Background A large amount of new HIV infections worldwide is observed amongst key populations which include e.g., commercial sex workers or transgender people and their respective sexual partners. Therefore, this study examined the multi-level context of inconsistent condom use (ICU) in sexual interactions of transgender street-based workers (KSWs) with commercial and non-commercial sexual partners in Lahore. Methods We conducted 20 in-depth interviews with street-based KSWs to investigate challenges to consistent condom utilization with sexual partners. The qualitative data was analyzed using reflexive thematic analysis to produce an initial set of codes and identify broader themes through a recursive exploration of the text. Results Within a socio-ecological analysis we identified factors influencing ICU among KSWs at three levels. At the individual level, we identified knowledge and awareness, age, pleasure and pain, and mental health issues impacting on ICU. perceived characteristics of sexual partners, dynamics of cruising spots and places of sexual interactions, competition in sex trade, violence and lack of safety nets in street-based sex work, and condom use with lovers were factors associated with ICU. Risk factors at community level were changing urban geography of sex work, discrimination, harassment and regular evictions, networks with non-governmental organizations and the influence of gurus and Dera culture. Conclusions Until now, HIV prevention efforts in Pakistan have primarily focused on HIV risk factors at the level of individual behaviors within specific networks of target populations. However, our study points towards both the effectiveness and the urgency of interventions that address macro-level risk factors specific to key populations in Pakistan, in addition to behavioral interventions.

Background: A large amount of new HIV infections worldwide is observed amongst key populations which include e.g. commercial sex workers or transgender people and their respective sexual partners. Therefore, this study examined the multi-level context of inconsistent condom use (ICU) in sexual interactions of transgender street-based workers (KSWs) with commercial and non-commercial sexual partners in Lahore. Methods: We conducted 20 in-depth interviews with street-based KSWs to investigate challenges to consistent condom utilization with sexual partners. The qualitative data was analyzed using thematic analysis to produce an initial set of codes during the first-level round. An essence-capturing strategy was utilized to identify broader themes through a heuristic exploration of the text. Results: Within a socio-ecological analysis we identified factors influencing ICU among KSWs at three levels. At the individual level, we identified knowledge and awareness, perceived characteristics of sexual partners, age and physical attributes, pleasure and pain, and mental health issues impacting on ICU. Gentrification of historical red-light district, discrimination, harassment and regular evictions, dynamics of cruising spots and places of sexual interactions, competition in sex trade, violence and lack of safety nets in street-based sex work, condom use with lovers, networks with non-governmental organizations were factors associated with ICU. Risk factors at community level were poverty, the influence of gurus, and Dera culture.Conclusions: Until now, HIV prevention efforts in Pakistan have primarily focused on HIV risk factors at the level of individual behaviors within specific networks of target populations. However, our study points towards both the effectiveness and the urgency of interventions that address macro-level risk factors specific to key populations in Pakistan, in addition to behavioral interventions.

This ethnographic endeavor seeks to explore the ritual of Zikr and its association with the shift and dilemmas in American Sufism at a Sufi Shrine in Manhattan, The United States of America. The study highlights the ways in which Islam accommodate sociocultural change without losing its traditional identity: It has not changed in essence. Also, it throws light on the ways such monotheistic religions create social relevance for their followers in a culture alien to universalizing discourses and identities. The paper argues that esoteric versions of traditional monotheistic religions, like Sufism are more suited to postmodern religious consciousness of modern day individuals. The study employs the conceptual lens of postmodern religiosity. Four formal interviews of the Sufi followers (dervishes) alongside field jottings that expanded from January 2012 till December 2012 were conducted. The analysis was thematic in nature. The structure of the Zikr ritual was elaborated followed by offering prayer the 'Sushi' way. This form of prayer ensures convivial coexistence amongst intra-religious collectivities. The study concluded that the concept of religiosity is poly-symbolic in nature. The Zikr ritual acts as a distinct plain that invokes a sense of belonging for the participants in diverse settings. American Sufism is multifaceted in essence and in spirits.

The study examines the primary individual and organizational drivers of policy-making on women's development in Pakistani infrastructure development projects. There is general consensus that large-scale projects could be planned and carried out to improve the conditions of communities, especially women, as well as to lessen the project's negative consequences. 33 in-depth, semi-structured interviews with senior Pakistani decision-makers who are active in formulating policy were done for this study. This paper employs McConnell and Hart's (2019) fivefold typology of policy inaction and the results reflect four types of policy responses to gender components in infrastructure projects among our participants: 1) Ideological inaction 2) imposed inaction 3) inadvertent inaction and 4) support for gender policy. Furthermore, mid-career participants with extensive face-to-face interactions with community people in the field showed the highest levels of support for gender policy. Lastly, our research points to the existence of multi-level obstacles to the creation of a national gender policy.

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