hiv / aids in pakistan
. islamabad, pakistan, national aids control programme of pakistan, national aids control programme of pakistan, 2006 .
. islamabad, pakistan, national aids control programme of pakistan, national aids control programme of pakistan, 2008 .
developing a surveillance system for hiv / aids in pakistan. - pubmed - ncbi
hiv / aids, surveillance project, aids block, islamabad. drfaran @ urltoken
arshad altaf (pakistan hiv / aids surveillance project (hasp), karachi, pakistan. )
abrar n. aids / hiv knowledge, attitude and beliefs of adolescents of pakistan .
national aids control programme. hiv second - generation surveillance in pakistan, national report round 2, 2006–7; islamabad: nacp; 2007. ministry of health and canada–pakistan hiv / aids surveillance project .
in pakistan, hiv is still a taboo that leads to discrimination - pakistan - dawn. com
according to pakistan global aids response progress report, pakistan’s hiv epidemic started in the 1980s when cases surfaced mostly amongst migrant workers employed abroad .
hyder aa, khan oa. hiv / aids in pakistan: the context and magnitude of an emerging threat .
shreedhar j: aids in india. harv aids rev. 1995, fall: 2 - 9 .
zafar iqbal akh, sultana bakhsh, haroona jatoi. need and significance of hiv / aids preventive education in pakistan .
after being diagnosed with hiv, his experiences were not very different from other hiv carriers in pakistan .
epidemiological situation of hiv / aids in pakistan. hiv positive (1765) + aids (233) = total 1998 cases at islamabad, karachi, lahore, rawalpindi and fana (pakistan demographic health survey, 2007 - 08) .
pakistan' s first hiv / aids case was detected in 1987 [ 1, 2 ]. the number has been increased according to the annual report of pakistan national aids control program (nacp) [ 3 ] .
the health workforce for hiv / aids is not only deficient in number but also lacks the required set of skills needed for dealing with hiv / aids cases (14) .
unaids. global aids response progress report 2014; islamabad, pakistan: unaids; 2014 .
pakistan' s national aids control program (ncp) is one of the pioneer institutions providing free treatment to any person found to be suffering from aids through its 20 aids treatment centers all over the country .
in 2009, unaids pakistan and the national aids control programme estimated that there were around 98 000 (79 000–120 000) hiv cases in pakistan, with an overall general population prevalence of less then 0. 05% .
non‐governmental organizations (ngos): at least 54 ngos are involved in hiv / aids public awareness and in the care and support of persons living with hiv / aids. these ngos also work on education and prevention interventions targeting sex workers, truck drivers, and other high‐risk groups. ngos serve as members of the provincial hiv / aids consortium, which has been set up in all four of pakistan’s provinces to coordinate hiv / aids prevention and control activities. although ngos are active in hiv / aids prevention activities, it is believed that they are reaching less than fifteen percent of the vulnerable population .
pakistan global aids response progress report further states that female sex workers reported an average of three clients a day .
correa m, gisselquist d. routes of hiv transmission in india: assessing the reliability of information from aids case surveillance .
the bulk of the credit in this regard goes to the private sector. over 50 non - governmental organizations (ngo) are working to improve the hiv / aids status quo in pakistan [
1. cia the world factbook 2005, pakistan; urltoken; july 2005. 2. the world health report 2005, pakistan urltoken en /; july 2005. 3. unaids country profile, urltoken + area / by + country / pakistan; july 2005. 4. unaids / who epidemiological fact sheet urltoken; july 2005. 5. hiv and aids in pakistan, hiv in pakistan, aids in pakistan, indicators, estimates, figures, hiv situation urltoken; july 2005. 6. usaid hiv / aids country profile urltoken 7. hiv / aids profile pakistan, urltoken; july 2005. 8. the united nation' s office for the co - ordination of humanitarian affairs, integrated regional information networks (un ocha irin). urltoken; july 2005 9. world bank country development gateway urltoken urltoken? selectedregions = 87249; july 2005 10. u. s. census bureau hiv / aids country profile urltoken; july 2005 11. marie stopes international - pakistan urltoken pakistan; july 2005 12. unicef country tables urltoken; july 2005
“over the years, through efforts at various fronts, i managed to introduce registered medicines for hiv in pakistan in 2003. ”
national aids control programme. the hiv / aids surveillance project (hasp): summary report – integrated biological and behavioral surveillance study; islamabad: ministry of health; 2007 .
khan oa, hyder aa: hiv / aids among men who have sex with men in pakistan. sex health exch. 1998, 5 (2): 12 - 3 .
a draft national aids policy and hiv and aids law (both recommending the formation of a national aids council) have been prepared by the national aids control program and will be presented to the national cabinet and parliament. approval of the policy and law would be an important step towards the multi‐sectoral dimension of the national response .
“there were no medications or guidelines available for hiv carriers in pakistan and my life was doomed in every sense, ” nazir recalls .
