OJPHI: Vol. 5
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Journal ID (publisher-id): OJPHI
ISSN: 1947-2579
Publisher: University of Illinois at Chicago Library
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open-access: This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
Electronic publication date: Day: 4 Month: 4 Year: 2013
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Volume: 5E-location ID: e141
Publisher Id: ojphi-05-141

FSWs Typology and Condoms Use Among HIV High Risk Groups in Sindh, Pakistan: A Developing Country Perspective
Suleman M. Otho*1
Shazia Perveen2
Qamar Abbas1
1Aga Khan University Hospital, Karachi, Pakistan;
2Global Funds for AIDS, TB and Malaria, Round 9, Sindh AIDS Control Program, Karachi, Pakistan
*Suleman M. Otho, E-mail: drotho@hotmail.com


We aimed to determine the association of FSWs typology with condom use among HIV high risk groups in Sindh, Pakistan


HIV is growing rapidly worldwide resulting in estimated 34 million population [1]. Recently, its epidemic has spread in Africa, Latin America, and the Caribbean, and most parts of Asia [2]. According to Antenatal sero surveillance study conducted in 2011 by Agriteam canada, it’s prevalence in Pakistan is <0.1 [3].Focusing narrowly, its prevalence in Sindh, (one of the provinces of Pakistan) is similar in general population, but it is in the phase of concentrated epidemic (having more than 5% of prevalence in high risk groups)in vulnerable groups like IDUs and Male sex workers and transgender [4].

Sexual intercourse has been identified as major route especially in HIV high risk groups including male sex workers, female sex workers (FSWs), transgender (hijras) and IV drug users. Among them, FSWs are at high risk because of unprotected sex and illicit drug use. Their prevalence is found to be 30.7% in low and middle income countries [5]. South Asia contributed with 12.63 lakh FSW in India only [6]. On the basis of their station of work, they are categorized into facility based (kothikhana, brothel or home) and mobile (street, mobile or beggars). They use different preventive measures including condom for their protection from HIV [7]. It varies with availability and access [8] . FSWs typology have different cliental and mode of action, therefore, it important to explore the preventive methods.


Data was extracted from Second Generation Surveillance, Integrated behavioral and biological survey, Round IV for HIV infection conducted by Agriteam Canada in partnership with National AIDS Control Program, Pakistan in 2011. It was a cross sectional survey for high risk groups including FSWs from Pakistan. It was ethically approved by Review Board of the Public Health Agency of Canada and HOPE International’s Ethical Review Board, Pakistan. From Sindh province, FSWs based in Karachi, Sukkur and Larkana were recruited. Considering typology, they were categorized as mobile or facility based. After informed consent, socio-demographic and risk behavior were inquired. HIV was tested by ELISA/EIA and confirmed by Western Blot. Data was analyzed on SPSS 19. Continuous variables were expressed as mean±SD while categorical as frequency(%). Logistic regression assessed the association of FSWs typology with condoms use among HIV high risk groups.


Out of 4567 high risk population, 1127 were identified as FSWs. Mean age was 26.9 years. Most of them were facility based (72.8%) and 81.3% used condoms. Typology, age, education, duration of involvement, number of client per day, number of paid oral sex per month, knowledge about STI and knowledge about drop in center were significantly associated with condom use among HIV high risk groups.


Majority of facility based FSWs use condoms to prevent HIV infection. Awareness and access to home based FSWs should be increased. It may help in targeting and designing preventive strategies for them at government and mass level.

World Health OrganizationGlobal summary of HIV/AIDS epidemic December 2010 Accessed on June 19, 2012. URL: http://www.who.int/hiv/data/en/
2.. UNAIDS2010UNAIDS report on the global HIV epidemic: 2010 Accessed on June 19, 2012. URL: http://www.unaids.org/globalre-port/global_report.htm
3.. USAID/ Pakistan: HIV/ AIDS Health Profile Accessed on June 19, 2012. URL: http://www.usaid.gov/our_work/global_health/aids/Countries/asia/pakistan_profile.pdf
4.. Enhanced HIV/AIDS Control Program Sindh Data. Accessed on June 19, 2012. URL: http://www.sacp.org.pk/data.php
5.. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysisLancet Infect Dis. 2012 [doi: 10.1016/S473-3099(12)70066-X]
6.. Annual Report 2010–11. National AIDS Control Organization: Department of AIDS Control. Accessed on June 19, 2012. URL: http://www.nacoonline.org/upload/REPORTS/NACO%20An-nual%20Report%202010-11.pdf
7.. Joseph TFL, Amy SYT, Tsui HS. The relationship between condom use, sexually transmitted diseases, and location of commercial sex transaction among male Hong Kong clientsAIDS: Epidemiology & Social 2003;17(1):105–12.
8.. Morris CN, Morris SR, Ferguson AG. Sexual behavior of female sex workers and access to condoms in Kenya and Uganda on the Trans-Africa highwayAIDS Behav 2009 Oct;13(5):860–5.

Article Categories:
  • ISDS 2012 Conference Abstracts

Keywords: FSW, typology, condoms, HIV high risk groups, Pakistan.

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