Condom use during commercial sex among clients of Hijra sex workers in Karachi, Pakistan (cross-sectional study)

Siddiqui, Anees ur Rehman; Qian, Han-Zhu; Altaf, Arshad; Cassell, Holly; Shah, Sharaf Ali; Vermund, Sten H.

doi:10.1136/bmjopen-2011-000154

Cited by 27 publications

(16 citation statements)

References 12 publications

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“…In Pakistan the male-to-female ratio in the reported HIV cases is 10 : 1 6. This gender difference was also evident in HIV positive TB patients in our study.…”

Section: Discussionsupporting

confidence: 69%

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Hasnain

Memon

Memon³

et al. 2012

BMJ Open

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ObjectiveTo describe feasibility and results of systematic screening of tuberculosis (TB) patients for HIV.DesignCross-sectional study.SettingSix selected sentinel sites (public DOTS clinics) in the province of Sindh, Pakistan.ParticipantsAll TB patients aged 16–60 years registered for treatment from April 2008 to March 2012.MeasurementDemographic information of registered TB patients, screening for HIV through rapid testing and confirmation by referral lab of Sindh AIDS Control Program, according to national guidelines.ResultsOf a total of 18 461 registered TB patients, 12 882 fulfilled the inclusion criteria and were given education and counselling. Of those counselled 12 552 (97.4%) were screened for HIV using a rapid test. Men made up 48% of the sample and 76.5% of patients had pulmonary TB. Of the total patients tested, 42 (0.34%) were HIV-positive after confirmatory testing at the Sindh AIDS Control Program Laboratory. Prevalence of HIV among male patients was 0.67% whereas prevalence among female patients was 0.03% (p value <0.001). Prevalence of HIV among pulmonary TB patients was 0.29% and among extrapulmonary TB patients was 0.48% (p value=0.09).ConclusionIn public DOTS clinics in Pakistan it is feasible to test TB patients for HIV. Prevalence of HIV is three times higher among TB patients as compared with the general population in Pakistan. Although the results are not representative of Pakistan or Sindh province they cover a large catchment area and closely match WHO estimate for the country. Routinely screening all TB patients for HIV infection, especially targeting men and ensuring antiretroviral therapy, can significantly improve TB/HIV collaborative activities in Pakistan and identify many cases of HIV, improve health outcomes and save lives.

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“…In Pakistan the male-to-female ratio in the reported HIV cases is 10 : 1 6. This gender difference was also evident in HIV positive TB patients in our study.…”

Section: Discussionsupporting

confidence: 69%

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Hasnain

Memon

Memon³

et al. 2012

BMJ Open

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“…Although Pakistan currently has a low HIV prevalence (<0.1%) in generation population [2], a widespread of HIV epidemic is predicted, primarily due to high-risk practices among three populations; people who inject drug (PWID), Hijra (Transgender) sex workers (HSW), and men who have sex with men (MSM) [4, 5]. Importantly, only 50% of PWIDs are tested for HIV-1 infection [6], while more than half of HSWs (57.6%) never used condoms [7, 8]. These high-risk factors have accelerated HIV-1 epidemic in Pakistan.…”

Section: Introductionmentioning

confidence: 99%

Fast Dissemination of New HIV-1 CRF02/A1 Recombinants in Pakistan

et al. 2016

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A number of HIV-1 subtypes are identified in Pakistan by characterization of partial viral gene sequences. Little is known whether new recombinants are generated and how they disseminate since whole genome sequences for these viruses have not been characterized. Near full-length genome (NFLG) sequences were obtained by amplifying two overlapping half genomes or next generation sequencing from 34 HIV-1-infected individuals in Pakistan. Phylogenetic tree analysis showed that the newly characterized sequences were 16 subtype As, one subtype C, and 17 A/G recombinants. Further analysis showed that all 16 subtype A1 sequences (47%), together with the vast majority of sequences from Pakistan from other studies, formed a tight subcluster (A1a) within the subtype A1 clade, suggesting that they were derived from a single introduction. More in-depth analysis of 17 A/G NFLG sequences showed that five shared similar recombination breakpoints as in CRF02 (15%) but were phylogenetically distinct from the prototype CRF02 by forming a tight subcluster (CRF02a) while 12 (38%) were new recombinants between CRF02a and A1a or a divergent A1b viruses. Unique recombination patterns among the majority of the newly characterized recombinants indicated ongoing recombination. Interestingly, recombination breakpoints in these CRF02/A1 recombinants were similar to those in prototype CRF02 viruses, indicating that recombination at these sites more likely generate variable recombinant viruses. The dominance and fast dissemination of new CRF02a/A1 recombinants over prototype CRF02 suggest that these recombinant have more adapted and may become major epidemic strains in Pakistan.

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“…17 Thus, the potential for a substantial increase in transmission within networks of SWs and their clients exists 7,16,18,19 consistent with the pattern of HIV epidemics in other countries in Asia, whereby HIV transmission begins among PWID and subsequently spreads to SWs and their clients. 20–24 …”

Section: Introductionmentioning

confidence: 81%

Heterogeneity Among Sex Workers in Overlapping HIV Risk Interactions With People Who Inject Drugs

et al. 2016

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Concerns remain regarding the heterogeneity in overlapping human immunodeficiency virus (HIV) risk behaviors among sex workers (SWs) in Pakistan; specifically, the degree to which SWs interact with people who inject drugs (PWID) through sex and/or needle sharing.Following an in-depth mapping performed in 2011 to determine the size and distribution of key populations at highest risk of HIV acquisition in Pakistan, a cross-sectional biological and behavioral survey was conducted among PWID, female (FSWs), male (MSWs), and hijra/transgender (HSWs) sex workers, and data from 8 major cities were used for analyses. Logistic regression was used to identify factors, including city of residence and mode of SW-client solicitation, contributing to the overlapping risks of drug injection and sexual interaction with PWID.The study comprised 8483 SWs (34.5% FSWs, 32.4% HSWs, and 33.1% MSWs). Among SWs who had sex with PWID, HSWs were 2.61 (95% confidence interval [CI], 1.19–5.74) and 1.99 (95% CI, 0.94–4.22) times more likely to inject drugs than MSWs and FSWs, respectively. There was up to a 3-fold difference in drug injecting probability, dependent on where and/or how the SW solicited clients. Compared with SWs in Larkana, the highest likelihood of drug injection use was among SWs in Multan (OR = 4.52; 95% CI: 3.27–6.26), followed by those in Lahore, Quetta, and Faisalabad.Heterogeneity exists in the overlapping patterns of HIV risk behaviors of SWs. The risk of drug injection among SWs also varies by city. Some means of sexual client solicitation may be along the pathway to overlapping HIV risk vulnerability due to increased likelihood of drug injection among SWs. There is a need to closely to monitor the mixing patterns between SWs and PWID and underlying structural factors, such as means of sexual client solicitation, that mediate HIV risk, and implement prevention programs customized to local subepidemics.

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Condom use during commercial sex among clients of Hijra sex workers in Karachi, Pakistan (cross-sectional study)

Cited by 27 publications

References 12 publications

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Screening for HIV among tuberculosis patients: a cross-sectional study in Sindh, Pakistan

Fast Dissemination of New HIV-1 CRF02/A1 Recombinants in Pakistan

Heterogeneity Among Sex Workers in Overlapping HIV Risk Interactions With People Who Inject Drugs

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