]. after the larkana episode, hiv has been documented among idu all over pakistan. currently, idu do not comprise the bulk of drug users in pakistan [
hanif m: no safer sex for pakistan' s gays. world aids. 1993, london: panos institute, 11 :
]. idu all over the country have started recording alarmingly high rates of hiv. according to the latest figures released by the national aids control program of pakistan, hiv / aids prevalence among idus has jumped from 0. 4% in december 2003 to 7. 6% in 2004. however, in larkana, where pakistan' s first hiv outbreak among idu was reported, the number approached an astounding, twenty - seven percent [
brody s et al. evidence of iatrogenic hiv transmission in children in south africa .
talking to news lens pakistan, faisal majeed, project director, provincial aids control program, punjab, said the government of pakistan is working hard to prevent hiv transmission with measures such as safe blood transfusions, establishment of surveillance and dealing with hiv - related stigma .
agha s: potential for hiv transmission among truck drivers in pakistan. aids. 14 (15): 2404 - 6. 10. 1097 / 00002030 - 200010200 - 00024. 2000 oct 20
in 2016, the joint united nations team on aids (joint team) provided support to the government of pakistan to implement an effective hiv response at provincial level and to improve the quality and the continuum of hiv testing, treatment and care in the country .
in an effort to fully analyse and understand the hiv situation and its epidemiology in pakistan, a bilateral collaboration between the national aids control program and the canadian international development agency resulted in the establishment of an effective second - generation surveillance (sgs) system for hiv / aids between 2004 and 2012 in accordance with the published guidelines. this paper presents findings from the 4th round of sgs .
nih: national institute of health; nacp: national aids control program; arv: antiretroviral; fana: federally administered northern areas; hiv: human immunodeficiency virus; aids: acquired immunodeficiency syndrome .
fighting hiv / aids in pakistan: unicef strategy and major lines of action explains a strategy and six lines of action for the hiv / aids intervention of the unicef pakistan country programme. the need for this strategy arose from unicef decision to develop hiv / aids as a cross - sectoral theme, several international and unicef global commitments, the funding of the government of pakistan’s enhanced hiv / aids control programme, and a growing understanding of the potential impact of hiv / aids on young people in pakistan. while there is limited data on risk behaviours and hiv prevalence in pakistan, there is evidence to show high levels of risk behaviours among vulnerable groups. this includes low condom use among female sex workers and syringe sharing among injecting drug users – both predictors of a growing epidemic. who / unaids forecast modeling estimated, in 2002, that there were approximately 70, 000 - 80, 000 people infected. what this might mean for young people is uncertain, as no sero - or behavioural surveillance of young people have been conducted .
the hiv epidemic is well established in pakistan. it is defined as a concentrated epidemic meaning that the prevalence in traditional risk groups exceeds 5% .
to improve hiv testing among children in pakistan, unicef additionally supported a situation analysis of early infant diagnosis (eid) of hiv in the country, using dried blood spots (dbs) .
pakistan is preparing to submit a concept note under new funding model to the gfatm in april 2015. in this context, national authorities and un partner agencies will compile and review available information on the epidemiology of hiv in pakistan and develop an up - to - date epidemiological profile, of the country. the who country office will provide support to the national aids control programme in the epidemiological analysis of the hiv epidemic and aids response in pakistan. the consultant will also work closely with the technical working group constituted for providing oversight to the concept note development, under the new funding model for pakistan .
]. pakistan, as compared to its neighbors, has remained relatively safe from any indigenously acquired cases of hiv for about two decades. the situation however changed in 2004 when pakistan experienced its first full - fledged hiv outbreak [
the future of the hiv epidemic in pakistan will depend on the scope and effectiveness of hiv prevention programmes for pwids, their sexual partners, sex workers and their clients .
decades of corruption and poor planning of resources have translated into a fight for pakistan' s very own continued existence. keeping this in mind and the horde of other problems currently encountering pakistan, any efforts directed towards prevention and control of hiv / aids are quite laudable .
more than 1, 700 collaborators in 124 countries including pakistan contributed to the study .
]. the government has to come forward and face the truth about hiv in pakistan. embarking not only upon national - level mass awareness programs, practical steps including wide - spread screening for the high - risk populations has also to be instituted. stigma and discrimination about hiv / aids in society could only be removed when prominent figures including politicians and sport stars start discussing about hiv / aids in public. as soon as this stigmatization barrier is overcome, a major chunk of the battle against hiv in pakistan would be conquered. what has to be reiterated again is that the time to act is now. timely steps taken at the present can go a long way in preventing a wide - spread hiv epidemic in pakistan .
1. in a country with low literacy rate one should expect low level of awareness about hiv / aids. awareness needs to be created at all levels especially in rural areas .
“better late than never. with the help of a christian charity organisation in lahore, i was able to gather enough courage to fight hiv. i did that by initiating a platform called ‘new life aids control society’ to raise awareness regarding medication and treatment for hiv carriers in pakistan since 1999 .
funding: the hiv / aids surveillance project was funded by the canadian international development agency (cida) grant number pk - 30849 .
according to the study conducted by pakistan demographic health survey, 2007 - 08, from all the four provinces of pakistan along with fata and ajk. in the light of the above said study, total 1998 patients were identified as hiv infected out of which, 1765 were hiv positive only while 233 developed aids. the study above said study showed that hiv is most prevalent in the sindh province while least prevalent in ajk (figure
khan aj et al. unsafe injections and the transmission of hepatitis b and c in a periurban community in pakistan .
ahmed j, shaikh bt. an all - time low budget for healthcare in pakistan .
pakistan is following an hiv epidemic trend having moved from low prevalence, high risk, to a more concentrated epidemic in the early 2000s .
