ISLAMABAD: Unprotected sex and limited access to preventive measures have triggered a troubling rise in HIV prevalence among key populations, including transgender persons (TGs), men who have sex with men (MSM), and female sex workers (FSWs).

These findings emerge from the 6th round of the Integrated Biological and Behavioural Surveillance (IBBS), which presents both progress and alarming trends in Pakistan’s HIV epidemic.

The preliminary findings of the study, conducted nearly a decade after the previous round by the Health Services Academy (HSA) in collaboration with the Progressive Development Initiative (PDI), UK, and the HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance (HIVHUB), Iran, were shared with the Ministry of National Health Services, Regulations, and Coordination on Tuesday.

The findings paint a mixed picture, highlighting the success of harm reduction services for people who inject drugs (PWID) while exposing rising HIV prevalence in sexual networks, which serve as a bridge between key populations and the general population.

The HIV prevalence among TGs has reached 10%, up from 7.2% in 2016, while MSM report a prevalence of 7%, compared to 5.6% in the last survey. Similarly, the prevalence among FSWs has climbed from 2.2% in 2016 to 3.8% today. In contrast, HIV prevalence among PWID has declined significantly from 38.4% in 2016 to 27%, attributed to harm reduction programs and a shift to non-injectable drug use, including methamphetamine or Ice.

One of the most concerning findings is the 4.7% HIV prevalence rate among prisoners, a population surveyed for the first time in IBBS. Overcrowding, lack of access to condoms, and unaddressed drug use in prison facilities contribute to the spread of HIV within this neglected population.

The IBBS Round 6 surveyed and tested 28,377 individuals, including 6,500 PWID, 7,606 MSM, 6,670 FSWs, 7,601 TGs, and 5,000 prisoners, making it one of the largest surveys to date assessing HIV prevalence in Pakistan.

The study was conducted across 31 districts, ensuring wide geographical representation, including Karachi, Lahore, Islamabad, Peshawar, Quetta, Faisalabad, Multan, Sukkur, Hyderabad, Jacobabad, Larkana, Rawalpindi, Gujranwala, and Gujrat.

The findings highlight significant barriers to condom use among TGs, MSM, and FSWs. While over 50% of TGs and MSM reported condom use, gaps in consistent use persist, particularly during high-risk encounters. Among FSWs, condom use remains at approximately 40%, hindered by limited availability of female condoms, client refusal, and stigma associated with carrying or requesting condoms.

These gaps underscore the urgent need for targeted interventions to increase condom access and promote their consistent use. Harm reduction efforts for PWID have demonstrated success, with increased availability of needle exchange programs in both public and private sectors contributing to the decline in HIV prevalence within this group. However, challenges such as unsafe injecting practices, stigma, and substance abuse continue to pose risks.

The inclusion of prisoners as a vulnerable population in the IBBS for the first time has shed light on the vulnerabilities of incarcerated individuals.

The findings emphasise the urgent need for comprehensive HIV prevention, testing, and treatment services within correctional institutions.

The comparative analysis with 2016 data reflects a mixed outcome. While the declining prevalence among PWID signifies progress, the rising rates among TGs, MSM, and FSWs reveal serious gaps in prevention strategies. These gaps are further exacerbated by stigma, discrimination, and limited outreach efforts, which hinder access to care and protective measures for these populations.

The report also highlights educational disparities among key populations. A significant proportion of TGs, MSM, and FSWs lack secondary education, limiting their awareness of HIV prevention and protective measures. Among PWID, education levels are even lower, with many being completely illiterate. The survey also assessed prisoners, revealing that while some had completed primary or secondary education, many lacked comprehensive knowledge about HIV prevention.

The IBBS study also evaluated other vulnerable populations, such as truck drivers, migrant workers, and street children, whose high mobility, low condom use, and limited outreach make them particularly vulnerable to HIV. These groups require focused interventions to address their specific risk factors.

The study also highlights a critical oversight: the lack of focus on HIV transmission through weak infection prevention and control measures in healthcare settings.

Previous outbreaks, such as the devastating Rato Dero outbreak of 2019, underline the role of unsafe medical practices in spreading the virus. Future HIV prevention strategies must incorporate robust infection control protocols to mitigate these risks.