Objectives: To investigate the nature and extent of human rights abuses against three vulnerable groups (injecting drug users (IDUs) and male and female sex workers), to understand the social and sexual linkages between them and to examine how protecting their rights could enhance the impact of HIV prevention policies.Methods: In-depth interviews were carried out with 38 high-risk respondents (IDUs and female, male and transgender sex workers) and a bio-behavioural survey was performed of 813 IDU/sex worker respondents in Rawalpindi.Results: People in all vulnerable groups interacted both sexually and socially. All groups experienced human rights abuses by state and non-state actors which increased their HIV risk. Non-state actors, including relations and sex worker clients, are responsible for verbal, physical and sexual violence. State actors (particularly police) perpetrate harassment, exploitation and abuse of all vulnerable groups with impunity. Health service providers fail to provide adequate services for vulnerable groups.Conclusions: High levels of discrimination and abuse of human dignity of all groups studied were revealed. This violates their physical and mental integrity and also leads to an increased risk of HIV. The sexual and social interactions between groups mean that human rights abuses experienced by one high-risk group can increase the risk of HIV both for them and other groups. The protection of human rights needs to become an integral part of a multisector response to the risk of HIV/AIDS by state and non-state agencies. The Government of Pakistan should work at both legal and programme levels to protect the rights of, and minimise discrimination against, groups vulnerable to HIV in order to reduce the potential for the spread of HIV before the epidemic takes hold.

OBJECTIVES:To assess sexual risk behaviour and prevalence of treatable sexually transmitted infections (STI) in migrant male workers in Lahore, Pakistan. METHODS:Behavioural interviews were conducted on a representative sample of 590 migrant men aged 20-49 years. Biological samples were collected from a subsample of 190 and tested for chlamydia, gonorrhoea, and syphilis. RESULTS:Over half (55%) of single men were sexually experienced and 36% of married men reported premarital sex. The median ages at first intercourse and first marriage were 21 years and 28 years, respectively. In the total sample (including virgins), 13% reported any female non-marital partner in the past 12 months, 7% contact with a female sex worker, and 2% sex with a man. Only 10% reported using a condom during most recent contact with a sex worker. STI symptoms in the past 3 months were reported by 8% of men. Laboratory tests disclosed that STI prevalence was 3.2%. CONCLUSIONS:If and when HIV infection spreads among sex workers in Lahore, the reported behaviour of migrant men suggests that they may act as a conduit for further transmission to the general population. Condom promotion focused on the sex trade is likely to be the most effective way of reducing this risk.

Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON

Since reproductive tract infections (RTIs) are a common problem among women of reproductive age in Bangladesh it would be good if the identification and treatment of such infections could be integrated into family planning and maternal and child health programs. 172 female clients in 46 selected family planning service facilities were interviewed and their interaction with health care providers observed during November-December 1996. 112 physicians and family welfare visitors were also interviewed at the end of the observation period. 77% of clients reported at least 1 symptom associated with RTIs at the time of the intake interview but service providers only followed up on those complaints or obtained a comprehensive reproductive history in 22% of the cases. 21% of symptomatic women were diagnosed with a RTI of which one third received specific rather than opportunistic treatment. Only 6 of 18 women receiving a new IUD were screened for RTIs. Providers investigated the symptoms of only half of all women using the injectable who reported problems typical of RTIs. Pelvic exams were performed on 40 of the 68 new family planning clients and 21 of 50 family planning clients making follow-up visits. During pelvic exams a speculum was used in 20 of 35 exams in public clinics and 23 of 33 exams in nongovernmental clinics. During most pelvic exams providers failed to follow basic practices for preventing infection.

The IUD is a highly popular contraceptive method, used by almost 500,000 women in Bangladesh alone. One concern with IUD use, however, is the potential risk of post-insertion pelvic inflammatory disease (PID), a serious disease which can lead to chronic lower abdominal pain, ectopic pregnancy, infertility, and death. An increased risk of PID exists for approximately 1 month after IUD insertion, presumably related to the introduction of bacteria into the uterus during the insertion procedure. Proper processing of IUD instruments and supplies and close attention to aseptic technique can help to reduce the risk of post-insertion PID. Concern over the ability to maintain aseptic technique is particularly high with regard to health care workers who travel between clinics in rural areas. In Bangladesh, providers in rural areas had problems transporting equipment, obtaining fuel and clean water, and finding the time needed to boil and cool instruments. A portable, easy-to-use steam sterilizer has now been developed and made available, allowing health workers to fully sterilize IUD instruments before visiting rural clinics, so that they no longer have to boil the instruments on site. AVSC was one of several organizations which worked with Bangladesh's National Task Force to develop the portable sterilizer for IUD instruments and supplies.

All female sterilization patients in Bangladesh receive five-day courses of tetracyoline capsules every six hours as a postoperative prophylactic. A double-blind randomized study was conducted by the Bangladesh Fertility Research Programme (BFRP) to determine whether prophylactic antibiotics reduced infection after minilaparotomy, and to compare the prophylactic effectiveness of tetracycline and ampicillin. Women recruited from throughout Bangladesh (N = 1350) received five-day courses of 250 mg tetracycline, 250 mg ampicillin, or placebo. The infection rate was significantly lower with tetracycline than with placebo (6% vs 10% with placebo), but did not differ significantly between the ampicillin and placebo groups or between the tetracycline and ampicillin groups.