New face of female sex work in Pakistan: need for innovative interventions

The prime objective of this paper is to contextualize the socio-economic and environmental factors contributing to and resulting from behaviours and practices of FSWs for transmission of STI/HIV infections. Information on these independent predictors is the key to design health systems related interventions for minimizing risks and vulnerabilities of FSWs. In the bio-behavioural survey, 545 FSWs were recruited for the quantitative component and 13 in-depth interviews were completed for qualitative arm. Data was collected on socio-economic characteristics, sexual interactions, marital relationship, violence and harassment and reproductive and sexual health. Most FSWs are illiterate [n=345, 64%], married]n=490, 91%],having children [n=462, 98%] living with their families [n=478, 91%] sell sex part-time during the day at kothie khana's1, small hotels in the locality. The mean age at first intercourse was reported to be 16 years, yet a significant proportion had had sexual contact before the age of 15 [39%] with someone other than their husband [37%]; the experience was perceived [unwanted] [40%] or even [forced] [5%]. The high contraception rate [64%] especially condom use [54%] reported in the quantitative arm of the study was not validated during in-depth interviews due to client preferences. Abortion is used as a frequent method [58%] of contraception, assisted by locally available midwives or dais[2]. A sizeabie proportion reported experiencing STI symptoms [n=317, 63%] for which informal healthcare providers were accessed. Most common perpetuators were husbands [66%] for physical violence and police [43%] for sexual abuse. Female sex trade in Pakistan is mainly part-time by married women who sell sex due to lack of education, skilled training and formal employment resulting from gender disparities. Standardized reproductive and sexual healthcare interventions, involving informal healthcare sector would improve reproductive health indicators, yet socio-economic and gender disparities demand long-term multi-sectoral structural strategies