Amid the Shadows, Pakistan's Third Sex Face HIV Threat: Hijras Could Trigger Disease Explosion, Says Report

HIV levels in Pakistan are low: An estimated 100,000 of its 150 million people are HIV-positive, compared to about 5 million in neighboring India. But health experts warn that hijra, part of South Asia's ancient community of transsexuals, hermaphrodites, and eunuchs, are at high risk of contracting and spreading HIV/AIDS.

A recent survey by Family Health International (FHI) found a concentrated epidemic among drug users, one-quarter of whom tested HIV-positive in Karachi. Only 2 percent of hijra were infected, but the prevalence of STDs, approximately 60 percent have syphilis, coupled with poor public health systems and ignorance about HIV/AIDS give warning of serious epidemic potential in Pakistan, according to the study.

Interactions among high-risk groups compound the danger. Drug users frequently buy sex from female sex workers and hijra, who in turn sleep with truckers and married men. The hijra infection rate is low for now, but risk is high and it could easily spread into the general population, said FHI's Naseer Nizamani.

Attitudes toward hijra compound the problem. Many Pakistanis believe hijra have supernatural powers while others scorn and persecute them. The close-knit community has its own language, laws, and leaders. Their insular status fosters ignorance about HIV/AIDS. FHI found that more than 40 percent of hijra have never heard of HIV and only 9 percent use condoms. "Nobody wants to use one," said Gori Shermi, a hijra peer educator.

Shermi works for the AIDS Prevention Association of Pakistan (APAP), one of a few small nongovernmental organizations working with hijra. Volunteer workers build links by offering gifts, said APAP Director Muhammad Hanif. "Only then will they listen to us," he said.

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