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Abstract
Modelling the HIV epidemic in Pakistan: male and transgender sex workers (MTSW) and their male clients who have sex with men (MSM)
J.R. Williams1, M. Collumbien2, P. Vickerman3, L. Platt3, S. Hawkes4
Background: Recent qualitative research showed that male and transgender sex workers (MTSW) can be classed as one of 3 broad categories: Khusra (transgenders dressing as women), Khotki (feminised males dressing as men), and Bantha (men with male gender identities and dress). Group norms and taboos govern patterns of sexual contacts within and between these MTSW groups. It is unclear to what extent these distinctive sexual contact patterns might impact on the evolution of the HIV epidemic in Pakistan within these communities. A preliminary understanding of HIV/STI transmission dynamics in a population of MTSW and their MSM clients in a major city of Pakistan is presented to explore the potential impact of interventions aimed at reducing HIV prevalence.
Methods: A deterministic compartmental transmission dynamics model was parameterised using data from Pakistan and fitted to HIV, HSV-2 and chlamydia prevalence data for each MTSW grouping simultaneously. Plausible scenarios were investigated for the evolution of HIV incidence and prevalence, in absence and presence of interventions, in each of the three intermixing MTSW populations and their clients.
Results: Model results suggested peak HIV prevalences of 6.5%/2.7%(Bantha), 10%/4.4% (Khotki), 46%/25% (Khusra) and 3.6%/1.5% (MSM clients), depending on scenario. Early introduction of specified levels of condoms or STI treatment based interventions substantially reduced HIV prevalence, the least effective of these - increasing condom use by 25% of contacts - providing a greater than two-thirds reduction in peak prevalence.
Conclusions: Although data suggests low HIV prevalence and incidence in these populations, there is potential for rapid increase, emphasising the need to monitor prevalence closely over time. However more data on these sexual contact patterns are needed, as uncertainty here may have a large impact on the projected epidemic and effectiveness of interventions. Nevertheless it is clear that early introduction of appropriate interventions is critical for reduction of peak prevalence.
AIDS 2008 - XVII International AIDS Conference
Abstract no.
CDC0027
Suggested Citation
"J.R.Williams, et al.
Modelling the HIV epidemic in Pakistan: male and transgender sex workers (MTSW) and their male clients who have sex with men (MSM).
:
AIDS 2008 - XVII International AIDS Conference:
Abstract no.
CDC0027"
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