ESTIMATING THE RISK OF CARDIO VASCULAR DISEASES AMONG PAKISTANI DIABETICS USING U.K. PDS RISK ENGINE.

BACKGROUND: The concept of risk estimation of Coronary Heart Disease (CHD) is helpful for clinician to identifying high risk populations for their effective treatment. Latest studies recommended only initiating cardioprotective treatment in diabetic patients based on personalized CHD risk estimates so as to reduce undue harm from overly aggressive risk factor modification. The United Kingdom Prospective Diabetes Study (UK PDS) Risk Engine is a widely used tool to assess the risk of Cardio Vascular diseases (CVD) in diabetics. The literature search so far did not reveal any study of risk assessment among Pakistani Diabetics. METHODS: This descriptive study is based on the data of 470 type-2 diabetics seen in Department of Endocrinology and Metabolism, Services Institute of Medical Sciences, Lahore during 2011. The data of these 470 patients was analyzed through UKPDS Risk Engine. CHD risk was calculated. RESULTS: The 10 years risk of CHD, fatal CHD, stroke and fatal stroke was 9.4%, 4.4%, 1.7% and 0.2% respectively. CONCLUSIONS: The present study show a lower risk of CVD occurring among Pakistani diabetics as compared to studies from western countries.

Genital examination of Hijras.

There is a common belief in Pakistan that hijras are born hermaphrodites or have undergone an emasculation procedure. There are many studies about socio-sexual behaviour of hijras, but one rarely finds any study regarding genital examination of hijras. Four hundred hijras from Karachi and Lahore were examined as part of National Study of Reproductive Tract Infection conducted in 2004. A random sample of the Gurus of Hijras in each city was taken and all hijras under selected Gurus were included in the study. The purpose of study was explained to each Guru/participant and only those, who consented, were included. Out of 400 hijras, penis and testes were absent in only three hijras (0.8%). Among the remaining 397 hijras, 98.3% were circumcised and 1.7% were non-circumcised. Inguinal Lymphadenopathy was the most common finding. The study dispels the myth that Hijras in Pakistan have ambiguous genitalia, are hermaphrodites or have undergone removal of male sexual organs.

Socio-sexual behaviour of hijras of Lahore.

OBJECTIVE: To assess risk behaviours including number and type of sex partners, condom use, knowledge of STIs and HIV/AIDS among hijras (eunuch) of Lahore. METHODS: Two hundred hijras were recruited through Respondent Driven Sampling and interviewed by a team of experienced interviewers. RESULTS: The mean age of the respondents was 29.2 +/- 6.3 years (Range 18-55). More than two third (68.5%) were illiterate; 23% were married. Among married, 89% were married to women and had 1 to 7 children. Sixty percent had taken some hard drug (Cocaine, Heroin, Morphine and Amphetamine) during the last 12 months and 3% had injected drugs. Eight percent had sex with a woman during the last year. During the last one week, 82% respondents had 1-21 new clients and 69.5% never used condom; 21.5% had oral sex with new clients. During the same period, 72% respondents had 1-12 regular clients and 71.5% of them never used condom while 7% respondents had 1-5 non-paying partners. During the last one month, five hijras had paid women to have vaginal sex. Nineteen hijras paid another man to have sex with them. Only 27.1% were not aware of any symptom of sexually transmitted Infections. Majority of the hijras (81.5%) were familiar with HIV/AIDS. However knowledge about its mode of transmission was faulty. CONCLUSION: Due to low level of accurate knowledge regarding STI/HIV and pernicious risk behaviours, hijras may become a potent source of HIV transmission, if necessary remedial measures are not taken.

HIV risk in Karachi and Lahore, Pakistan: an emerging epidemic in injecting and commercial sex networks.

The objective of this study was to measure HIV prevalence and risk behaviour in injecting drug users (IDUs), male sex workers (MSWs), Hijras (transgenders), female sex workers (FSWs) and male truckers in Karachi and Lahore, Pakistan. The design was a linked-anonymous cross-sectional study of individuals identified at key venues or through peer referral. Approximately 400 respondents in each group (200 for Hijras) responded to a standardized questionnaire and were tested for HIV antibodies at each site. In Karachi, 23% of IDUs and 4% of MSWs were HIV positive, and HIV-positive individuals were identified in all risk groups in at least one city. Two-thirds of all IDUs used a shared needle in the previous week, and unprotected commercial sex activity with men and women was high. The HIV epidemic has entered IDU and male and female commercial sex networks in Karachi and Lahore. Targeted intervention services must be scaled up and risk group surveillance intensified.