Pride Month 2025 | “We Are Still Here”: Trans Lives, HIV, and the Unseen Epidemic in Eastern Europe and Central Asia

“Pride without truth is performance. Pride with truth is resistance.”

They told us the epidemic was over. That the era of fear had passed. That medicine had won, and that the rest was just policy clean-up. But in the quiet corridors of hospitals in Tashkent and Minsk, in unregistered apartments in Chisinau and Yerevan, in the backstreets of Bishkek and Omsk, the story remains unfinished. HIV is still here. And so are we.

In Eastern Europe and Central Asia, HIV is not declining — it is rising. This is the only region in the world where the epidemic is growing, yet global attention remains turned elsewhere. It is easier, it seems, to focus on places where hope is easier to package. But in this region, hope is not packaged. It is forged. Day by day. Syringe by syringe. Heartbeat by heartbeat.

Transgender people are not just disproportionately impacted by this epidemic — they are its uncounted, unprotected, unrecognised frontline. In most countries across the region, there is no official data on HIV among trans populations. Not because the epidemic doesn’t exist — but because to count us would be to acknowledge that we matter. So instead, we remain statistically invisible, medically under-served, and legally erased.

What happens when your name doesn’t match your ID? When your gender is denied by the state? When hormone therapy and antiretroviral drugs cannot be coordinated because no clinic offers both? You fall between the cracks of systems not designed to recognise you. And those cracks become graves.

HIV is not the result of identity. It is the result of abandonment. The virus thrives in silence, in shame, in systems that teach people they are unworthy of care. Trans people are often forced to navigate healthcare like a minefield — one wrong word, one wrong pronoun, one smirk from a nurse, and the door slams shut. Even access to testing becomes a gauntlet of humiliation. There are stories — too many to count — of trans women being mocked, misgendered, or told they must first “fix” their identity before being treated for HIV. These are not isolated incidents. These are standard procedures of exclusion.

And yet, we survive. Not just in the medical sense, but in the fiercest, most defiant way possible. In Georgia, trans organisers build peer-run clinics. In Ukraine, even during war, trans volunteers deliver hormones and medicine to those cut off from care. In Kazakhstan and Kyrgyzstan, they organise underground testing sites, offering dignity where institutions offer disdain. In Moldova, Armenia, Tajikistan — across borders and barriers — trans people continue to do what states refuse: to keep each other alive.

Trans people do not need saviors. They need systems that stop trying to kill them.

Across this region, HIV policy is often moral policy. Governments refuse to address the epidemic not because they don’t see it, but because they blame it. They treat HIV as divine punishment. And trans people — as ideological threats. In this context, to be a trans person living with HIV is to carry the weight of two exiles at once: exile from the health system, and exile from the human condition.

But this is not a story of despair. This is a story of survival so relentless it terrifies those who tried to erase us. This is a story of hormone vials hidden in backpacks crossing checkpoints. Of medical knowledge passed hand to hand in living rooms. Of chosen families distributing antiretroviral meds like sacred fire. This is the story of people who were told they should not exist — existing anyway.

Let it be said clearly: being trans is not a pathology. Being HIV-positive is not a moral failure. The real pathology is transphobia. The real failure is political cowardice in the face of human dignity.

In many ways, the virus itself is no longer the greatest threat. It is the laws that criminalise our existence. The doctors who deny us care. The border agents who strip away our names. The propaganda machines that call us dangers to children — when in fact, we are the ones building worlds safe enough for truth.

Every statistic that excludes trans people is a lie by omission. Every clinic that turns us away is complicit in violence. Every silence around our deaths is a second death.

And yet — we are still here.

We are here, not as ghosts of a forgotten epidemic, but as architects of a different future. One where health is not conditioned on conformity. One where gender is not a barrier to medicine. One where the full complexity of human life is met not with bureaucracy, but with care.

To be trans in this region is to live under siege. To be HIV-positive is to be blamed for surviving. But to be both — and still wake up, still take your meds, still help others live — is nothing less than heroic.

They want us quiet. We answer with voice.

They want us invisible. We answer with presence.

They want us gone. We answer with life.

Because we are not the epidemic.

We are the historians of survival.

And we will not be erased.

Karen Badalyan

EATG Transgender HIV/AIDS Focal Point

EATG Ombudsperson

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