Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
The New York Times - July 22, 2008
Donald G. McNeil Jr.
In Pakistan, seven times as many men as women are reported to be infected with the AIDS virus, but the country's taboos about sex make it very difficult to even address the epidemic, researchers are reporting this week.
The findings, published in The Lancet Infectious Diseases, are by researchers at two Pakistani universities, who said India and Bangladesh, with similarly conservative Muslim cultures, had addressed the issues more openly.
Pakistan has at least 85,000 citizens infected with the virus, according to Unaids, the United Nations AIDS agency.
Islamic law forbids sex outside marriage, and many Pakistanis believe the disease is not a threat in Muslim countries, the authors said. As a result, safe-sex education is rare.
In Pakistan as in many other countries, gay relationships and networks of male sex workers exist. Moreover, there are specialized subcultures of hijiras and zenanas - once mostly eunuchs and devotees of a Hindi mother goddess in India, now a "highly stigmatized group," the authors write, of men who dress as women and are receptive partners in anal sex. There are also areas where it is traditional to use young boys as sexual partners.
Condom use is low; they cannot be displayed in shops, the authors said, and some sex workers even believe that infection is "divine punishment" for their own sexual practices.
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