Condom use during commercial sex among clients of Hijra sex workers in Karachi, Pakistan (cross-sectional study).
Objective To describe the prevalence and predictors of condom use and sexual risk in the male clients of Hijra sex workers (HSWs) in Karachi, Pakistan.  Design Cross-sectional study.  Setting Karachi, Pakistan.  Participants Clients of HSWs were recruited with assistance from HSWs and a non-governmental organisation (NGO) focused on men who have sex with men (MSM) during October-November 2010.  Measurements The interviewer administered the questionnaire to each participant to solicit information on demographics, HIV/AIDS knowledge/attitudes and sexual risk behaviours/practices, including condom use in the last sexual act with the HSW.  Results Of the 203 participants, 42.4% reported that they used condoms during their last sexual act with HSW, 40% were married, 18% had ever used drugs or alcohol, and 52% reported also engaging with female sex workers in the last month. Casual HSW clients were more likely to use condoms than regular clients (adjusted OR (AOR), 2.50; 95% CI 1.34 to 4.65), as were persons with a higher education level (AOR 5.8; 95% CI 1.6 to 20.3). Drug/alcohol users and non-users were equally likely to use condoms (AOR 1.11; 95% CI 0.51 to 2.24).  Conclusion Clients of HSWs in Pakistan are at risk of acquiring HIV/STI infections. Concerted efforts are needed to increase condom use in this key bridge population to curtail the spread of HIV in the general population.
Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA.
Anees Ur Rehman
AU
Siddiqui
Han-Zhu
HZ
Qian
Arshad
A
Altaf
Holly
H
Cassell
Sharaf Ali
SA
Shah
Sten H
SH
Vermund