International Journal of STD & AIDS > Volume 19, Number 12 > Pp. 817-820

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Original research articles

Correlates and prevalence of HIV and sexually transmitted infections among Hijras (male transgenders) in Pakistan

A A Khan MBBS MS ^* , N Rehan MBBS MSc , K Qayyum M Phil  and A Khan MBBS MPH 

^* Research and Development Solutions, Islamabad; Research Associates, Lahore; The Family Health International; National AIDS Control Programme, Ministry of Health, Pakistan

Correspondence to: Dr Adnan A Khan, Research and Development Solutions, 746-A Ibn-e-Sina Road, G-11/2, Islamabad 44000, Pakistan Email: adnan{at}khans.org

This study explored the role of Hijras (male transgenders) as a core group in Pakistan's HIV epidemic. Four hundred and nine Hijras underwent detailed behavioural and biological assessment. Our subjects were young (median age: 24 years), debuted sex early and used alcohol and drugs. Sex with men, women and other Hijras along with co-habitation/marriage were reported. Most (84%) had sold sex. These reported a median of four times and at least one regular client weekly. Few used condoms. Most (94%) could identify a condom, but 42% reported never needing one. Over two-thirds had correct HIV and protective knowledge. Many reported experiencing physical abuse or forced sex (40%) and sexual orientation-related discrimination (45%). Most (58%) had sexually transmitted infections (STIs) and 38% had multiple infections. The commonest infections were syphilis (50%) and gonorrhoea (18%). Care-seeking was mainly (87%) from the private sector. High STI prevalence, commercial sex, bisexuality and infrequent protective behaviours are described. Their communal living and wider sexual networks suggest a more central role for Hijras in Pakistan's HIV epidemic. Effective HIV/STI control programmes must take the above factors into account to enrich their programme content.

Key Words: Hijra • transgender • Pakistan • HIV • sexually transmitted • STI

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