HIV antibody seroprevalence and associated risk factors in sex workers, drug users, and prisoners in Sindh, Pakistan
OBJECTIVE: To determine prevalence of HIV infection and risk behaviors in commercial sex workers (CSWs), drug users, and prisoners in Sindh, Pakistan. METHODS: A medical clinic was established in a "red-light" district of Karachi. Eighty-one CSWs who registered at the clinic between November 1993 and June 1994 were provided HIV counseling and testing and administered a risk factor questionnaire. Next, 316 male drug users were tested for HIV-1 antibody from April to July 1994. Finally, a voluntary serosurvey of HIV-1 and HIV-2 and risk behaviors of 3525 prisoners in Sindh was conducted between July 1994 and December 1994. Abbott Recombinant HIV third-generation enzyme-linked immunosorbent assay (ELISA) and confirmatory testing with Western blot analysis were used in all three groups.
RESULTS: None of 81 CSWs tested for HIV-1 antibody were positive. None of 316 drug users tested positive for HIV-1 antibody. Of 3441 male prisoners, 1 was HIV-1 infected, and of 84 female prisoners, 1 was HIV-1 infected. No prisoner was positive for HIV-2 antibody.
DISCUSSION: The prevalence of HIV in CSWs, drug users, and prisoners in Sindh is low at present. Intervention programs implemented at this stage can make an impact in HIV prevention.
PIP: A three-stage study conducted in Pakistan's Sindh province in 1993-94 investigated HIV seroprevalence in commercial sex workers, drug users, and prisoners. First, the 81 sex workers who registered at a medical clinic established in a "red light" district in Karachi in a 7-month period were provided HIV counseling and testing and administered a risk factor questionnaire. Second, 316 male drug users who presented to a charitable drug rehabilitation center over a 3-month period (n = 202) or were arrested in a drug raid and sent to the center (n = 114) were tested. The third stage entailed voluntary HIV-1 and -2 testing and a risk factor questionnaire for 3525 prisoners. Recombinant HIV third-generation enzyme-linked immunosorbent assay with confirmatory testing by Western blot were used in all three groups. There were no cases of HIV-1 infection among either sex workers or drug users. HIV-1 antibody was present in 1 of the 3441 male prisoners and 1 of the 84 female prisoners. The infected male prisoner reported multiple encounters with sex workers in Bombay in 1990; the only identifiable risk factor in the HIV-positive female prisoner was several injections at the prison dispensary with reused syringes. No prisoner was positive for HIV-2 antibody. 65% of the sex workers used no contraception and condom use was negligible. 52% of injecting drug users shared needles. 22% of the male prisoners reported sexual relations with men prior to incarceration. Of concern was the finding that 26% of drug users and 23% of prisoners were paid blood donors. The low prevalence of HIV in high-risk groups in Pakistan, despite an alarming incidence of high-risk behaviors, provides a window of opportunity for implementation of AIDS prevention programs.
Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
(1998). HIV antibody seroprevalence and associated risk factors in sex workers, drug users, and prisoners in Sindh, Pakistan. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18(1), 73-79.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_haematol_oncol/17