HIV Prevalence and Associated Factors among Transgender Individuals in Kasur, Pakistan

Background: Transgender and hijra communities in Pakistan remain among the most marginalized groups, facing discrimination, violence, and exclusion from education, employment, and healthcare. These social inequalities heighten their risk of HIV infection and limit access to prevention and treatment services. The Khawaja Sira Society (KSS), a community-based organization working in Punjab since 2012, provides HIV prevention, testing, counselling, and treatment referral services for transgender individuals. However, limited district-level evidence exists on the magnitude of HIV infection and its determinants in smaller cities such as Kasur. Aims: This study aimed to determine the prevalence of HIV among transgender individuals in Kasur and identify socioeconomic, behavioral, and structural factors associated with infection. Methods: A cross-sectional study was conducted among 150 transgender individuals registered with KSS. Data were collected using structured questionnaires and HIV testing. Associations between HIV status and participant characteristics were analyzed using chi-square tests. Results: Of 150 participants, 50 (33.3%) tested positive for HIV. Infection was significantly associated with low income, engagement in sex work, longer duration of sex work, living in a dera or with a guru , inconsistent syringe sterilization, and multiple sexual partners. Eighty-two percent of those diagnosed were successfully linked to antiretroviral therapy. Conclusion: A high HIV burden among transgender individuals in Kasur reflects socioeconomic vulnerability and social exclusion. Strengthening community-led interventions like KSS can improve prevention, care, and treatment outcomes.