Shah Sharaf A, Zubair Maria, Soomro Altaf, Sheikh Rasheed, Zhamalbekova Alnara, Abidi Syed Hani
Bridge Consultants Foundation, Karachi, Pakistan.
Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan.
PLoS One. 2025 Jan 24;20(1):e0312683. doi: 10.1371/journal.pone.0312683. eCollection 2025.
Co-infections of syphilis and HIV have been found to exacerbate the impact on sexual and reproductive health, especially among key population groups such as Female Sex Workers (FSWs) and Transgender Individuals (TGs). The data on the prevalence and determinants of syphilis and HIV in Pakistan, particularly in Sindh province, is limited. This prospective cross-sectional study aimed to determine the seroprevalence and risk factors for HIV and syphilis infections among FSWs and TGs in different cities of Sindh, Pakistan.
A total of 1120 participants (531 FSWs and 589 TGs) were recruited from Karachi, Sukkur, Hyderabad, and Larkana. Community-based serological testing for HIV and syphilis was performed using Abbot Bioline HIV/syphilis Duo test kits, and sociodemographic and risk factor data were collected through questionnaires. Chi-square and logic regression were applied to determine variables associated significantly with syphilis in TGs and FSWs.
TGs exhibited higher rates of syphilis (16.29%) and syphilis-HIV (6.79%) as compared to FSWs (syphilis: 15.63%; syphilis-HIV: 0.75%). Inconsistent condom use was more common among FSWs (75.32%), and over half reported STI symptoms. Regression analysis showed that for TGs, having five years (adjusted OR: 0.52, p = 0.04) and graduate-level education (adjusted OR: 0.40, p = 0.04) was associated with a lower risk of syphilis, while an income between 30,000 and 50,000 Pakistani rupees (OR: 1.93, p = 0.028) and more than three years in profession (adjusted OR: 2.20, p = 0.04) was associated with a higher risk. For FSWs, five (OR: 0.34, p = 0.03) and ten (OR: 0.02, p = 0.02) years of education were associated with a lower risk of syphilis, whereas an income between 30,000 and 50,000 PKR (OR: 3.05, p < 0.01) and self-reported HIV-negative status (OR: 3.08, p = 0.01) were associated with a higher risk of syphilis mono-infection.
In conclusion, the results of the study show higher rates of syphilis and HIV co-infection among TG compared to FSW from Sind. The study findings provide valuable insights for national health agencies and policymakers to devise data-driven strategies for preventing and controlling syphilis and HIV infections among FSW and TG populations in Sind.
梅毒和艾滋病毒合并感染已被发现会加剧对性健康和生殖健康的影响，尤其是在女性性工作者（FSW）和跨性别者（TG）等关键人群中。巴基斯坦，特别是信德省，关于梅毒和艾滋病毒流行率及决定因素的数据有限。这项前瞻性横断面研究旨在确定巴基斯坦信德省不同城市的女性性工作者和跨性别者中艾滋病毒和梅毒感染的血清学流行率及风险因素。
从卡拉奇、苏库尔、海得拉巴德和拉尔卡纳招募了总共1120名参与者（531名女性性工作者和589名跨性别者）。使用雅培生物线艾滋病毒/梅毒双联检测试剂盒对艾滋病毒和梅毒进行基于社区的血清学检测，并通过问卷调查收集社会人口统计学和风险因素数据。应用卡方检验和逻辑回归来确定与跨性别者和女性性工作者中梅毒显著相关的变量。
与女性性工作者相比（梅毒：15.63%；梅毒 - 艾滋病毒：0.75%），跨性别者的梅毒（16.29%）和梅毒 - 艾滋病毒合并感染率（6.79%）更高。不一致地使用避孕套在女性性工作者中更为常见（75.32%），超过一半的人报告有性传播感染症状。回归分析表明，对于跨性别者，拥有五年（调整后的比值比：0.52，p = 0.04）和研究生学历（调整后的比值比：0.40，p = 0.04）与梅毒风险较低相关，而收入在30000至50000巴基斯坦卢比之间（比值比：1.93，p = 0.028）以及从事该职业超过三年（调整后的比值比：2.20，p = 0.04）与较高风险相关。对于女性性工作者，接受五年（比值比：0.34，p = 0.03）和十年（比值比：0.02，p = 0.02）教育与梅毒风险较低相关，而收入在30000至50000巴基斯坦卢比之间（比值比：
