Factors, practices and health needs of men who have sex with men, transgender and female sex workers engaged in sexualized drug use in Pakistan.

The objective of the study is to explore factors, practices, and health needs of men who have sex with men (MSM), transgender (TG), and female sex workers (FSW) engaged in sexualized drug use in Pakistan. A qualitative exploratory study was conducted from August 2024 to December 2024. Community-based organization (CBO) staff (stakeholders) for MSM, TG, and FSW, as well as self-identified MSM, TG, and FSW who have engaged in SDU previously or currently, were recruited. Four focus group discussions (FGD), one each with MSM, TG, FSW engaged in SDU, and HIV Treatment Center staff, were conducted. Interviews were transcribed, and English translation was imported into NVIVO version 14.0. Eight themes were identified. Participants reported a common practice of SDU in large cities, primarily with stimulant-type substances. Key reasons for engaging in SDU included poor mental health and the demands of sex work. Participants reported increased risky sexual practices such as group sex and violent sex. Participants also noted psychotic, homicidal, and suicidal experiences with those engaged in SDU. Participants suggested the incorporation of comprehensive harm reduction, HIV prevention, and mental and physical health services through CBO as an acceptable method of service delivery to people engaged in SDU.