High-risk sexual behaviours among drug users in Pakistan: implications for prevention of STDs and HIV/AIDS

Abstract

Our objective was to describe HIV/STD risk behaviours and awareness among a community-based sample of drug users in Pakistan. Drug users contacted through street outreach by a non-governmental organization in Quetta, Peshawar and Rawalpindi underwent interviewer-administered questionnaires. Descriptive statistics were used to characterize sexual behaviours by city, marital status and the use of injection drugs. Logistic regression was used to identify correlates of ever having an STD. Of 608 drug users studied, all but one was male; median age was 32 years and 45% had no formal education. Half were married, of whom 25% were living with their wives. Sexual behaviours were reported as follows: 14% had sex with other males, 28% reported sex with both males and females, 49% had paid money to have sex and only 10% had ever used condoms. One-fifth reported having had an STD and about 40% reported having suffered from either one or more STD-related symptoms. Only 41% had heard about HIV/AIDS, of whom 17% knew that HIV/AIDS could be transmitted through sexual contact. In conclusion, high-risk sexual behaviours are prevalent among male drug users in Pakistan, and awareness of transmission risks is low. These data attest to the urgent need for effective and specific interventions in Pakistan to prevent transmission of HIV and STDs among drug users and their sex partners.

Sexually transmitted infections in Pakistan

“…Lack of knowledge and misconceptions in beliefs and attitudes were prominent in our cohort, as reported earlier 47–49. Although relatively fewer numbers of sexual partners per subject were reported in this study, consistent condom use was low.…”

HIV risk in Karachi and Lahore, Pakistan: an emerging epidemic in injecting and commercial sex networks

“…1 However, previous studies have warned that high levels of injecting and sexual risk networking behaviour give notice of HIV epidemic potential in Pakistan. 2 This would follow the pattern noted in other countries in Asia, where the HIV epidemic is concentrated among high-risk groups, most severely affecting those involved in injecting drugs and individuals buying and selling commercial sex. 3 Clearly, the sexual partners of such individuals are also at risk of acquiring HIV infection.…”

Male-to-male sex among men who inject drugs in Delhi, India: Overlapping HIV risk behaviours

“…Surveys in Iran (11.3%) (Zamani et al, 2010), Brazil (26.4%) (Ferreira et al, 2006), Bangladesh (10%) (Chan & Khan, 2007) and Afghanistan (25.7%) (Todd et al, 2010) have similarly found a high proportion of male PWID who have a history of sex with men. Haque et al (2004) surveyed male PWID across multiple sites in Pakistan and found that 13% exclusively had sex with males and 30% had sex with both males and females in their lifetime. Reports of sexual behaviour among PWID from elsewhere in India reveal regional variation in MSM behaviour.…”

“…Research elsewhere has identified sizeable sub-populations for whom injecting drug use overlaps with male-to-male sex (Chan & Khan, 2007;Ferreira, Caiaffa, Bastos, Mingoti, & Projeto, 2006;Haque et al, 2004;Johnston et al, 2010;Kral et al, 2005;Parviz et al, 2006;Strathdee & Sherman, 2003;Todd et al, 2010;Zamani et al, 2010). Men who both inject drugs and have sex with men are particularly vulnerable to HIV infection and have the potential to transmit the virus across multiple populations.…”