Hawkes S, Collumbien M, Platt L, Lalji N, Rizvi N, Andreasen A, Chow J, Muzaffar R, ur-Rehman H, Siddiqui N, Hasan S, Bokhari A
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Sex Transm Infect. 2009 Apr;85 Suppl 2:ii8-16. doi: 10.1136/sti.2008.033910.
The extent and possibilities of spread of the HIV epidemic are not fully understood in Pakistan. A survey was conducted among men, women and transgender populations selling sex in Rawalpindi (Punjab) and Abbottabad (North West Frontier Province) in order to inform evidence-based programme planning.
A cross-sectional survey was performed with participants recruited through respondent-driven sampling. Male and transgender sex workers were analysed in three gender groups; women were analysed as one group. Behavioural surveys were conducted and clinical specimens collected. Laboratory tests looked for evidence of acute infection (gonorrhoea, Chlamydia, syphilis, Trichomonas) and infection over the lifetime (HIV, herpes simplex virus-2, syphilis). Predictors of infection were explored using univariable and multivariable logistic regression.
The prevalence of HIV was low in 917 male and transgender sex workers and absent in 533 female sex workers in the study. High levels of current sexually transmitted infections were found, predominantly among transgender sex workers. Risk behaviours were common and knowledge of HIV was extremely low. Multivariable analysis found a large number of factors associated with higher levels of infection, including experience of forced first sex. Protection against risk was low, but those sex workers who reported using condoms at last sex had lower rates of infection.
The HIV epidemic is currently in its early stages among people who sell sex, but there may be potential for a much greater spread given the levels of other sexually transmitted infections found and the concomitant low levels of both protective knowledge and risk-reducing behaviours. Action is needed now to avert an epidemic. Framing interventions by upholding the recognition and protection of human rights is vital.
在巴基斯坦，人们尚未完全了解艾滋病毒流行的范围和传播可能性。在拉瓦尔品第（旁遮普省）和阿伯塔巴德（西北边境省）对从事性交易的男性、女性和变性人群进行了一项调查，以便为基于证据的项目规划提供信息。
通过应答者驱动抽样招募参与者进行横断面调查。男性和变性性工作者分为三个性别组进行分析；女性作为一组进行分析。开展了行为调查并收集了临床标本。实验室检测寻找急性感染（淋病、衣原体、梅毒、滴虫）和终生感染（艾滋病毒、单纯疱疹病毒2型、梅毒）的证据。使用单变量和多变量逻辑回归探索感染的预测因素。
在该研究中，917名男性和变性性工作者中艾滋病毒感染率较低，533名女性性工作者未感染艾滋病毒。发现当前性传播感染水平较高，主要集中在变性性工作者中。危险行为很常见，对艾滋病毒的了解极低。多变量分析发现大量因素与较高的感染水平相关，包括被迫首次性行为的经历。预防风险的措施较少，但那些报告在最后一次性行为中使用避孕套的性工作者感染率较低。
艾滋病毒在性工作者中目前处于流行初期，但鉴于所发现的其他性传播感染水平以及保护性知识和降低风险行为的水平较低，可能存在更大范围传播的可能性。现在需要采取行动避免疫情爆发。通过坚持对人权的承认和保护来制定干预措施至关重要。
