Risky sexual behavior, knowledge of sexually transmitted infections and treatment utilization among a vulnerable population in Rawalpindi, Pakistan.

As a part of a second generation surveillance, we investigated the sociodemographics, risky sexual behavior, knowledge of HIV and sexually transmitted infections (STIs) and treatment seeking behavior among a vulnerable population. A cross-sectional study preceded by mapping, was conducted in Rawalpindi, Pakistan during 2005. Subjects were recruited through snowball, time location cluster and cluster sampling techniques. Behavioral interviews were conducted with 203 female sex workers (FSWs), 101 male sex workers (MSWs), 101 Hijras (transgender men) and 200 injecting drug users (IDUs), who were deemed a vulnerable population for STIs. Among this population 136 (67%) FSWs were illiterate, 145 (71.4%) were married and entertained on average 23 clients per month. Consistent condom use during one month was reported by 34 (17%) FSWs. One hundred thirty-three (66%) FSWs had a knowledge of STIs, 69 (34%) suffered from STIs. MSWs and Hijras had the youngest average ages at 24.4 (+/- 6.8), 25.8 (+/- 5.9) and started sexual activity even at age 14.7, and 13.9 years, respectively. Consistent condom usage was as low as 3 (3.1%) and 4 (4%) among MSWs and Hijras. IDUs had lowest monthly income of US$ 69 (+/- 41) and had a predominant migratory pattern. Fifty (25.2%) IDUs shared a needle with the last injection. Though knowledge of STIs was lowest among IDUs, 61 (30.7%), however, all utilized the public health facility for their treatment. Difference between knowledge of STIs and educational levels among IDUs and Hijras were found to be statistically significant (p=0.015 and p=0.04, respectively). The present study indicates the knowledge of HIV/STIs is high among the vulnerable population but condom usage is very low.