HIV/AIDS PREVENTION IN PAKISTAN (www.nacp.com.pk)

BACKGROUND:

In Pakistan, the burden of disease has not been very significant which is derived from the fact that the HIV prevalence in the country is still below 1% although existing behaviour patterns and services signify it to be a high risk situation. Up until end December 2003 1951 cases of HIV and 246 AIDS cases have been reported to the NACP, the actual number is however, believed to be higher due to under reporting. Based on the limited surveillance data and computer modeling, UNAIDS has estimated that there are about 70,000-80,000 HIV positive people, approximately 0.1% of the total adult population.

Pakistan’s response to HIV/AIDS began in 1987 with WHO support. The first government financed program was initiated in early 1990 with a focus on HIV/AIDS case detection. In 1994 the Programme was scaled up to include information education, blood screening and developing provincial implementation units, at a cost of Rs. 774.35 million. In 1999 and 2000, GoP with the assistance of UNAIDS and other development partners undertook a strategic planning exercise with input from all stakeholders. The framework envisages multi-sectoral response and development of partnerships and collective action, essential for decreasing the vulnerability of Pakistan population. The Government of Pakistan is expanding its response to HIV/AIDS by translating the strategic plan into action through the Enhanced HIV/AIDS Programme.

• The Enhanced Programme will address the important issues related to HIV/AIDS, while prioritizing the interventions and broadly encompasses the following actions:

• Controlling the spread of HIV/AIDS so that it does not further drain the limited health sector resources.

• Providing an example of successfully and rapidly scaling up important communicable disease control activities using targeted approach.

• Helping introduce a systematic approach to quality assurance including effective monitoring and supervision.

• Helping to establish a mechanism for the Government to work with the private sector on a larger scale especially in the delivery of services to the vulnerable populations.

 The components of the program include:

 Expansion of Interventions for Vulnerable Populations:

The component aims to increase prevalence of safe behaviors among vulnerable populations and improved availability of STI services. Vulnerable populations to be covered include sex workers, Hijras, men who have sex with men, injecting drug users and long distance truck drivers. This would be implemented through two sub-components:

• NGOs program for vulnerable populations

• Pilot testing of innovative approaches in order to cover street based commercial sex workers and MSM

 Improved HIV Prevention by the General Public:

The aim is to: "improve knowledge and practice of HIV preventive measures including use of high quality STI services by general adult population". This would be implemented through:

• Behavior Change Communication and Advocacy;

•  Targeted Interventions for Youth, Labor and Uniformed Personnel; and

• Improved Management of STI Services.

Prevention of Transmission through Blood Transfusion:

 The main objective of this component is to reduce transmission of HIV through transfusion of blood and blood products. The component would support establishment of national and provincial Blood Transfusion Committee/Authorities, human resource development, quality assurance, monitoring/supervision systems development and blood screening for HIV, Hepatitis B and C.

Capacity Building and Program Management:

 The program would strengthen capacity public and private sector to effectively manage HIV/ AIDS programs.  This would be achieved through four sub-components:

• Strengthening Program Management (including federal, provincial and other sector program units)

• NGO Capacity Development

• Second Generation HIV Surveillance and Operational Research

• Strengthening management & care for people living with HIV/AIDS

PROGRESS ON ACHIEVEMENTS:

Creation of enabling environment:

§      The Program is undertaking the implementation of a specific Behaviour Change Communication strategy aimed at creating an enabling environment for People living with HIV/AIDS as well as providing adequate and upto date information to vulnerable and general populations. The  focus of interventions would be on:

§         Advocacy.

§         General awareness.

§         Skill development of health care workers.

§         Education n use of condoms for disease prevention and

§         Education for infection control in hospital/clinic settings.

§         Advocacy/sensitization sessions have also been planned (and are being implemented) for key policy makers and opinion leaders at the federal, provincial and selected district levels.

§       Development and strengthening of institutional mechanisms and linkages for multi-sectoral coordination and collaboration through the establishment of National and Provincial Steering Committees and Technical Advisory Committees is envisaged.

§       Development/adaptation of training modules/national guidelines and educational material for health care workers in HIV related areas such as clinical management of HIV/AIDS, syndromic management of STIs, Quality Assurance in Blood Transfusion, Infection Control in blood banks and management of blood bank waste, Voluntary Counseling and Testing for HIV/AIDS.

