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

Abstract

The objective of this study was to measure HIV prevalence and risk behaviour in injecting drug users (IDUs), male sex workers (MSWs), Hijras (transgenders), female sex workers (FSWs) and male truckers in Karachi and Lahore, Pakistan. The design was a linked-anonymous cross-sectional study of individuals identified at key venues or through peer referral. Approximately 400 respondents in each group (200 for Hijras) responded to a standardized questionnaire and were tested for HIV antibodies at each site. In Karachi, 23% of IDUs and 4% of MSWs were HIV positive, and HIV-positive individuals were identified in all risk groups in at least one city. Two-thirds of all IDUs used a shared needle in the previous week, and unprotected commercial sex activity with men and women was high. The HIV epidemic has entered IDU and male and female commercial sex networks in Karachi and Lahore. Targeted intervention services must be scaled up and risk group surveillance intensified.

An old enzyme for current needs: adenosine deaminase and a dendritic cell vaccine for HIV

“…As in other regions, in Asia there is often considerable overlap between the populations of sex workers and injecting drug users (Bokhari et al, 2007). In a study of injecting drug users in Sichuan province in China, more than 40% of females and 34% of males were engaged in sex work (Gu et al, 2009).…”

“…In Indonesia, HIV prevalence is nearly three times higher among male sex workers (20.3%) than among female sex workers (7.1%) (National AIDS Commission, 2008). In the Pakistani cities of Karachi and Lahore, 4% of male sex workers are infected with HIV (Bokhari et al, 2007). Sex work is common among male transgender people (hijras) in South Asia (Khan et al, 2008).…”

“…In Thailand, 30-50% of injecting drug users are believed to be living with HIV (National AIDS Prevention and Alleviation Committee, 2008). More than one in three injecting drug users in Myanmar (37.5%) are HIV-infected, and nearly one in four (23%) injecting drug users in urban settings in Pakistan are HIV-positive (Bokhari et al, 2007). More than half of injecting drug users (52%) in Indonesia are living with HIV, with a slightly higher prevalence among female injectors (National AIDS Commission, 2008).…”

“…Among injecting drug users surveyed in Pakistan, two thirds reported sharing needles during the previous week (Bokhari et al, 2007). Surveys in China indicate that 40% of injecting drug users share needles (Wang et al, 2009).…”

Distinct Circulating Recombinant HIV-1 Strains Among Injecting Drug Users and Sex Workers in Afghanistan

“…[3][4][5] Behavioral assessments of these high-risk populations in multiple settings have identified a strong potential for bridging of the HIV epidemic from IDUs to other groups, chiefly sex workers (SWs). 1,[6][7][8] HIV genotype information may be useful to describe transmission linkages between risk groups. In analyzing HIV-1 strains from IDUs in Iran, Tagliamonte et al 5 identified greater homology within the isolated subtypes from Tehran than those from Mashad, providing some objective insight into the duration of the respective epidemics in the two cities and interactions between their IDU networks.…”