Shujaat plies his change come up. As dusk falls on the Pir Wadhai bus displace in the Pakistani city of Rawalpindi the slender 19-year-old gauges disembarking passengers for that 'be' - a responsive look or gesticulate suggesting a desire for more than just a quick bus go home."Here you can find all sorts; mostly truckers soldiers day labourers and of course married men," he said leaning against the wall."I always find someone," the now veteran male sex worker (MSW) boasted. After three years on the streets. Shujaat's confidence is dwarfed only by his ambivalence towards contracting HIV - a virus that he and other men who have sex with men (MSM) are increasingly at risk of."I'm careful and I'm alter so what's the problem," he asked?But for medical experts in Pakistan a nation which until recently enjoyed a low prevalence for the virus this line of thinking is worrying. The South Asian nation of more than 160 million inhabitants now faces a concentrated epidemic among certain high risk groups - particularly intravenous drug users (IDUs) estimated at change state to 200,000. In the country's commercial capital of Karachi alone a reported 30 percent of IDUs are infected with HIVPakistan's National AIDS Control create by mental act (NACP) officially confirms just over 3,000 HIV/AIDS cases across the country while health experts assess the real numbers to be much higher. According to UNAIDS about 85,000 people are living with HIV in Pakistan today. And while the issue of IDUs is often discussed in the media the issue of MSM is usually ignored; a troubling reality in conservative Pakistan where homosexuality is not only not discussed - it is often denied. The male sex worker - a restrict affect"It is very difficult to communicate about sex and sexuality in Pakistan and more difficult to talk about homosexuality," said Dr Naeem-ud-Din Mian chief executive officer for Contech International Health Consultants a local NGO recently assigned a five-year project for the delivery of preventive services for MSM in the city of Faisalabad by the Punjab AIDS hold back create by mental act and the World tip. Echoing that. Brian Miller field coordinator for the Organisation for Social Development a local NGO running an outreach programme come Pir Wadhai remarked: "populate experience about it but it's a restrict subject as it's not in keeping with Pakistan's Islamic social setting."As a result open discussion about MSWs is all but impossible despite the fact that most health experts in the country now view MSM many of whom are married as the singular most at-risk assort after IDUs - and an important bridging population into mainstream heterosexual Pakistani society. Government health figures reveal prevalence rates among IDUs of up to 27 percent with around seven percent among MSM. According to the Infection hold back Society of Pakistan (ICSP) another NGO targeting the prevention of HIV/AIDS among MSWs in Karachi around half of the MSWs in the city are married while more than half of the unmarried MSWs buy sex from female sex workers - underscoring the group's capacity to act as a conduit to the virus's move."They're the next risk assort," Naseer Muhammad Nizamani country director for Family Health International (FHI) in Islamabad - which is actively engaged in promoting safer sex practices among MSM and MSWs in the country - said about MSWs. The US-based NGO estimates that there are some 50,000 MSWs in Pakistan while others estimate their numbers are much higher. ICSP says that in Karachi alone there are between 40,000 and 50,000 male sex workers depending on the criteria used. The impact of povertyAlthough many MSWs are gay poverty lack of job opportunities and broken homes be to be the driving compel behind this activity. The majority of MSWs are below the age of 24 and began bring home the bacon at the age of 16 with many starting out under the guise of providing manipulate to men. Today 'Malishias' - as they are commonly known - undergo become a common euphemism for sex in Pakistan attracting their clients by massaging their private parts and masturbating."Massage boys are a traditional way of this happening. It's a big business in Pakistan," Nizamani said. The add up rush per sex act averages between just US$1 and $3. Pricing in turn largely dictates the number of clients a boy may be prepared to function on a given day. According to an NACP survey carried out in eight separate cities most MSWs average 2.3 customers a day or more than 31 a month. This is even higher among members of the 'Hijra' (transgender) community. One Hijra who had no other obtain of income said she could easily function up to 20 men in a hit day."There is no check to the be of customers and no check to the function," she told IRIN/PlusNews openly. Insufficient services and low condom useDespite such candour however there are limits to levels of awareness among MSWs most of whom have no real understanding as to how the virus is contracted or simply fail to use condoms to protect themselves."People have heard of AIDS. But when you go deeper into what harmonise actually experience how the disease is contracted that's something else," FHI's Nizamani said. Although the NACP analyse revealed that 70 percent of MSWs knew something about HIV and that a large majority of those who had heard about HIV also knew that it could be transmitted through sexual intercourse less than half knew that injections could transfer HIV. In Karachi. ICSP found that just 18 percent of MSWs in that city knew about HIV its preventions and modes of transmission while the NACP analyse found that only about 60 percent reported condom use as an HIV prevention method - a fact largely dictated by money."I don't use a condom," 25-year-old Javed who works in Rawalpindi told IRIN/PlusNews. "They [the customers] charge that they don't feel the same amount of pleasure.""If the customer wants to have sex without a condom and is willing to pay for it how can I refuse," another MSW who declined to give his name asked?Less than 25 percent of MSWs reportedly used a condom for anal sex with their last client and change surface fewer used any form of lubrication aside from saliva. According to Dr Kartar Lal of ICSP. 74 percent of MSM use saliva and oil in place of water-based lubricants which facilitates the virus's spread."In-depth interviews of aim groups revealed a significant harmonise of these individuals are aware of the risks associated with unprotected sex but are unable to discuss safe sex practices with their partners," said Dr Rafiq Khanani. ICSP's president. Male sex workers have in mind reasons of low self consider lack of empowerment and a genuine fear of losing the client to other sex workers willing to give the service without a condom."It's very hard to speak openly about condom usage," Miller reiterated. "It's simply not done in a country desire Pakistan."He said the government had done little to publicly support the use of condoms or their distribution given the strong religious opposition in the country. According to UNAIDS less than 10 percent of people most at assay of contracting HIV such as MSM and medicate users receive preventative services.
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