By : Farhan khalil
A healthcare facility can be open to everyone and still not be designed for everyone. For a transgender person in Pakistan, exclusion may begin long before meeting a doctor. It can start at the registration counter, with an identity document that does not correspond with the name or gender expression the patient uses. It can continue with a waiting area divided into male and female sections, uncertainty over which queue to join, or staff who do not know how to respond respectfully. None of these barriers may have been deliberately created to exclude transgender people, but together they can make an ordinary visit to a healthcare facility unnecessarily difficult.
A Qualitative Research on Understanding the Impact of HIV Stigma on Transgender Persons Living with HIV in Khyber Pakhtunkhwa, conducted by Blue Veins and National Commission for Human Rights, involving transgender women from various districts has documented some of these experiences. Participants described discrimination in healthcare settings, uncomfortable waiting environments and difficulties navigating facilities organised strictly around male and female categories. For some, even deciding where to sit or which queue to join created anxiety and unwanted attention. These experiences illustrate an important point: discrimination in healthcare is not always the result of an openly hostile doctor or nurse. Sometimes exclusion is built into procedures, physical spaces and administrative systems that were designed without considering the diversity of the people who would use them.
This is why trans-inclusive healthcare should not be understood simply as asking healthcare workers to be more polite. Respectful behaviour is essential, but inclusion also requires institutions to examine how patients move through the entire healthcare system. Registration procedures, identity documentation, waiting arrangements, toilets, admission processes, medical records, confidentiality practices and complaint mechanisms can all influence whether a transgender patient experiences healthcare with dignity. A technically competent consultation cannot entirely compensate for a system that has humiliated the patient before they reach the examination room.
Registration is a good example. Healthcare facilities need accurate information about patients, but administrative requirements should not become an opportunity for public questioning or ridicule. Where a person’s official documents differ from the name or gender presentation they use, staff should know how to handle the situation professionally and privately. The objective is not to ignore official documentation where it is legally or clinically required, but to ensure that administrative procedures do not unnecessarily expose a patient to embarrassment. The same principle applies when calling patients from waiting areas or discussing personal information where others can hear.
The physical organisation of healthcare facilities also matters. Separate male and female queues, wards or waiting spaces may create uncertainty for transgender patients when no appropriate arrangement exists. Toilets and admission procedures can raise similar difficulties. In October 2025, the Khyber Pakhtunkhwa Health Department directed hospitals to provide dedicated wards, toilets and other facilities for transgender patients following complaints involving violence, admission difficulties and delays in treatment. The directive was an important recognition that healthcare infrastructure itself can affect dignity and access. The next challenge is ensuring that such measures are implemented consistently and accompanied by improvements in the wider patient experience.
A trans-inclusive healthcare facility, however, cannot be created simply by allocating a toilet or putting up a sign. Inclusion must extend into the consultation room. A transgender person may visit a doctor because of fever, diabetes, an injury, an infection or any of the health concerns experienced by the wider population. Healthcare professionals should focus first on the medical reason for the visit and ask questions about gender identity or personal circumstances only when they are relevant to providing appropriate care. Curiosity is not a clinical indication. Patients should not have to explain or defend who they are before receiving treatment for what brought them to the facility.
This principle becomes particularly important in HIV services. Transgender people are among the populations disproportionately affected by HIV, but their healthcare needs cannot be reduced to HIV alone. When a transgender person is living with HIV, confidentiality, continuity of treatment and trust in healthcare providers become especially important. A poorly designed or disrespectful healthcare environment can create another barrier to regular testing, medication and follow-up. Trans-inclusivity should therefore be integrated across the health system rather than confined to specialised HIV programmes.
Healthcare workers need practical training to make this possible. Such training should go beyond terminology and awareness sessions. Receptionists need to know how to manage registration respectfully. Nurses need guidance on privacy, communication and admission procedures. Doctors need sufficient understanding of transgender health to distinguish between clinically relevant questions and assumptions about a patient’s identity. Managers need to know how to respond when discrimination occurs. Training is most useful when it changes everyday practice rather than simply demonstrating that a workshop has been held.
Accountability is equally important. A patient who experiences humiliation or discrimination should have somewhere safe to report it, and complaints should lead to appropriate review and action. Healthcare institutions should examine whether their existing complaint mechanisms are accessible to transgender people and whether patients trust them enough to use them. Without accountability, respectful treatment can depend too heavily on the attitude of whichever healthcare worker happens to be on duty. Inclusion needs to become an institutional standard rather than an individual favour.
Transgender communities themselves should have a meaningful role in defining that standard. Hospital administrators may not recognise barriers that appear obvious to patients who encounter them repeatedly. Consulting transgender people when reviewing registration procedures, staff training, privacy arrangements and complaint mechanisms can reveal problems that routine administrative data will never capture. Their participation should therefore extend beyond being invited to awareness events; it should influence how services are designed, monitored and improved.
Pakistan does not need a parallel healthcare system for transgender people. What it needs is a healthcare system capable of serving the population in all its diversity. Trans-inclusion means removing unnecessary barriers from the same clinics, hospitals and health programmes used by everyone else. It means recognising that equality is not achieved simply by keeping the hospital door technically open; it is achieved when people can move through that door and through the healthcare system without being unnecessarily singled out, exposed or humiliated.
The real test of a trans-inclusive clinic is therefore surprisingly ordinary. A transgender person should be able to enter a healthcare facility, register without humiliation, explain what is wrong, receive competent treatment, trust that personal information will remain confidential and leave without their gender identity becoming a problem unrelated to the illness that brought them there. That is not special treatment. It is what equal healthcare should look like.
