Pakistan: Sex work a dangerous game

On Napier Road, the notorious red light district in Karachi, Pakistan's commercial centre and largest city, thousands of women regularly risk contracting HIV or other sexually transmitted infections (STIs) by having unprotected sex for as little as 50 Rupees (US$0.60). "I was beaten black and blue by my pimp on my refusal to have unprotected sex," said Nazli, a brothel-based female sex worker, pulling up her shirt to show her badly bruised back. "If I insist on using protection, I lose my customers and if anyone of them complains to my pimp, I am in trouble." Although she followed her mother and her grandmother into prostitution, Nazli had no knowledge about the importance of practicing safe sex and often suffers from STIs. "I grew up in this environment and I wonder how it would feel to live without the fear of getting myself beaten up or forced," she said, preparing a bottle for one of her two children at the same time as applying a thick layer of makeup. Two years ago, the first reported case of a female sex worker (FSW) testing HIV positive in Karachi created a scare in the city's brothels. Many of the women began trying to insist on condoms, but the customers mostly refused. Mirza Alim Baig, president of the Gender and Reproductive Health Forum, a local NGO, prides himself on having visited every brothel in Pakistan, in a mission to educate FSW on how to protect themselves against STIs and HIV. "Women in our society are regarded as second class citizens and when it comes to female sex workers, the situation is worse. Men want their money's worth and they are the ones who insist on having sex without protection," said Baig, who has been involved in HIV/AIDS efforts since 1995. Baig is currently managing a FSW project funded by the United Nations Population Fund (UNFPA) that is spreading awareness about HIV and AIDS through an educational programme that includes components on basic health, STIs and the use of condoms. "It used to be a thankless job, but I am happy that the FSW have the tools and knowledge to better protect themselves against HIV/AIDS, STIs and hepatitis," said Baig. "Every day we give out hundreds of free condoms (provided by the UNFPA) in the hope that somewhere a life might be saved." Baig relies on a crew of outreach workers that includes former FSW and dancing girls. "These women know what these FSWs are going through and can relate to them in a better way," he said, adding that most of the sex workers had little or no knowledge about safe sexual practices. "[They] often end up having sex with injecting drug users and bi-sexual male sex workers who are already high risk groups." According to a UNFPA survey conducted in 2007, out of 11,324 FSWs in Karachi, 1,015 had tested for HIV and two had tested positive. "We may not be on the brink of an epidemic when it comes to FSW, but the fact remains that these women are vulnerable," commented Baig. Nazli is sitting with a potential customer, who calls himself Majid, trying to brief him about the risks of STIs and HIV. "If I am paying for sex, why should I use protection? I might as well sleep with my wife," he responded, shaking his head. "I should have gone to a mosque rather then coming here for the sermon." "Sadly, our nation has been brainwashed that being Muslims we cannot get HIV," said Nazli, who dreads one day testing positive for the virus. "Each night I think, 'What if this is it?' but even with that fear on my mind, I cannot ask the man in my bed to use a condom because I know my children will end up hungry."