LocationsThe Cost of Stigma: Lives Behind the Legal Gap
January 27, 2026
Camouflaged in a densely populated area of old Lahore, hiding in plain sight, is a place that serves as a haven for many living on the periphery of society. There is no signboard outside. We knock on a black metal door. A voice asks us who we are. We are let in once we identify ourselves and walk up a narrow staircase that leads to an office-like room.
Plastered across the walls are pamphlets on HIV testing and awareness, some with helpline numbers visible. Inside, the room is modest, familiar, and quietly alive. A few plastic chairs line the walls, and the afternoon heat presses in through half-open windows. This is not a clinic. It is a safe space: Dostana, a community-based organization running a drop-in centre for HIV services, where people come not only for prevention and testing but to feel accepted and breathe a little easier.
It is here that a focus group discussion for the UNDP-commissioned Legal Environment Assessment on HIV and Human Rights in Pakistan is being conducted – one of 17 discussions held nationwide, each taking place in a similar setting, and offering a rare window into lives that are usually pushed into invisibility.
The study’s purpose was to understand whether Pakistan’s HIV response and legal framework protect the rights of key populations and people living with HIV, and whether these systems help limit the spread of HIV.
The methodology was comprehensive. The assessment combined 17 focus group discussions with 119 respondents, 119 key informant interviews, five multi-stakeholder consultations, 50 institutional questionnaires, 233 online surveys, and a desk review of 112 national and provincial laws, policies, and international commitments. The evidence was both quantitative and deeply human.
As the focus group began, one participant spoke first.
“We have seen efforts for prevention and treatment,” they said slowly. “But not for the social and legal side. There is still very little effort to stop stigma and discrimination.” Heads nodded around the room.
“People come to us,” another participant said, “they take our stories for research and case studies. But nothing changes. We are still living the same reality.”
“People come to us,” another participant said, “they take our stories for research and case studies. But nothing changes. We are still living the same reality.”
The stories began to overlap, revealing recurring patterns rather than isolated experiences. Routine moments rarely stay routine for individuals from key populations. A road stop by law enforcement often turned into an interrogation. A National Identity Card became a weapon used against them.
“Why does your ID card say male? Is this really you?” More officers are called in. More eyes are invited to stare, to judge, to decide.
In smaller towns, the fear was worse. One story lingered longer than the others. It was Ramadan. A transgender woman was accused of a crime she did not commit. She was fasting when she was taken to a police station. By the time she was released, her back was bruised from beatings. No one had allowed her to break her fast.
The room fell quiet.
For many participants, police stations were not places of safety. They were spaces to avoid, even after harm had occurred.
The same plight followed them into hospitals.
When I asked for treatment,” one participant said, “the doctor told me I should think about the time I was enjoying sex.”
There was no anger in their voice, only exhaustion. Others spoke of confidentiality being broken, of surgeons refusing to operate, of care becoming conditional.
Yet, amid the fear, there were places that felt different. When participants spoke about Dostana and other community-based organisations, their voices softened. These were spaces where explanations came without interrogation, where testing kits were offered without judgment, and where no one asked you to justify your existence before offering help.
“They are always there for us,” one participant said. “They listen.”
Across all focus group discussions, common experiences emerged: hesitation before visiting a clinic, fear when approaching a police station, discrimination at work and in everyday life. The desk review showed where protections exist and where gaps leave people exposed.
While Pakistan’s general HIV prevalence remains low (under 0.2%), new infections surged by 84% between 2010 and 2020, highlighting a growing crisis that is not only medical but legal and social.
The review also highlighted a key structural gap: devolution of health to the provinces has left HIV laws uneven and incomplete. Sindh is the only province with HIV-specific legislation, while Punjab, Balochistan, and Khyber Pakhtunkhwa lack legal protections that address HIV violations. Even where laws exist, implementation remains weak.
The online surveys found that medical awareness is high, with 94% of respondents understanding how HIV is transmitted. Yet this knowledge does not guarantee safety. Forty-two percent of respondents, particularly transgender persons and people who use drugs, reported discriminatory treatment from the very healthcare providers meant to care for them. More than half reported discrimination from police, while transgender individuals and sex workers shared horrific accounts of sexual violence, blackmail, and harassment by law enforcement.
The result is a profound mistrust in public institutions. Fifty-six percent of victims did not file complaints, largely due to fear of further stigma or a belief that the police would not help them.
Seventeen percent of respondents also reported discrimination from lawyers or judges. This suggests that despite progressive rulings, the doors of the courthouse may be as heavy as the doors of the clinic.
Despite these gaps, there is reason for hope. Courts are increasingly interpreting the constitutional rights to life and dignity not just as the right to exist, but as the right to a life free from degradation.
The 2025 Legal Environment Assessment makes one thing clear: medical care can treat the disease, but the law must reshape social structures to cure the stigma. A stigma-free HIV response requires legal empowerment, institutional accountability, and, most importantly, respect for human dignity.
The recommendations, aimed at federal and provincial governments, health departments, legal institutions, and law enforcement agencies, are grounded in voices like these. They aim to strengthen implementation, improve institutional response, and ensure that access to HIV care is not undermined by fear or discrimination.
More detailed findings and recommendations from the Legal Environment Assessment Scan can be found in the full report here.
Listening, as this assessment shows, is not passive. It is the first step toward justice and toward an HIV response rooted not only in prevention and treatment, but in dignity.
Authors:
Summayyah Rasheed (Programme Officer Stigma and Discrimination) – UNDP Pakistan
Eman Javed (Project Manager) & Zaman Faraz Karamat (Policy Analyst) – CERP
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