]. the number of idu is bound to increase in the near future, and as this happens, the relative cases of hiv / aids will also rise. the first hurdle in the spread of hiv seems to be already traversed .
] suggest that the hiv prevalence among hijras in karachi, a city of 13 million people in southern pakistan, approximates around 4% . the situation is bound to be even worse in the rural parts, particularly in the pathan - dominated northern pakistan, where homosexuality is socially tolerated [
unaids: report on the global aids epidemic 2006. accesed: 2 feb 2007, [
prescribing practices of 354 physicians practicing in city of karachi in pakistan were audited in 2001. antimicrobials, vitamins / minerals and injections were over prescribed .
the deaths from hiv / aids in pakistan increased from 350 in 2005 to 1, 480 in 2015, showing an average increase of 14. 42 percent a year, says the findings of the meta - analysis coordinated by the institute for health metrics and evaluation (ihme) at the university of washington in seattle .
emmanuel f, fatima m. coverage to curb the emerging hiv epidemic among injecting drug users in pakistan: delivering prevention services where most needed .
1. review descriptive epidemiological data of published / unpublished resources and reports to describe the epidemiology of hiv and aids in pakistan, including an assessment of the quality and availability of data and the investments needed to improve measurement of disease burden .
the findings were released on the heels of an international aids conference in durban, south africa, that started on tuesday .
the number of new hiv infections in pakistan grew at an average of 17. 6 percent per year between 2005 and 2015, making it the highest increase in the world .
shah sa, altaf a, mujeeb sa, memon a. an outbreak of hiv infection among injection drug users in a small town in pakistan: potential for national implications .
similar to its south - east asian neighbors, the greatest risk for the spread of hiv in pakistan stems from idu. currently estimated at over 180, 000 in number [
the overuse of injection practices in pakistan has become a therapeutic norm in the practice of general practitioner (gp). majority of these injections is administered under unsafe conditions exposing the patient to infectious diseases, including abscesses, hiv / aids and viral hepatitis b & c .
the overall goal of this exercise is to review and amalgamate hiv data of pakistan to determine strategic priorities for the hiv response and suggest efficient resource allocation for the programmes .
shaikh ia, shaikh ma: teachers attitudes about hiv / aids prevention education in secondary schools. j coll physicians surg pak. 2005, 15 (9): 582 -
reaction (referring to allergic reactions) and abscesses were reported as the most common side effects of injections. aids was the predominant risk mentioned by communities because of poor injection practices. they also believe that aids is widespread in
khanani rm, hafeez a, rab sm, rasheed s: human immunodeficiency virus - associated disorders in pakistan. aids res hum retroviruses. 1988, 4 (2): 149 - 54 .
lahore: nazir masih, 58, an hiv / aids patient, became an outcast when he socially disclosed he was suffering from the deadly disease .
]. 97, 400 cases of hiv / aids were estimated in 2009 and more than 6, 000 cases are registered till now (2010). till march 2010, 3325 patients were registered at national aids control center nih islamabad. 1425 patients are on arvs (figure
mayhew s, collumbien m, qureshi a, platt l, rafiq n, faisel a, et al. protecting the unprotected: mixed - method research on drug use, sex work and rights in pakistan' s fight against hiv / aids .
raglow gj, luby sp, nabi n. therapeutic injections in pakistan: from the patients’ perspective .
shah sa, altaf a, mujeeb sa, memon a: an outbreak of hiv infection among injection drug users in a small town in pakistan: potential for national implications. int j std aids. 2004, 15 (3): 209 - 10. 1258 / 095646204322916713 .
in pakistan, the hiv / aids programme has always depended on the donors and extra mural funding. the bilateral and multilateral donors and other development partners have invested to address the hiv threat in pakistan. the global fund' s total pledge to hiv / aids in pakistan is us $ 37, 523, 500. however, the grant performance has been rated as inadequate and did not meet the expectations (16). in all times, capacity of the national programme to coordinate with provinces has been a challenge, and this has been even grimmer after the 2011 devolution. accountability has to be instituted strictly at all levels and in all components of the programme. the private sector must be involved in the sharing of responsibility and risk pooling .
rai ma, khan mn, khan s, khanani r, ali sh: pakistan / india open borders... to hiv? . aids. 20 (4): 634 - 5. 2006 feb 28 ;
hiv (human immunodeficiency virus) transmission has been reduced by protected sex and screening of blood products and other body fluids in the developed countries. it has been reported that pakistan is at high risk of hiv / aids infection but presently the prevalence rate is considerably low. the number of reported cases of hiv / aids in pakistan has been continuously increasing since 1987. by 2010 the total number of registered cases has reached to 6000 and this figure is on the rise with the passage of time. some serious strategies must be implemented to control this deadly disease .
shaikh fd, khan sa, ross mw, grimes rm. knowledge and attitudes of pakistani medical students towards hiv - positive and / or aids patients .
