title: Correlates and prevalence of HIV and sexually transmitted infections among Hijras (male transgenders) in Pakistan.
abstract: This study explored the role of Hijras (male transgenders) as a core group in Pakistan's HIV epidemic. Four hundred and nine Hijras underwent detailed behavioural and biological assessment. Our subjects were young (median age: 24 years), debuted sex early and used alcohol and drugs. Sex with men, women and other Hijras along with co-habitation/marriage were reported. Most (84%) had sold sex. These reported a median of four times and at least one regular client weekly. Few used condoms. Most (94%) could identify a condom, but 42% reported never needing one. Over two-thirds had correct HIV and protective knowledge. Many reported experiencing physical abuse or forced sex (40%) and sexual orientation-related discrimination (45%). Most (58%) had sexually transmitted infections (STIs) and 38% had multiple infections. The commonest infections were syphilis (50%) and gonorrhoea (18%). Care-seeking was mainly (87%) from the private sector. High STI prevalence, commercial sex, bisexuality and infrequent protective behaviours are described. Their communal living and wider sexual networks suggest a more central role for Hijras in Pakistan's HIV epidemic. Effective HIV/STI control programmes must take the above factors into account to enrich their programme content.
authors.affiliation: Research and Development Solutions, Islamabad, Pakistan. adnan@khans.org
authors.forename: A A
authors.initials: AA
authors.lastname: Khan
authors.forename: N
authors.initials: N
authors.lastname: Rehan
authors.forename: K
authors.initials: K
authors.lastname: Qayyum
authors.forename: A
authors.initials: A
authors.lastname: Khan
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000517:prevention & control; D014189:Transsexualism; D055815:Young Adult