Pakistan: Marginalised male sex workers vulnerable to HIV/AIDS

Lahore - Under the illuminated Minar-e-Pakistan, the towering monument that marks the birth of the country, Pervaiz Din lays out the accessories of his trade. The tiny bottles of massage oil and aromatic colognes tinkle cheerfully as he pulls them out of a cloth bag and sets them out on a tray. Through much of the balmy September night, Pervaiz will await customers who seek a soothing roadside massage, a head rub - or something more."Some nights I get lucky. I get two or even three 'good customers' and I return home happy," Pervaiz tells IRIN.

The 'good' customers he refers to are men who seek sex and will pay less than US $8 or so for a few hours with Pervaiz. They also pay for the room usually rented out in a cheap, 'bazaar' hotel, although some take him to the rooms or apartments in which they live.

"I have some 'regulars' who drop by several times a month. They really enjoy my services," Pervaiz said.

Pervaiz is one of the hundreds of male sex workers (MSWs) in Lahore, the teeming capital of the Punjab province, and with a population of 8 million Pakistan's second largest city after Karachi. Beneath its lush trees, and the domes and minarets of the Mughal buildings scattered across its older parts, scores of MSWs operate.

Although the precise number of men who have sex with men (MSM) in Lahore is unknown, according to the Pakistan National AIDS Programme, on the basis of findings by international agencies in 2002, they number around 38,000.

This number includes male transsexuals or 'hijras', who live in large family groups and have devised their own, unique system of leadership, inter-marriage and complex rituals, and a significant number of masseurs, like Pervaiz, who can be found in many parts of Lahore and other major cities, congregating at selected spots as dusk falls each evening.

The vast grounds surrounding the Minar-e-Pakistan and the banks of the city's canal are two of their favourite places.

While such behaviour is strictly illegal, homosexuality is fairly widespread in Pakistan. Under the country's Islamic laws, sodomy carries a penalty of whipping, imprisonment or even death - but the fact on the ground is that it is also for the large part silently accepted.

This uncomfortable compromise means there are strongly entrenched taboos about talking publicly about sex between men, and the result is that levels of awareness about the risk of HIV infection among male sex workers is extremely low.

The social marginalisation of communities such as the hijras and the fact that few male sex workers have access to healthcare or contact with awareness-raising programmes, makes them all the more vulnerable.

"There are groups working with women prostitutes and helping them, but no one offers to help us. We are social outcasts," maintained Hanif, a friend of Pervaiz and also a MSW. He refused to give his full name.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), at the end of 2005 Pakistan had a total of between only 70,000 to 80,000 HIV-infected persons, from a population of 150 million. As such the prevalence rate is low (0.1 percent).

However, the World Bank, UNAIDS and other international agencies have consistently pointed out that because of the existence of various high-risk behaviours, coupled with a lack of awareness, and the fact that 50 percent of the population remains illiterate, the possibilities of a full-blown epidemic remain very real. Among the behaviours considered to be high-risk is sex between men.

UNAIDS reports that according to a study conducted in 2005, HIV prevalence was 4 percent among MSWs and 2 percent among hijras. Other sexually transmitted diseases occurred far more frequently, again suggesting a high risk of HIV infection.

The AIDS Prevention Association of Pakistan (APAP) has been working over the past several years to raise awareness about AIDS. To do so, it has set up camps at the shrines of 'Sufi' (traditional religious preachers) saints, where hijras, eunuchs and MSWs traditionally gather, especially during festivities held to mark birth anniversaries.

"Currently, we are focusing on young people at seminary schools, where male-to-male sex is known to occur," explained Dr Hamid Bhatti at APAP. The organisation is also attempting to take AIDS awareness outside major cities and is working in smaller towns, such as Okara.

The challenge will inevitably be a long one though. Despite a heightened commitment by the government of Pakistan to combating AIDS, levels of awareness remain low - while social taboos mean that marginalised communities, such as MSWs, remain most at risk of falling victim to an infection that is feared could assume the proportions of an epidemic in the years to come.

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