Hospitals in this Pakistani province reserve a special room for transgender patients

Khyber Pakhtunkhwa’s recent announcement that a dedicated ward will be set aside in government hospitals for the care of transgender patients is being hailed by trans activists in the province as a breakthrough – a step towards dignified access to proper care for a highly marginalised and underserved community.

A room of one’s own

On April 1, Khyber Pakhtunkhwa (KP) Chief Minister Ali Amin Gandapure issued instructions to the provincial health department that a separate ward should be reserved for trans people in district headquarters hospitals.

The announcement was widely welcomed by the transgender community and civil society organisations, with some hailing it as a step forward in overcoming the barrier to accessing specialist health services posed by stigma and discrimination.

“Access to better healthcare services was a dream for the transgender community who have faced multiple challenges including harassment, discrimination, denial of care and non-acceptance in case of admission to both male and female wards of hospitals,” comments Katrina Khan, a transgender rights activist who conducts professional trainings to empower transgender people.

Transgender people deserve the same level of health care and access to treatment as everyone else, Khan emphasizes.

Pay more for less

Khan shares a personal anecdote that, for most Pakistanis, would hardly be worth mentioning. She recently visited Lady Reading Hospital (LRH), Pakistan’s largest teaching hospital, with a headache and fever. Yet for Khan, it was a significant milestone: in the past, she would have avoided going to a government facility and preferred private clinics for privacy.

“Access to better health services was a dream for the transgender community who had to face multiple challenges, including harassment, discrimination, denial of care and non-acceptance when admitted to male and female wards of hospitals.”

– Katrina Khan, transgender rights activist

This confidentiality comes at a price. “In private clinics, we had to pay large sums for consultations on minor health problems, while in public hospitals, examinations were completely free, which was a great financial relief for me in the current context of rising prices in our country,” she said.

” Peace of mind “

“The (government) decision has boosted our confidence that we can visit public sector hospitals with peace of mind and avail health facilities,” said Farzana Riaz, president of TransAction Alliance Khyber Pakhtunkhwa chapter.

Until now, transgender people have generally only been hospitalized in cases of serious illness, too often as a result of violence. “Since 2015, more than 100 transgender people have been victims of violent attacks in Khyber Pakhtunkhwa, mostly due to altercations with male friends, about 10 percent due to honor killings and several due to the refusal of friendship,” Riaz said.

Even in these brutal cases, they faced sneers, outright insults and violations of confidentiality, she said.

More than just a safe space, Riaz hopes the new policy will send a message to disrespectful healthcare professionals to change their attitudes toward trans people in need.

When it comes to addressing the health needs of transgender people, there is still a long way to go. Riaz recounted the heartbreaking case of a transgender rights activist, Alisha, who died in a Peshawar hospital in 2017 due to treatment delays caused by doctors’ indecision over which ward she should be treated in – male or female.

Had there been a separate room at that time, Alisha would have been sent straight to be treated and saved, Riaz said, her voice choking.

The low levels of trust in the healthcare system among trans people can be gauged by the fact that only seven members of the trans community were registered in 2023 with the KP government’s flagship health insurance initiative, the Sehat Insaf card, which provides access to free medical care worth a total of Rs 1 million (US$3,597) per year, for KP residents, Riaz said.

“Improve health”

Calling the announcement “groundbreaking,” Civil Society Alliance Young Omang, a leading national sexual and reproductive health rights group, said in a statement that the move promises to be a step towards comprehensive and accessible health services for all, especially the particularly vulnerable transgender community.

“This decisive action will significantly improve the health and social status of the transgender community in Khyber Pakhtunkhwa,” commented Qamar Naseem, a prominent transgender rights advocate and author of a research paper analyzing the gaps in public health policy for sexual and gender minorities in Pakistan.

In the report, which was compiled from interviews with 240 transgender and intersex people, Naseem found that health workers do not treat transgender people in a gender-sensitive manner and need training. The health ministry should take steps to sensitize transgender people to the social and institutional stigma that creates fears and barriers to health care for sexual and gender minorities, he recommended.

Inclusive diagnostics for disease control gains

Fear of stigmatization by medical personnel is known to restrict transgender people from visiting medical facilities, thereby limiting the community’s access to diagnostic testing for serious health threats like HIV/AIDS and COVID-19, observed Heer Jamal, a trans woman and activist for members of her community.

Jamal is currently working with a United Nations Development Programme (UNDP) project on transgender health and is advocating for increased awareness of HIV/AIDS treatment among the transgender population.

The initiative has helped convince about 300 transgender people to undergo HIV/AIDS testing. Of these, 137 tested positive and were enrolled in the National Integrated HIV Control Programme for free treatment.

While trans people are reluctant to access care in health care settings in general, the situation is even more dire when it comes to diagnoses that are stigmatized even within the trans community, Jamal said.

She recalled the case of a transgender woman who was diagnosed with HIV and died on the street in Peshawar a few years ago. She had been evicted from her apartment by her roommates because they were afraid of contracting the disease.

“The (government’s) decision has strengthened our confidence that we can visit public sector hospitals with peace of mind and benefit from health facilities,”

– Farzana Riaz, President of the Khyber Pakhtunkhwa Chapter of TransAction Alliance

Currently, the system relies too often on chance to diagnose and treat transgender people living with HIV without knowing it. Muhammad Asim, the transgender healthcare access manager at Lady Reading Hospital (LRH), recalls a transgender woman who recently came to LRH for treatment for a broken leg from an accident and a blood test showed that the patient was HIV positive.

The LRH administration not only treated his fractured leg, but also started him on HIV treatment by enrolling him in the Department of Health’s AIDS Control Program.

Opening the doors to free HIV/AIDS care

“Khyber Pakhtunkhwa Health Department is providing free treatment for HIV infection to 137 transgender persons of the province,” said Dr Yasir Hayat Taj, Deputy Director, Integrated HIV and Thalassemia Control Programme, Khyber Pakhtunkhwa.

Of these 137 people living with HIV, about 59 are registered at LRH, where they also receive psychological support, said Hilal Ahmad, a psychologist at the AIDS Control Programme.

Patients receive free medication and viral load tests every six months, Hilal said. VaccinesWork.

“We have instructed medical staff of major hospitals to provide proper treatment to the transgender community by ensuring their confidentiality,” said Syed Qasim Ali Shah, Khyber Pakhtunkhwa Health Minister.

Talk to VaccinesWorkThe minister said the facility is initially available in six divisional capitals and will soon be extended to all major hospitals in the province.

He also urged the transgender community to take advantage of the new facility, visit hospitals with peace of mind and access free treatment they may need, thereby helping the government achieve its goal of advancing the right to health for all citizens.