but he did not give up. masih launched an organisation to help aids patients and spread awareness about the disease in the country .
the situation concerning pakistan and hiv is indeed very precarious. the country lies at a very crucial junction. hiv has as yet not exploded. most of the populace remains safe, as for now. however, concentrated epidemics have emerged, which means that very little time is left before a steep rise in infections occurs. the battle against hiv / aids in pakistan has to be fought on a number of fronts: not just the afflicted population, but also on changing peoples' perspectives and ushering in the proper government policies and response measures. neighboring china serves as a good example to follow as regards formulation of a national policy about hiv / aids [
“i took the medical test as a formality and was diagnosed as hiv positive, thus leading to my deportation to pakistan. ”
the government had registered 14, 705 hiv carriers across pakistan till december 2015 but fighting cultural ignominy is still a serious challenge .
according to pakistan global aids response progress report, the epidemic trend is moving from low prevalence to high risk due to the steady increase in the number of persons injecting drugs regularly for non - therapeutic purposes .
another hiv carrier from rahim yar khan, who wishes to remain anonymous, told news lens that he was diagnosed with hiv at a medical camp in lahore in 2010 .
national aids control programme. available from: urltoken of treatment centres. pdf [ cited 21 august 2014 ]
gender - and age - disaggregated data was collected as part of ibbs in 23 cities, and is currently being analysed. this data will enable the joint team and partners to address gender specific issues of the aids epidemic in pakistan. in order to assess gender related issues regarding tb / hiv coinfection, the joint team, along with the national aids control programme and the national tb control programme, also undertook a gender assessment of hiv / tb health sector, in order to evaluate gender barriers related to access, treatment and services .
the hiv / aids epidemic in pakistan is following along the same atypical lines as it has done so far in the rest of asia. starting from isolated high - risk population subgroups, the virus jumps the barrier to cross into the mainstream general populace. once this barrier is crossed, little if at all anything can be done to prevent a complete hiv onslaught .
khanani rm, hafeez a, rab sm, rasheed s. human immunodeficiency virus - associated disorders in pakistan .
the world bank was the largest financer of hiv / aids programs in pakistan. it assisted the government’s hiv / aids efforts through funding the second social action program (1998‐2003). in addition, the world bank worked with the government and other development partners (cida, dfid, usaid, and un agencies) to support the government’s program through the hiv / aids prevention project. the bank provided us $ 37. 1 million, 75 percent of which was a no‐interest credit and 25 percent of which was grant money. the project which closed in december 2009 supported hiv prevention services to most at risk groups, mass media campaigns aimed at raising awareness and reducing stigma, promoting safe blood transfusion and building management and institutional capacity .
the number of hiv infections in pakistan grew at an average of 17. 6 percent a year from 8, 360 to 45, 990 during the period under review .
though statistics show that hiv is a grave problem, the ban placed on condom advertisements in 2014 depicts how reluctant the government of pakistan is to address this serious issue .
between 2004 and 2012, a bilateral collaboration between the national aids control program and the canadian international development agency resulted in the establishment of an effective national sgs system for hiv / aids through the canada–pakistan hiv / aids surveillance project. this was implemented by a consortium of agriteam canada consulting, university of manitoba, canada and proaction: partners for community health inc, with technical assistance from the public health agency of canada. this sgs was designed to monitor the hiv epidemic among key populations at high risk, that is, pwids, and hijra, male and female sex workers (hsws, msws and fsws, respectively). since the first pilot sgs was conducted in 2004, pakistan has conducted four sgs rounds with pwids, hsws, msws and fsws in 8 major cities in 2005–2006, 12 cities in 2006–2007, 9 cities in 2007–2008 and 20 cities in 2011. 8–12 findings from these surveys revealed changes in the hiv magnitude and trends over time, which helped in developing a comprehensive response to the epidemic. 13–15 the approach proved to be extremely relevant in a concentrated epidemic such as pakistan' s, whereby behavioural information is vital in predicting epidemic transition .
although the countries of south asia have low hiv prevalence rate in the general population, and the number of new hiv infections has remained relatively stable in asia and the pacific, there has been high and increasing hiv percentage among key populations .
planning and development division. islamabad: ministry of finance, government of pakistan; 2013. health & nutrition expenditures (2001–2012). economic survey of pakistan .
it may sound ludicrous but the fact remains that to properly combat any problem, the affected have to first accept it and then conquer over it. the society in pakistan has as yet not accepted hiv / aids as having anything to do with them. trends may be changing, but the age - old stigmas and taboos related to hiv still persist. hiv is considered extremely shameful, particularly in the rural setting. even discussions on this topic are frowned upon. awareness about hiv / aids in general is extremely limited. the severity of the situation could be deduced from a survey conducted among school teachers in the capital city, islamabad. an outstanding sixty percent of the teachers responded by saying that' they thought hiv was irrelevant in our cultural setting.' [
gray rh et al. , rakai project team. probability of hiv - 1 transmission per coital act in monogamous, heterosexual, hiv - 1 - discordant couples in rakai, uganda .
the institute estimates there were about 39 million people globally living with hiv in 2015, as compared to 28 million in 2000 .
