High levels of discrimination and abuse of human dignity of all groups studied were revealed. This violates their physical and mental integrity and also leads to an increased risk of HIV. The sexual and social interactions between groups mean that human rights abuses experienced by one high-risk group can increase the risk of HIV both for them and other groups. The protection of human rights needs to become an integral part of a multisector response to the risk of HIV/AIDS by state and non-state agencies. The Government of Pakistan should work at both legal and programme levels to protect the rights of, and minimise discrimination against, groups vulnerable to HIV in order to reduce the potential for the spread of HIV before the epidemic takes hold.

To avoid imposing a "false clarity" on categorisation of identity and assumed behaviour, it is necessary to go beyond verbal accounts to document the fluidity of everyday reality.

Using data from a qualitative study and a subsequent quantitative survey among 918 male and transgender sex workers (MTSW), we explore the context of multiple risks they face. We show that over one-fifth of MTSW have sex with IDU clients. Combined with high levels of risk behavior and very low levels of risk reduction and knowledge, the extent of sexual networking with men who inject drugs contributes further to the sex workers' health risks. Our findings suggest that isolated interventions with single-risk groups are unlikely to be sufficient to control the spread of the epidemic in Pakistan. We highlight the need for integrated approaches to risk reduction programs among MTSW and IDUs.

This paper examines the biopolitics of HIV and labour migration from Pakistan (a country classified by UNAIDS as at 'high risk' of a generalised epidemic) to the countries of the Gulf Cooperation Council (GCC). The remittances by the labour migrants in the Gulf are an invaluable source of foreign exchange for Pakistan and a large number of households are entirely dependent upon them. At the same time, the National AIDS Control Programme regards Gulf migrants as a key risk factor for an HIV epidemic. The majority of HIV positive people in clinics comprise Gulf returnee migrants and their family members. This paper suggests that in the process of migrating, prospective migrants are subjected to structural violence that increases their HIV vulnerabilities. In this process, they are subjected to regimes of medical inspection, reduced to their certifiable labour power, inscribed with nationalist ideologies identifying HIV as a disease that strikes 'the other', and exposed to exploitation that increases their vulnerabilities. After migration, they are made to undergo compulsory periodic medical examinations in the GCC and, if found to be HIV positive, they are forcibly deported without papers, proper diagnosis or healthcare - only to return as 'failed subjects'. Taking a disaggregated view of the state, the paper argues that, in order to be effective, debates on structural violence and the HIV epidemic must make explicit the role of the state in producing migrants' vulnerabilities.

Existing research has documented how the expansion of HIV programming has produced new subjectivities among the recipients of interventions. However, this paper contends that changes in politics, power and subjectivities may also be seen among the HIV bureaucracy in the decade of scale-up. One year's ethnographic fieldwork was conducted among AIDS control officials in Pakistan at a moment of rolling back a World Bank-financed Enhanced Programme. In 2003, the World Bank convinced the Musharraf regime to scale up the HIV response, offering a multimillion dollar soft loan package. I explore how the Enhanced Programme initiated government employees into a new transient work culture and turned the AIDS control programmes into a hybrid bureaucracy. However, the donor money did not last long and individuals' entrepreneurial abilities were tested in a time of crisis engendered by dependence on aid, leaving them precariously exposed to job insecurity, and undermining the continuity of AIDS prevention and treatment in the country. I do not offer a story of global 'best practices' thwarted by local 'lack of capacity', but an ethnographic critique of the transnational HIV apparatus and its neoliberal underpinning. I suggest that this Pakistan-derived analysis is more widely relevant in the post-scale-up decade.