Until recently, Pakistan was considered as a ‘low HIV prevalence, high risk country’ in relation to HIV. The country is now classified as having a concentrated epidemic, with an HIV prevalence of more than 5% among injecting drug users (IDUs) in at least eight major cities in three of the four provinces and among Hijras sex workers in at least one city [1, 2]. At the end of 2009, it was estimated that were 97,400 people living with HIV and AIDS, with 2,917 patients registered across the country, among whom 1,320 are on antiretroviral drug therapy . The national adult HIV prevalence among the general population remains under 0.1% .
In the past, the majority of reported cases were among repatriated Pakistanis who had acquired HIV abroad, but currently most HIV infections are acquired indigenously – especially among the key populations at higher risk comprising IDUs, sex workers, and prison inmates [3, 4]. Although HIV infection rates among female sex workers (FSWs) remains low at just under 1%, there is evidence of sexual networking between FSWs and IDUs [5, 6]. Thus, the rising number of HIV prevalence among IDUs increases the risk of spilling over into the network of FSWs and their clients . SEX WORK
Sex work is illegal in Islamic Republic of Pakistan, but has a long history and is a thriving industry in the country. Over the past three decades, sex work has evolved from a predominantly brothel‐based culture to a more diverse and dispersed pattern where women, men and transgenders (Hijras) sell sex. Male sex workers (MSWs) and Hijras mainly operate in public areas such as parks or streets