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Condom use during commercial sex among clients of Hijra sex workers in Karachi, Pakistan (cross-sectional study)
  1. Anees ur Rehman Siddiqui1,2,
  2. Han-Zhu Qian1,3,
  3. Arshad Altaf1,2,
  4. Holly Cassell1,
  5. Sharaf Ali Shah2,4,
  6. Sten H Vermund1,5
  1. 1Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA
  2. 2Bridge Consultants Foundation, Karachi, Pakistan
  3. 3Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
  4. 4Dow University of Health Sciences, Karachi, Pakistan
  5. 5Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA
  1. Correspondence to Dr Anees Siddiqui; asiddiqui09{at}


Objective To describe the prevalence and predictors of condom use and sexual risk in the male clients of Hijra sex workers (HSWs) in Karachi, Pakistan.

Design Cross-sectional study.

Setting Karachi, Pakistan.

Participants Clients of HSWs were recruited with assistance from HSWs and a non-governmental organisation (NGO) focused on men who have sex with men (MSM) during October–November 2010.

Measurements The interviewer administered the questionnaire to each participant to solicit information on demographics, HIV/AIDS knowledge/attitudes and sexual risk behaviours/practices, including condom use in the last sexual act with the HSW.

Results Of the 203 participants, 42.4% reported that they used condoms during their last sexual act with HSW, 40% were married, 18% had ever used drugs or alcohol, and 52% reported also engaging with female sex workers in the last month. Casual HSW clients were more likely to use condoms than regular clients (adjusted OR (AOR), 2.50; 95% CI 1.34 to 4.65), as were persons with a higher education level (AOR 5.8; 95% CI 1.6 to 20.3). Drug/alcohol users and non-users were equally likely to use condoms (AOR 1.11; 95% CI 0.51 to 2.24).

Conclusion Clients of HSWs in Pakistan are at risk of acquiring HIV/STI infections. Concerted efforts are needed to increase condom use in this key bridge population to curtail the spread of HIV in the general population.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Correction notice The “To cite: …” information and running footer in this article have been updated with the correct volume number (volume 1).

  • To cite: Siddiqui AuR, Qian H-Z, Altaf A, et al. Condom use during commercial sex among clients of Hijra sex workers in Karachi, Pakistan (cross-sectional study). BMJ Open 2011;1:e000154. doi:10.1136/bmjopen-2011-000154

  • Funding This study was supported, in part, by NIH grant #D43 TW001035 (Fogarty AIDS International Training and Research Program).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Institutional Review Board of Vanderbilt University, USA and Bridge Consultants Foundation, Pakistan.

  • Contributors AuRS is the principal investigator, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. H-ZQ helped in the statistical analysis and development of the manuscript. AA helped in the data-collection process in Karachi, Pakistan and in the development of manuscript. HC helped on ethical issues of the data-collection process and in designing the questioner. SAS contributed to the conceptualisation and design of this study, and the development of manuscript. SHV contributed to the conceptualisation of the study, development and critical revision of the manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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