janjua nz, akhtar s, hutin y. injection use in two districts of pakistan: implications for disease prevention .
janjua nz, akhtar s, hutin yj. injection use in two districts of pakistan: implications for disease prevention .
since it was first detected in 1986, the hiv / aids epidemic in pakistan has progressed from a low - level epidemic to a concentrated epidemic, with measurable prevalence rates among all prominent risk behaviour groups. pakistan' s hiv epidemic, once concentrated primarily among pwids, is now increasingly characterised by significant sexual transmission (ie, msws, hsws and fsws ,). 19 while many countries in the mena region are still trying to identify and describe their key populations, pakistan has already established a knowledge base to characterise, operationalise and estimate the sizes of their key populations. 16
panda s et al. transmission of hiv from injecting drug users to their wives in india .
shah sa, khan oa, kristensen s, vermund sh: hiv - infected workers deported from the gulf states: impact on southern pakistan. int j std aids. 1999, 10 (12): 812 - 4. 10. 1258 / 0956462991913600 .
although the estimated hiv burden is still low—around 0. 1 percent of the adult population – pakistan is facing a concentrated epidemic among injecting drug users (idus) with hiv prevalence of 21 percent among idus in major urban centers across the country. given linkages between idus and other vulnerable populations including male and female sex workers, pakistan needs to scale up targeted intervention urgently to prevent rapid increase in hiv among vulnerable groups .
pakistan millenium development goals report. 2005, accessed: may 11, 2006, [
in 2015, 41 percent of the people living with hiv were using art, as compared to less than 2 percent in 2000 .
like many developing countries, pakistan faces elavated risk of hiv transmission as a result of poverty, low literacy, gender - related discrimination, ignorance about modes of transmission and the stigma that prohibits people with risk behaviours from seeking hiv testing or disclosing their hiv positive status .
the joint team’s resources are limited, in a context where funding the national hiv response despite considerable improvements in the last decade, levels of stigma and discrimination against people living with hiv and key populations remains high in pakistan, leading to increased vulnerabilities and barriers to access hiv care. there are numerous other issues hindering access to hiv treatment, care and support services by key populations, including existence of discriminatory laws and policies, economic hardships among people living with hiv and lack of awareness on existing services .
on the other side, the current government policy falls under the auspices of the national hiv / aids strategic framework. the program has four foci: improved hiv prevention, expanding interventions among vulnerable groups, preventing transfusion related infections and improving infrastructure [
globally, unicef will work to stop the spread of hiv / aids and ensure that children and young people already affected by the disease are cared for. this means… • preventing parent - to - child transmission of the disease; • preventing transmission among young people; • expanding care facilities for children and parents living with hiv and aids. expected results by 2005… • a gender and age disaggregated situation assessment and analysis of hiv / aids and its impact on children and young people; • national policies and strategies approved and action plans under implementation to reduce the risk and vulnerability of young people and to ensure protection and care for children orphaned or made vulnerable by hiv / aids; • national policies, strategies and action plans under implementation to prevent parent - to child transmission of hiv / aivs
the joint team also supported the development of by - laws and operational manuals of the association of people living with hiv (aplhiv). this process supported institutional strengthening of aplhiv to be a more progressive organization in engaging communities in the national aids response .
the joint team supported the national and provincial aids control programmes of balochistan, punjab and sindh in the development of their capacities to ensure quality assured diagnosis and treatment services in alignment with the new who guidelines disseminated in 2016. selected staff members from the provincial and national chapters were thus, trained in global and regional courses conducted by who. forty one healthcare providers (physicians and gynaecologists) received capacity building training on the new hiv treatment guidelines. hiv treatment, care and support facilities are available to people living with hiv in pakistan through 21 antiretroviral therapy (art) centres, which include six paediatric hiv treatment centres, 16 hiv testing services, 11 prevention of parent - to - child transmission (pptct) sites and 21 community home - based care (chbc) sites. tb - hiv co - infection sites were also scaled up from 17 in 2015 to 31 in 2016. a total of 9570 tb patients were screened for hiv and 49 tb patients were found positive for hiv. the number of people enrolled in care have significantly increased from 12 929 in 2015 to 17 224 in 2016, as well as the number of people living with hiv on treatment from 6292 in 2015 to 8888 in 2016 .
schwartländer b, stover j, hallett t, atun r, avila c, gouws e, et al. towards an improved investment approach for an effective response to hiv / aids .
abbasi w. thousands of aids patients face doom as billions misappropriated. available from: urltoken [ cited 28 july 2014 ]
in 2016, the unaids secretariat was critical in providing support to the government to generate reliable strategic information, to engage stakeholders into the national aids response and to mobilise resources to improve its sustainability .
pakistan' s hiv epidemic that once was characterised primarily by transmission among people who inject drugs (pwids) is now increasingly characterised by significant sexual transmission .
government: pakistan’s federal ministry of health initiated a national aids prevention and control program (nacp) in 1987. in its early stages, the program was focused mainly on blood screening and some health promotion and hiv education activities for the general population. it suffered from a weak strategy that did not address high risk populations and inadequate surveillance and research whereby there was little credible data to inform decision making. the national strategic framework for hiv aids was developed in 2001 through a broad consultative process that set out priorities for effective control of the epidemic. based on the framework the government launched the “enhanced hiv‐aids control program” for the period from 2003‐2008. the program marked a shift to a decentralized approach with the nacp and five provincial programs that would oversee implementation of most activities .
