Despite that, "it's actually easier being gay in Pakistan than in the US," says Qasim, 41, dragging on a cigarette in a smart coffee shop, as he explains how to live under the radar in one of the world's most conservative countries.
"We can hold hands," says Qasim, reaching for Ali under the table. "We can sit casually like this. Nobody gives it a second thought in Pakistan."
Qasim says he is never insulted in the street, or called names -- something that happened when he lived in the United States.
In tribal societies in Pakistan's northwestern border areas with Afghanistan and in southwestern Baluchistan on the Iranian border, there is an ancient custom of tolerated, albeit secret sexual relationships between men and young boys.
In a society where women are kept to the sidelines and pre-marital sex is a taboo, there are no concerns when it comes to men holding hands or hugging in the street with what is viewed as platonic affection.
Born in Pakistan, Qasim migrated to the United States with his parents when he was three years old.
The family owned clothing factories and enjoyed an affluent life with a swimming pool in the garden. They could afford a university education -- degrees in fashion and computing, then finally an MBA.
Qasim was working for Microsoft when he was diagnosed with HIV in his mid-20s. Under the law at the time, naturalised US citizens had to give up their citizenship if they were HIV positive.
After a fruitless battle in the courts, he renounced his US citizenship and flew back to Pakistan, a country that he barely knew, where homosexuality is illegal.
"When I came here it was a culture shock. I wasn't comfortable. I ran off to Dubai for three or four months, but I couldn't find a job. Then I moved to Sydney for six months but couldn't find a job, but now I'm happy here," he said.
Qasim set up a charity for gay men and transgenders. Under the radar, with no public profile, it is supported by the government. It provides medical care and runs drop-in centres, where young men can relax, listen to music and watch TV.
"I get respect. I feel appreciated for the work I'm doing. Hopefully I'm changing people's lives and making a difference," he said.
Qasim and his boyfriend Ali, 26, live in a flat in a leafy, well-to-do neighbourhood of Lahore, arguably the most liberal city in Pakistan, steeped in the history of the Mughal empire and the British Raj.
There is modern art on the walls. There is a gardener and two housekeepers -- both members of Pakistan's vibrant but shunned transgender community, hired traditionally to sing at weddings and celebrate the birth of sons.
"The neighbours have no idea. We mind our business," says Qasim, adding with a smile: "We don't have these big gay parties or flamboyant people coming over."
"To me it's a normal thing living as a gay couple," says Ali. "Before meeting him I felt alone and depressed but now I have a happiness which I cannot describe in words."
Lahore, like other major cities in Pakistan, has an underground gay scene. Its one and only gay bar was sold off when the owner got fed up paying off the police, according to Qasim, but there are still a lot of parties.
You have to be part of the circuit to get invited. Security is tight and police are bribed. Guests pay $10 for tickets and take alcohol, prohibited in Pakistan.
"It's a meat market. You get 400-500 sexually frustrated guys in one room," says Qasim.
He and Ali say they have turned their backs on the party scene for a life of domesticity involving going to the gym or cooking together.
They say they are never threatened or insulted, but they minimise the risk by living apart from the rest of society. Living under the radar is how they cope.
In Pakistan, the elite have the money and clout to live largely as they please, but the poor and lower classes are less protected from abuse. It is gay men from these backgrounds that Qasim's charity tries to help the most.
Ali has not come out to his family. Qasim told his parents he was gay when he was a teenager. When he and Ali visit Islamabad, they stay with Qasim's parents, albeit in separate bedrooms.
The couple say they welcome the legalisation of gay marriage in other countries, but do not believe in making an issue out of gay rights in a conservative, religious country like Pakistan.
Ali says they talk about getting married overseas, and then coming home to host a private ceremony in front of their friends. "We dream of the day when we can adopt a little girl to raise as our own," he adds.