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Original research
Prevalence and factors associated with HIV epidemic among female sex workers in Pakistan: results of the fifth round of integrated biological and behavioural surveillance
  1. Faran Emmanuel1,
  2. Baseer Khan Achakzai2,
  3. Tahira Reza1
  1. 1 Centre for Global Public Health, University of Manitoba, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
  2. 2 National AIDS Control Programme, Islamabad, Pakistan
  1. Correspondence to Dr Faran Emmanuel, Centre for Global Public Health, University of Manitoba Faculty of Health Sciences, Winnipeg, MB R3T 2N2, Canada; Faran.Emmanuel{at}umanitoba.ca

Abstract

Objectives We examined data collected as part of the fifth round of integrated biological and behavioural surveillance to determine the prevalence and factors associated with HIV infection among female sex workers (FSWs) in Pakistan.

Methods FSWs were defined as ‘all females, age 13 years and above, who receive money or goods in exchange for sexual services, regardless of the site of operation’. Data were collected between October 2016 and January 2017 in 18 cities using multistage sampling techniques to randomly select FSWs from spots facilitated by peers. Behavioural data were collected by interviewers using structured questionnaires, which was followed by obtaining finger prick blood samples tested for HIV using two rapid tests. Multivariate logistic regression analysis was done to assess independent associations of potential correlates using HIV status as dependent variable.

Results We invited 5728 FSWs to participate, of which 68 refused to participate (refusal rate=1.2%). Of the 5660 FSWs who participated, 121 were HIV seropositive (weighted HIV prevalence 2.3%; 95% CI 1.9% to 2.7%) mostly concentrated within cities in Sindh. Multivariate analysis showed being uneducated/illiterate (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.4), directly dealing with clients without a pimp (aOR 1.8; 95% CI 1.1 to 2.8), non-use of condom with clients (aOR 1.8; 95% CI 1.1 to 2.8), having sexual contact with people who inject drugs (PWID) (aOR 2.2; 95% CI 1.3 to 3.7) and non-participation in HIV programmes (aOR 1.7; 95% CI 1.0 to 3.1) as factors independently associated with HIV seropositivity.

Conclusions We found a weighted national HIV prevalence of 2.3% and identified factors independently associated with HIV in FSWs. The country needs to scale up HIV prevention programmes to improve coverage, prioritising FSWs who are illiterate, work independently and have PWID as sex partners. Emphasis should be laid on strategies to improve condom use with both regular and non-regular partners.

  • epidemiology (general)
  • HIV
  • risk factors
  • surveillance

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Footnotes

  • Handling editor Catherine H Mercer

  • Twitter @achakzaib

  • Contributors FE conceptualised the research design, conducted analysis and led the development of the manuscript by writing key sections of the manuscript. BKA contributed by writing parts of the manuscript, provided support in accessing data and provided final approval of the manuscript. TR assisted in conducting analysis, wrote the results section and helped in finalising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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