sex workers in pakistan represent the second most serious threat for hiv transmission. the government refuses to accept illicit sex underway in the country, although there are established prostitution centers in all the major cities of pakistan. the so - called' red - light' areas, in addition to female prostitutes, also house hijras – male transvestites. these hijras provide valuable insight into hiv demographics, as data pertaining to female commercial sex workers is very limited. reports [
efforts directed towards emtct in pakistan recognized the role of men in infecting their wives and thus, the importance of their involvement in prevention of infection of wives and their children. this is why the pptct programme in pakistan includes counselling for partner disclosure and couples counselling to make informed decisions about planning and spacing pregnancies. in 2016, as a result of counselling, 21 hiv positive married women decided to use contraception to avoid unwanted pregnancies .
a man holds a red ribbon to mark world aids day, at the entrance of emilio ribas hospital, in sao paulo december 1, 2014. photo: reuters
according to usaid estimates, there are 94, 000 individuals in pakistan living with hiv, out of which 26, 000 are females aged 15 and above, while 2, 100 are children .
coates tj, the voluntary hiv - 1 counseling and testing efficacy study group. efficacy of voluntary hiv - 1 counselling and testing in individuals and couples in kenya, tanzania, and trinidad: a randomised trial. the voluntary hiv - 1 counseling and testing efficacy study group .
meeting with national aids control programme officials dr. baseer khan achakzai, dr. quaid saeed and other partners, nacp, islamabad
rafay, who has contributed to the study said one of the main reasons of increase in the infections in pakistan is the use of infected syringes among injecting drug users .
health systems factors present the fourth category of bottlenecks that need to be addressed to achieve the 90–90–90 targets in paediatric and adolescent hiv in this region. children and adolescents under 15 years of age who are living with hiv are considerably less likely to receive treatment than adults, with less than one in four children between the ages of 0 and 14 [ 24% (22–26 %) ] accessing art in 2013. for instance in india, paediatric hiv treatment continues to be initiated at specialized centres of excellence paediatric centres of excellence, mostly situated in urban settings; whereas in pakistan and nepal treatment initiation is either at provincial or district health facilities, which are also fairly limited in numbers. this inadequate decentralization of care limits the access to hiv treatment for children in rural localities. interrupted procurement and supply of antiretroviral drugs and commodities for early infant diagnosis has also been reported. inadequate data on paediatric hiv are also evident in most countries limiting the capacity of countries to generate necessary evidence for decision making. in 2015, only five countries in the region reported hiv data in the unaids - led global aids response progress reporting .
the human immunodeficiency virus (hiv) epidemic in pakistan has become well established among injection drug users (idus) [ 1–3 ]. in 2008, the national aids control programme estimated that there were about 100 000 street - based idus in pakistan, of whom nearly 21% had hiv infection [ 2, 3 ]. more recently male and transgender sex workers have shown early evidence of epidemic transmission, particularly in cities where they have the most sexual contacts with idus [ 2, 3 ]. at present, there is little evidence of hiv transmission to the general population, and it is unclear which subgroups will provide the bridge for transmission from idus to the population .
i am sufferer and i know how difficult to live with that in pakistan but you are to be very strong to stay alive .
bossert tj, mitchell ad. health sector decentralization and local decision - making: decision space, institutional capacities and accountability in pakistan .
in order to better understand unicef’s challenges in developing and implementing hiv / aids programming for young people, including adolescents, a swot analysis (strengths, weaknesses, opportunities, threats) was conducted. the proposed lines of action for unicef reflect its comparative advantages and existing opportunities .
pakistan, the world' s second most populous muslim nation, has started to finally experience and confront the hiv / aids epidemic. largely portrayed as having free of this menace till now, this south - asian republic seems to be following in suit with its hiv - havocked neighbor, india. with isolated outbreaks being reported all over the country, time already seems to be running out for the sixth most populous country in the world .
about 95% of idus in pakistan are sexually active and 38% have a regular sexual partner [ 3 ]. a recent modelling study demonstrated that idus were more likely to transmit hiv to their spouses and regular sex partners than to sex workers in any city in pakistan [ 4 ]. this is consistent with regional experience. a 2000 study showed that 45% of wives of hiv - positive idus from manipur, india were also hiv infected [ 5 ]. however, it is unclear if’ the spouses and regular partners of idus are merely at risk of hiv infection or if they play a bridging role in the onward transmission of the infection to others. to date, few studies provide information about this vulnerable population, and none have examined the vulnerabilities or hiv transmission potential of the spouses of idus in pakistan .
