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Methods: Two hundred hijras were recruited through Respondent Driven Sampling and interviewed by a team of experienced interviewers.
Lessons Learned: The mean age of the respondents was 29.2 ± 6.3 years (Range 18 - 55). More than two third (68.5%) were illiterate; 23% were married. Among married, 89% were married to women and had 1 to 7 children. Sixty percent had taken some hard drug (Cocaine, Heroin, Morphine and Amphetamine) during the last 12 months and 3% had injected drugs. Eight percent had sex with a woman during the last year. During the last one week, 82% respondents had 1 - 21 new clients and 69.5% never used condom; 21.5% had oral sex with new clients. During the same period, 72% respondents had 1 - 12 regular clients and 71.5% of them never used condom while 7% respondents had 1 - 5 non-paying partners. During the last one month, five hijras had paid women to have vaginal sex. Nineteen hijras paid another man to have sex with them. Only 27.1% were not aware of any symptom of sexually transmitted Infections. Majority of the hijras (81.5%) were familiar with HIV/AIDS. However knowledge about its mode of transmission was faulty.
Conclusion: Due to low level of accurate knowledge regarding STI/HIV and pernicious risk behaviours, hijras may become a potent source of HIV transmission, if necessary remedial measures are not taken.
Learning Objectives: Issue: Pakistan, the second most populous Muslim nation in the world, has started to finally experience and confront the HIV/AIDS epidemic. The country had been relatively safe from any indigenous HIV cases for around two decades, with most of the infections being attributable to deported HIV positive migrants from the Gulf States. However, the virus finally seems to have found a home-base, as evidenced by the recent HIV outbreaks among the injection drug user community. Extremely high-risk behavior has also been documented among Hijras (sex workers) and long-distance truck drivers. The weak government response coupled with the extremely distressing social demographics of this South-Asian republic also helps to compound the problem. The time is ripe now to prepare in advance, to take the appropriate measures to curtail further spread of the disease. If this opportunity is not utilized right now, little if at all could be done later.