Prevalence and factors associated with HIV epidemic among female sex workers in Pakistan: results of the fifth round of integrated biological and behavioural surveillance

Abstract

ObjectivesWe examined data collected as part of the fifth round of integrated biological and behavioural surveillance to determine the prevalence and factors associated with HIV infection among female sex workers (FSWs) in Pakistan.MethodsFSWs were defined as ‘all females, age 13 years and above, who receive money or goods in exchange for sexual services, regardless of the site of operation’. Data were collected between October 2016 and January 2017 in 18 cities using multistage sampling techniques to randomly select FSWs from spots facilitated by peers. Behavioural data were collected by interviewers using structured questionnaires, which was followed by obtaining finger prick blood samples tested for HIV using two rapid tests. Multivariate logistic regression analysis was done to assess independent associations of potential correlates using HIV status as dependent variable.ResultsWe invited 5728 FSWs to participate, of which 68 refused to participate (refusal rate=1.2%). Of the 5660 FSWs who participated, 121 were HIV seropositive (weighted HIV prevalence 2.3%; 95% CI 1.9% to 2.7%) mostly concentrated within cities in Sindh. Multivariate analysis showed being uneducated/illiterate (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.4), directly dealing with clients without a pimp (aOR 1.8; 95% CI 1.1 to 2.8), non-use of condom with clients (aOR 1.8; 95% CI 1.1 to 2.8), having sexual contact with people who inject drugs (PWID) (aOR 2.2; 95% CI 1.3 to 3.7) and non-participation in HIV programmes (aOR 1.7; 95% CI 1.0 to 3.1) as factors independently associated with HIV seropositivity.ConclusionsWe found a weighted national HIV prevalence of 2.3% and identified factors independently associated with HIV in FSWs. The country needs to scale up HIV prevention programmes to improve coverage, prioritising FSWs who are illiterate, work independently and have PWID as sex partners. Emphasis should be laid on strategies to improve condom use with both regular and non-regular partners.

Availability of HIV surveillance data in key populations in the countries of the World Health Organization Eastern Mediterranean Region

“…In Iran, HIV prevalence among FSWs in 13 cities was 3.8% (n=876) in 2010, 4.0% in 2010 (n=1005), and 2.1% in 2015 (n=1337) ( Mirzazadeh et al., 2020 ). In Pakistan, HIV prevalence increased from 2007–2016 from 0.02–2.3% (aggregate data), respectively, whereas in Tunisia it increased from 0.4% (aggregate data) in 2009 to 1.2% in 2017 ( Emmanuel et al., 2021) . Three rounds of IBBS of FSWs were carried out in Hargeisa in Somaliland, and HIV prevalence showed a declining pattern: 5.2% in 2018, 4.8% in 2014, and 3.6% in 2017 ( International Organization for Migration, 2017 ).…”

Differential burden of HIV among adolescent girls and young women by places associated with sex work: an observational study in Mombasa, Kenya

“…For objective 2, to select individual-level risk factors, we first examined which individual-level factors were associated with HIV status using prevalence ratios, adjusting for age. We considered the following individual-level factors (excluding subgroup and hotspot type) known to be associated with prevalent HIV infection based on prior literature and available variables: literacy, 53 marital status, 48 education level, 36,54 prior pregnancy, 55,56 duration of sexual activity, 57 age at first sex, 10,25 age of first sexual partner, 11,12 condom use at first sex, 25,58 drug use (ever), 36,37,59 alcohol consumption (past month), 60,61 prior experience of physical/sexual violence, 49,62,63 and HIV testing history. 36,64 Factors associated with HIV status with P , 0.1 were used to build a multivariable model of individual-level risk factors and HIV status, using Akaike information criterion to determine which factors were retained.…”

Understanding Women’s Knowledge, Awareness, and Perceptions of STIs/STDs in Asia: A Scoping Review

“…Migrant workers [50] Transgender [39,[54][55][56][57] FSW */inmates [42,47,52,[58][59][60][61][62][63] Homeless community [36] Women [64] Multiple sex partners Transgender [39,44,57] FSW * [42,59,65] Married community [66] Women [67,68] Social Fear of rejection, discrimination, and stigmatization FSW * [58] Migrant workers [50] Lacking awareness and knowledge Transgender [22,39] FSW * [52,60,69] Adolescents [24] Married community [24,37] Homeless community [36] Women (married/pregnant) [25,[27][28][29]67] Personal Personality behaviour: impulsivity FSW */inmates [6,51] Occupation-related risk FSW * [48,52,70,…”

“…The absence of protection during intercourse (n = 17) is the most dangerous behaviour identified in this analysis, with female sex workers and transgender women being the most susceptible. In Asia, female sex workers and transgender women may value monetary profit over their own safety and security [54,58,71]. This may cause them to engage in unprotected intercourse with higher-paying clients.…”

“…Furthermore, having several sexual partners is an employment hazard, especially for women who engage in transactional sex [52,65,69]. In addition, stigma and prejudice against female sex workers in Asia might make it difficult for them to discuss condom use with customers or partners out of fear of losing clients or being subjected to violence [58]. Ref.…”