]. their work ranges from providing needle - exchange programs for idu to spreading awareness about hiv / aids to the masses. worth mentioning is the organization,' amal,' which means' action' in pakistan' s national language, urdu. it has outreach hiv training programs focusing not only on idu but also for the out - of - the - limelight population, female sex workers .
finally, surveillance remained a major focus of the national response to hiv in pakistan during 2016. to this end, mapping and integrated biological and behavioural surveillance (ibbs) of key populations were conducted as part of the 5th round of second generation surveillance in 23 cities of the country, focusing on comprehensive assessment of the size, sociodemographic characteristics, behaviours and hiv prevalence in groups who are at higher risk of hiv and form an important part of the transmission paths through which hiv epidemics can emerge .
he promised to return to pakistan before leaving the country to visit his ailing wife in london, and now, after his ...
this paper shares the key results of the 4th round of sgs conducted in 20 cities in pakistan. we also present key experiences and lessons learnt in the development of an effective sgs system, which can be utilised within the asian, eastern european and latin american countries, but more importantly be contextually relevant for the middle east and north africa (mena) region, for the development of a response against hiv / aids .
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individual level injection history: a lack of association with hiv incidence in rural zimbabwe
, e37 .
nazir came to learn about the disease in 1990 when he visited pakistan’s embassy in abu dhabi for passport renewal and a visa extension which required a mandatory medical test for visa applicants .
the public sector health management information system (hmis) system lacks completeness, authenticity and therefore needs complete revamping. moreover, the information from the vertical programmes like hiv / aids needs a meaningful integration in hmis for timely decision making (15) .
establishment of 16 hiv treatment centers all over the country with functioning 07 pmtct centers where more than 2000 hiv positives are getting anti retroviral treatment .
securing technical support for the national and provincial aids response to strengthen access to combination prevention services tailored to people and populations at higher risk of hiv, including behaviour change communication, condoms, harm reduction, hiv testing services and pre - and post - exposure prophylaxis and disease surveillance .
]. the number of infected persons might be running in millions if proper screening is carried out. the behaviors conducive to the spread of hiv infection to young people are curiosity about sex and drugs, negative peer pressure, and economic frustration in pakistan [
the joint team under the leadership of unicef continued to work towards the elimination of vertical transmission in pakistan. in 2016, 125 hiv positive pregnant women received prevention of parent to child transmission (pptct) of hiv services and 65 children were born, all of whom received art prophylaxis during the first six weeks after their birth .
], and a mushrooming population (growth rate of pakistan lies at 2. 5 %) [
pasha o et al. household members of hepatitis c virus - infected people in hafizabad, pakistan: infection by injections from health care providers .
kassi m, afghan ak, khanani mr, khan ia, ali sh. safe blood transfusion practices in blood banks of karachi, pakistan .
serial prevalence data obtained from the sgs rounds in pakistan provide an understanding of the progression of hiv in this country. 8–11 the sero - prevalence among pwids has shown a consistent increase across all rounds, which increased from 10. 8% in 2005 to 37. 8% in 2011. although the analysis conducted in 2011 produced a weighted hiv prevalence, and the numbers cannot be strictly compared with the previous rounds (as previous analyses were not weighted), it does show an upward and a rapid progression of hiv prevalence in this group. likewise among hsws, the gradual and consistent increase in hiv prevalence from 0. 8% in 2005 to 7. 2% in 2011 indicates that the epidemic is now well established in this group. a similar trend is noted in msws, which now stands at an overall hiv sero - prevalence of 3. 1% . while only one fsw tested positive for hiv from a sample of 12 cities in 2007, 25 fsws tested positive for hiv from the same number of cities in this round. 10 even with lower prevalence rates, the sheer size of this population and its close links with the general population warrants careful monitoring of this population to ensure successful prevention of hiv transmission .
strong community health systems is another opportunity and is supported by various community health workers (chws) cadres, such as accredited social health activists in india, lady health workers in pakistan, and female community health volunteers in nepal .
with modern treatment hiv is no more a life threatening disease. in medical terms it is now called medically manageable disease. one survey conducted by uk says that people living with hiv and are on art have a higher life expectancy compared to other hiv negative people .
“i urged them to come forth and register themselves as hiv carriers for medication, hence making a breakthrough against the social stigma surrounding hiv carriers. ”
shao y: aids epidemic at age 25 and control efforts in china. retrovirology. 3: 87 - 10. 1186 / 1742 - 4690 - 3 - 87. 2006 dec 1
to build our main set of arguments, we have chosen the who' s health systems building blocks to elaborate the present situation with regards to the response to the hiv epidemic in pakistan. each building block is discussed separately in this article based on the information available in the existing literature. to explain the situation according to each building block, a literature search was conducted over the internet, using nomenclature of the building blocks, that is, service delivery, health workforce, information system, drugs - supplies - technologies, financing, and leadership, and governance in hiv / aids sector. the online library of pakistan' s national aids control programme and websites of the global fund to combat aids, tuberculosis and malaria and the world health organization were used for our literature search. we consulted google scholar, for the same medical subject headings (mesh) terms, and the full texts of articles of our choice were retrieved from medline / pubmed, where available .
in contrast to the overall slow decline in new infections, the number of people living with hiv has significantly increased globally, largely due to the expansion of art .
abdul s mujeeb, hashmi mr. a study of hiv - antibody in sera of blood donors and people at risk .
khan aj, luby sp, fikree f, karim a, obaid s, dellawala s et al. unsafe injections and the transmission of hepatitis b and c in a periurban community in pakistan .
