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.