Inconsistent Condom Use among Street-Based Transgender Sex Workers in Lahore, Pakistan: Socio-Ecological Analysis based on a Qualitative Study

Abstract

Background: A large amount of new HIV infections worldwide is observed amongst key populations which include e.g. commercial sex workers or transgender people and their respective sexual partners. Therefore, this study examined the multi-level context of inconsistent condom use (ICU) in sexual interactions of transgender street-based workers (KSWs) with commercial and non-commercial sexual partners in Lahore. Methods: We conducted 20 in-depth interviews with street-based KSWs to investigate challenges to consistent condom utilization with sexual partners. The qualitative data was analyzed using thematic analysis to produce an initial set of codes during the first-level round. An essence-capturing strategy was utilized to identify broader themes through a heuristic exploration of the text. Results: Within a socio-ecological analysis we identified factors influencing ICU among KSWs at three levels. At the individual level, we identified knowledge and awareness, perceived characteristics of sexual partners, age and physical attributes, pleasure and pain, and mental health issues impacting on ICU. Gentrification of historical red-light district, discrimination, harassment and regular evictions, dynamics of cruising spots and places of sexual interactions, competition in sex trade, violence and lack of safety nets in street-based sex work, condom use with lovers, networks with non-governmental organizations were factors associated with ICU. Risk factors at community level were poverty, the influence of gurus, and Dera culture.Conclusions: Until now, HIV prevention efforts in Pakistan have primarily focused on HIV risk factors at the level of individual behaviors within specific networks of target populations. However, our study points towards both the effectiveness and the urgency of interventions that address macro-level risk factors specific to key populations in Pakistan, in addition to behavioral interventions.

Addressing Workplace Violence Against Transgender Individuals Ensuring Inclusive And Safe Environments

“…A study published in the NCBI found that transgender people in Pakistan face social marginalisation in addition to physical and verbal assault, which drives many of them into commercial sex work. Economic marginalisation, restricted access to education and healthcare, and social stigma all contribute to transgender people's experiences of social exclusion (Bano et al ., 2023). Because of this discrimination, they are less likely to find gainful employment and are more likely to be victims of workplace abuse and exploitation.…”