Pakistan lacks documented data on the prevalence of HIV in the transgender community at the national level. Smaller regional studies, however, indicate that the transgender community has been one of the communities hit hardest by this epidemic. Transgender individuals face discrimination in a wide range of public and private settings, including employment, housing, health care, and access to social services. In Pakistan and few other Asian countries, stigma and discrimination against transgender individuals exacerbates their HIV risk, increasing the likelihood for substance abuse and survival sex and decreasing the likelihood of safer sex practices [2, 18, 19]. Among the factors that may place transgender men at increased risk for HIV in Asian countries are mental health concerns, physical abuse, social isolation, economic marginalization, incarceration, and unmet transgender-specific health care needs—all of which are heightened by stigma . There is broad diversity among trans-communities including variations in sexual orientation and HIV risk in addition to racial and ethnic diversity. The terms “transgender” or “transsexual” do not imply any specific sexual orientation and transgender individuals identify across the full spectrum of orientations with some considering conventional labels inadequate or inapplicable to them.
In the present study, various behavioral parameters were taken into account to elaborate and discuss the prevalence of HIV in our study categorically. During the interviews, respondents were questioned about their occupations. Hardly any of the subjects admitted to having sex as their occupation, being a taboo topic. However on persuasion, the Guru (boss) revealed that all of them were involved in promiscuity regardless of what their claimed occupation was. According to PCR results highest prevalence was found in the middle-aged transgender men and most of them claimed to be dancers which can be explained by the fact that they have larger business owing to greater exposure, and recognition. Furthermore, it was elucidated that the educated lot of the hijras is cautious and aware about unsafe sex and its consequences. Therefore, they take more care by avoiding unsafe sex and resultantly have lower prevalence of HIV amongst them. Interestingly, young people who drop out of school are more susceptible to become sexually active at younger ages and thus according to this study many of the transgender males were first sexually abused in their teenage . Lower literacy rate in this case was found to be directly proportional to the lack of awareness, which has miserably transformed the situation into a disaster.
Our data’s statistical analysis reveals that the hijras who visit barbers have potentially high risk of spreading or acquiring HIV as they face greater vulnerability to non-preventive measures while shaving i.e., blade re-use, no disinfection of instruments and frequent body shaves,etc . Although, shaving at home was also not as safe as previously perceived. Body shaving is a regular exercise for most of them and they share razors in this activity, so an elevated prevalence could be expected in future, if ignoranceof the consequences persists. Most of the respondents had no awareness about the mode of transmission of viral diseases and had never been tested for them.
This study shows that heterosexual transgender males, are a greater threat of HIV spread than regular homosexuals. 18.3% of respondents were married to females and even had children: their marital status has no effect on their sexual activity and thus channel out a way for HIV to be transmitted into the general population, both vertically and horizontally. Nevertheless, majority of subjects live together as a clan. Only four individuals out of a total of 306 interviewed live with their families while many had hidden contacts with at least one member of the family unit.
Transgender males ranging 25–40 years of age, having only five years of professional experience were seen to be at eminent risk of acquiring HIV infection in relevance to other activities.A fraction of the subjects stated to have had entered the field because they had been sexually abused and astonishingly they built one by tenth of this hijra community. However, the majority turned to the hijra clan for acceptance, security, satisfaction of sexual desires and easy-money.
Injecting drug use is reportedly one of the major factors behind HIV transmission besides sexual contact. However this case study showed negligible injectable drug users (IDUs) thereby eliminating the risk of HIV spread via unsafe injections, needle sharing etc . There were some alcohol addicted dancers amongst the respondents but their intake was relatively lower to be considered as a critical factor. Lastly the use of condom could also not be related or analyzed in this study because not even a single respondent accepted that he uses a condom with his customers or friends during sex. The reason for not using condoms came out to be an apprehension on the customer’s part and thus affecting their business.
The reported data clearly represents the problems in our population. The problems are further complicated by social stigmas of cultural and religious origin in Pakistan. Furthermore, building an HIV prevention response that effectively addresses the needs of transgender communities requires the active participation of the communities along with service providers, local public health leadership, and community planning or advisory groups. Above all, it is important that healthcare providers get to know the specific context and living situation of transgender populations from the regions in which they are working. Beyond the general fact that transgender people live partially or completely in a sex or gender that was not assigned to them at birth, they are extremely diverse. Their specific HIV‐related issues and challenges depend on the particular social determinants of health that affect them in their region, but also on the way they see themselves and on the body modifications they seek out.