Patient-related factors leading to AIDS from HIV infection among transgenders in Pakistan

Transgenders in Pakistan remain disproportionately vulnerable to HIV progression due to social exclusion, healthcare barriers, and stigma, with limited research exploring the influencing factors. This study aimed to identify patient-related, and structural determinants contributing to HIV progression among transgenders receiving care in Lahore, Pakistan. A qualitative exploratory study involving semi-structured interviews with 21 transgenders receiving antiretroviral therapy was conducted using a Delphi-validated interview guide, with interviews held in Urdu, audio-recorded, transcribed verbatim, and translated into English. Data were analyzed using thematic analysis following Braun and Clarke's framework, supported by NVivo software. Analysis generated three major themes: individual-level factors, psychosocial and interpersonal determinants, and structural barriers. Participants reported delayed HIV diagnosis due to limited awareness and misinterpretation of early symptoms. Irregular adherence to antiretroviral therapy was influenced by poor understanding of treatment, medication side effects, and inconsistent healthcare engagement. Psychosocial challenges, including stigma, discrimination, depression, and lack of family support, further hindered treatment continuity. Structural barriers including poverty, unstable income, and limited support services access contributed to treatment interruptions and advanced disease presentation. Progression from HIV to AIDS among transgenders is driven by delayed diagnosis, poor treatment adherence, psychosocial distress, and structural inequities, underscoring the need for integrated community-based interventions.