Heterogeneity among Sex Workers in Overlapping HIV Risk Interactions with People Who Inject Drugs: A Cross-Sectional Study from 8 Major Cities in Pakistan

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.

Below:  Unadjusted odds of injecting drugs in the past 6 months, by type of sex worker and sexual activity with people who inject drugs

Full article at:   http://goo.gl/PxD5ch

By:  Melesse DY1, Shafer LA, Shaw SY, Thompson LH, Achakzai BK, Furqan S, Reza T, Emmanuel F, Blanchard JF.

• 1From the Centre for Global Public Health, Department of Community Health Sciences (DYM, SYS, LHT, FE, JFB); Department of Internal Medicine (LAS), Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; and National AIDS Control Program (BKA, SF, TR), National Institute of Health, Islamabad, Pakistan. 
• Medicine (Baltimore). 2016 Mar;95(12):e3085. doi: 10.1097/MD.0000000000003085.

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Injection Drug User, Female Sex Workers & Combined Male Sex Workers/Hijra (Transgender) Sex Workers per 1000 Adult Men in Six Cities in Pakistan

Background

Considerable HIV transmission occurs among injection drug users (IDUs) in Pakistan and recently the HIV prevalence has been increasing among male (MSW), hijra (transgender; HSW) and female (FSW) sex workers. We describe past and estimate future patterns of HIV emergence among these populations in several cities in Pakistan.

Methods

The density of these key populations per 1000 adult men was calculated using 2011 mapping data from Karachi, Lahore, Faisalabad, Larkana, Peshawar and Quetta, and surveillance data were used to assess bridging between these key populations. We used the UNAIDS Estimation and Projection Package model to estimate and project HIV epidemics among these key populations in Karachi, Lahore, Faisalabad and Larkana.

Results

The density and bridging of key populations varied across cities. Lahore had the largest FSW population (11.5/1000 adult men) and the smallest IDU population (1.7/1000 adult men). Quetta had the most sexual and drug injection bridging between sex workers and IDUs (6.7%, 7.0% and 3.8% of FSW, MSW and HSW, respectively, reported injecting drugs). Model evidence suggests that by 2015 HIV prevalence is likely to reach 17–22% among MSWs/HSWs in Karachi, 44–49% among IDUs in Lahore and 46–66% among IDUs in Karachi. Projection suggests the prevalence may reach as high as 65–75% among IDUs in Faisalabad by 2025. HIV prevalence is also estimated to increase among FSWs, particularly in Karachi and Larkana.

Conclusions

There is a need to closely monitor regional and subpopulation epidemic patterns and implement prevention programmes customised to local epidemics.

Full article at:   http://goo.gl/gGnKI6

By:   Tahira Reza,1 Dessalegn Y Melesse,2 Leigh Anne Shafer,3 Momina Salim,1 Arshad Altaf,1 Altaf Sonia,1 Gayatri C Jayaraman,4 Faran Emmanuel,1,2 Laura H Thompson,2 and James F Blanchard2

¹Canada-Pakistan HIV/AIDS Surveillance Project, Islamabad, Pakistan

²Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Canada

³Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, Canada

⁴Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada

Correspondence to Dr James F Blanchard, Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, R070-771 McDermot Ave, Winnipeg, Canada R3E 0T6; Email: ac.abotinamu@drahcnalb_semaj

 

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