§         The BCC campaign would also focus on reducing the stigma and discrimination against PLWHA and increasing their access to adequate and affordable treatment both for opportunistic infections as well as anti-retroviral therapy.

Adequate and equitable access to health care services including HAART:

§         The major bulk of interventions have been designed for delivery of a defined package of services to the vulnerable groups which includes; sex workers, MSM, IDUs, long distance truckers, migrant workers etc. The service delivery include primary health care, access to adequate information and education, prevention and treatment of STIs, skill development and provision of Voluntary Counselling and Testing facilities. Currently the Programme is in the process of finalization of overall managing firm for service delivery to the vulnerable groups.

§         Five centers of excellence are being established in all Provincial capitals and the federal territory for the provision of comprehensive care and management to AIDS patients including provision of combination anti retroviral treatment to HIV positive patients. Training of health professionals (doctors and support staff) is being carried out with assistance from development partners. Provision of Anti-Retroviral Therapy for PLWHA is being supported by the project under the Global Fund for AIDS Tuberculosis and Malaria.

§         Interventions for in-school youth in private sector in six cities and street youth in three cities in the country.

§         Provision of HIV screening kits to registered private sector blood banks.

§         Establishment of 16 VCT centres country wide including areas where service delivery packages are in place to facilitate referrals.

§         Development of a peer education program to enable members of the vulnerable populations to protect themselves and their peers from HIV infection.

§         Enhanced capacity of NGOs to provide services to the vulnerable groups.

§         Development of an instructional package for students and teachers at secondary level with a focus on increasing awareness of HIV/AIDS.

§         A comprehensive education and information program for orientation of the migrant labour, staff of Bureau of Immigration, Protectorate of Immigrants and the Social Security Systems, in collaboration with the Ministry of Labor, Manpower and Overseas Pakistanis.

§         Condom promotion for disease prevention.

Resource mobilization and linkages with partners:

§         The Enhanced Programme is a multisectoral Programme with greater involvement of sectors other than health including Ministry of Population Welfare, Education, Labour and Manpower, Information, Interior and others.

§         The interventions for the vulnerable groups would be achieved through the Non Governmental Organizations making use of their experience of working with these groups. This would also improve and build upon public private partnerships.

§         Enhancement of public private partnership by providing technical and financial support to NGOs is also envisioned in the Programme.

§         Pakistan is also the first country in the region with successful application to the Global Fund in the second round of proposals and funding for initial two years of the project has been approved by the GFATM Secretariat. Proposal has also been submitted for the fourth round to the GFATM Secretariat.

§         Pakistan is also part of a Regional Proposal submitted by the countries of the SAARC Region to reduce the vulnerability of migrant populations in the Region to HIV/AIDS.

§         The Programme also has close linkages with international and bilateral donors and is being supported in the implementation of prevention interventions as follows:

§         Establishment of second generation surveillance system by CIDA.

§         National prevalence study of RTIs/STIs by DFID.

§         Harm reduction Programme for injecting drug users in six cities of the country by DFID.

§         Interventions for youth and adolescents by UNICEF and USAID.

§         Development and enhancement of private sector/NGOs through the NGO consortia on HIV/AIDS by the European Commission through Interactwide.

§         Local development of ARV is currently not part of the national strategy as the epidemic level is low.

Integration of prevention and treatment Programmes:

§         Utilization of existing networks of tertiary and secondary health care facilities and outreach workers and enhancing their skill for provision of HIV/AIDS and STI services.

§         Integration of STI services into general health care services at hospital level.

§         Improved availability of STI services in the private sector where NGOs are providing services to the vulnerable groups.

§         Strengthening of financial management system and procurement in order to ensure timely and uninterrupted supply of logistics and services.

§         Integration of HIV/AIDS and STIs services at PHC level by using the Lady Health Workers through awareness raising and strengthening of referrals

Capacity development:

 §         The capacity building would be done in terms of appropriate staff mix and skill mix; Exchange visits to other countries and training programs in the areas of STI services, monitoring and QA in Blood Transfusion services, higher degree courses for program staff.

 §         NGO capacity development through small grants scheme for HIV/AIDS related issues.

§         Training of master trainers and conduction of subsequent trainings on HIV/AIDS and STI related issues.

§         Training of health care workers, travel agents, staff of Ministry of Population Welfare, Bureau of Emigration, Social Security Services, Sensitization of Journalists and Media Personnel on HIV/AIDS related issues.