the combination of the high number of new infections and low antiretroviral therapy (art) coverage has proven deadly in pakistan, reveals the research study findings .
shaikh bt, ejaz i, achakzai dk, shafiq y. political and economic unfairness in health system of pakistan: a hope with the recent reforms .
like any other developing country, in pakistan, first level care is mostly sought in the private sector, because of distrust in the quality of care in the government system, limited working hours, shortage of trained human resources, and dearth of supplies (9). a meagre portion of gross domestic product (gdp) and a minimal developmental expenditure on health have been incurred persistently over the last two decades in the public sector health system of pakistan (10). most of the proportion in the allocation has chiefly gone to the recurring costs of a few big hospitals, and therefore the vertical programmes such as national hiv / aids control programme are primarily supported by the bilateral donors like global fund (11). by and large, the health system has been weak in all areas from service delivery, human resources, information system, to matters pertaining to governance and leadership. we used who' s framework of building blocks for health system strengthening and analysed the health system of pakistan for taking stock of the responsiveness towards the threat of hiv / aids in the country. below is an account of each building block with its issues and proposed solutions .
there has been skepticism unaids / who working group statistics, for fact sheets can be only as good as information made available. as these figures estimated by the working group (an annual increase of 1571 %) were not associated with evidence - based strategies, but rather on reports by various institutions and agencies whose reliability was questionable, the doubt still persists. following identical trends, and annual percent increases calculated above, there should have been an explosive hiv / aids epidemic in the country in 2005, this is not in evidence. nonetheless there is no denying the fact that there has been an increase in the number of hiv / aids cases in the country. my personal concern is that the inflated rates shown in 2003 by the unaids / who working group on global hiv / aids and sti surveillance, and estimates based on these figures may mask the true epidemic as and when it makes an appearance. this would be a national tragedy and may not be very far !
sex workers reported to engage in a combination of hiv risk practices such as having a high number of sex partners and engaging in unprotected sex with paying and non - paying partners. consistent condom use which is the key to preventing sexual transmission of hiv infection showed significantly low levels, most notably in msws and hsws. given the potential for the spread of hiv infection through unprotected anal sex, the progression of hiv in these populations and their possible role in bridging sexual networks to pwids is a cause for serious concern. service utilisation data from pakistan continues to show low levels of awareness about, and participation in, prevention programmes. this indicates the need to scale up interventions and bring substantial improvement in coverage to reach a larger proportion of these key populations .
pakistan: country profile. united nations office on drugs and crime. accessed on: 8 may 2006, [
4. use the evidence to suggest focused, targeted and cost effective and evidence - based response to hiv in the country.
hiv is an increasing health concern in pakistan with the number of cases growing . moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the aids epidemic to take hold in pakistan , mainly among injection drug users , male/female sex workers and repatriated migrant workers . aids may yet become a major health issue . the national aids programme ’s latest figures show that over 4,000 hiv cases have so far been reported since 1986 , but un and government estimates put the number of hiv/aids cases around 97,000 ranging from a lowest estimate of 46,000 to a highest estimate of 210,000 . more realistic estimates that are based on actual surveillance figures , however , suggest that this number may be closer to 40,000 – 45,000 . the overall prevalence of hiv infection in adults aged 15 to 49 is 0.1 % . ( 0.05 % if one accepts the lower estimates ) . officials say that the majority of cases go unreported due to social taboos about sex and victims ’ fears of discrimination . on the other hand , more detailed and recent data suggest that this may be an overestimate . 
hiv is an increasing health concern in pakistan with the number of cases growing. moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the aids epidemic to take hold in pakistan, mainly among injection drug users, male/female sex workers and repatriated migrant workers. aids may yet become a major health issue. the national aids programme ’s latest figures show that over 4,000 hiv cases have so far been reported since 1986, but un and government estimates put the number of hiv/aids cases around 97,000 ranging from a lowest estimate of 46,000 to a highest estimate of 210,000. more realistic estimates that are based on actual surveillance figures, however, suggest that this number may be closer to 40,000 – 45,000. the overall prevalence of hiv infection in adults aged 15 to 49 is 0.1%. ( 0.05% if one accepts the lower estimates). officials say that the majority of cases go unreported due to social taboos about sex and victims ’ fears of discrimination. on the other hand, more detailed and recent data suggest that this may be an overestimate.
hiv is an increasing health concern in pakistan with the number of cases growing. moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the aids epidemic to take hold in pakistan, mainly among injection drug users, male/female sex workers and repatriated migrant workers. aids may yet become a major health issue. the national aids programme ’s latest figures show that over 4,000 hiv cases have so far been reported since 1986, but un and government estimates put the number of hiv/aids cases around 97,000 ranging from a lowest estimate of 46,000 to a highest estimate of 210,000. more realistic estimates that are based on actual surveillance figures, however, suggest that this number may be closer to 40,000 – 45,000. the overall prevalence of hiv infection in adults aged 15 to 49 is 0.1%. ( 0.05% if one accepts the lower estimates). officials say that the majority of cases go unreported due to social taboos about sex and victims ’ fears of discrimination. on the other hand, more detailed and recent data suggest that this may be an overestimate.