United Nations National Development Programme (UNDP) and advocating for greater awareness among the transgender population regarding HIV/AIDS treatment.
The initiative helped persuade some 300 transgender people to undergo HIV/AIDS testing. Of these, 137 tested positive and were enrolled in the national integrated HIV control programme, which enabled them to receive free treatment.
While transgender people are generally reluctant to seek treatment at health facilities, the situation is even more dire when it comes to diagnoses that carry stigma, even within the transgender community, Jamal said.
She recalls the case of a transgender woman diagnosed with HIV who died on the street in Peshawar a few years ago. She had been evicted from her home by her roommates because they feared contracting the disease.
“The decision [du gouvernement] has given us confidence that we can safely go to public sector hospitals for treatment.”
– Farzana Riaz, President of the Khyber Pakhtunkhwa Chapter of TransAction Alliance
Currently, the diagnosis and treatment of transgender people who are unknowingly infected with HIV is too often left to chance. Mohammed Asim, who is responsible for transgender access to health care at Lady Reading Hospital, recalls that a transgender woman who was recently hospitalized with a broken leg tested positive for the virus in her blood.
The hospital not only treated her fracture, it also began treating her for HIV, after enrolling her in the Department of Health’s AIDS Control Program.
Transgender rights activists including Farzana (center), Sobia (right) and Arzoo (left) at a press conference.
Photo Credit: Adeel Saeed
Facilitating access to free care for people with HIV/AIDS
“Khyber Pakhtunkhwa Health Department is providing free treatment for HIV infection to 137 transgender persons in the province,” said Dr Yasir Hayat Taj, Deputy Director of Khyber Pakhtunkhwa Integrated HIV and Thalassemia Control Programme.
Of the 137 people living with HIV, about 59 are registered at Lady Reading Hospital, where they also receive psychological support, said Hilal Ahmad, a psychologist with the AIDS programme.
The drugs are provided free of charge to patients, who are also subjected to viral load tests every six months, he told VaccinesWork.
“We have instructed medical staff of major hospitals to treat transgender community members properly and respect their privacy,” revealed Syed Qasim Ali Shah, Health Minister of Khyber Pakhtunkhwa province.
Addressing VaccinesWorkthe Minister said the system was already in place at the headquarters of six divisions and would soon be extended to all major hospitals in the province.
He also called on members of the transgender community to take advantage of these new facilities, to go to the hospital with peace of mind and to access the free treatments they may need, which will enable the government to achieve its objective of advancing the right to health for all citizens.
