1. © Aahung 2004 Millennium Development Goals Expanding the Agenda:

2. © Aahung 2004 MDG Goals Goal 1 - Eradicate Extreme Poverty And Hunger Goal 2 - Achieve Universal Primary Education Goal 3 - Promote Gender Equality And Empower Women Goal 4 - Reduce Child Mortality Goal 5 - Improve Maternal Health Goal 6 - Combat HIV/AIDS, Malaria And Other Diseases Goal 7- Ensure Environmental Sustainability Goal 8 - Develop A Global Partnership Of Development

3. © Aahung 2004 Goal 6: Combat HIV/AIDS, Malaria And Other Diseases Target 1 Target 2 Have halted by 2015, and begun to reverse, the spread of HIV/AIDS (promote and protect) Have halted by 2015, and begun to reverse the incidence of malaria and other major diseases

4. © Aahung 2004 Targets and Existing Indicators Have halted by 2015, and begun to reverse, the spread of HIV/AIDS (promote and protect) Existing Indicators HIV prevalence among 15-24 pregnant women HIV prevalence among vulnerable groups (e.g. active sexual workers)

5. © Aahung 2004 Rationale for expanding indicators Pakistan is not a high prevalence country (adult prevalence rate 0.1 %) but is regarded as a “high risk country GOP recognizes this and has initiated a number of interventions to prevent the spread of HIV/AIDS in Pakistan In order to strengthen GOP commitment it is imperative to expand MDG indicators in order to ensure effective prevention of HIV/AIDS and other diseases Rationale

6. © Aahung 2004 Rationale for expanding indicators Data Total number of HIV cases documented 2431- NACP statistics (2004) Total number of AIDS cases documented 310 - NACP statistics (2004) Estimated number of HIV cases in 2003 – 74000 -UNAIDS statistics (low estimate) Estimated number of women (15-49) with HIV 8,900 in 2003– UNAIDS statistics Estimated number of deaths 4,900 in 2003 – UNAIDS statistics Reasons for vulnerability to HIV/AIDS: increase in poverty, gender inequality, un sterilized equipment and unscreened blood transfusions, high risk unprotected behavior (sex work), lack of knowledge about STIs and lack of access to formal health care, injecting drug users, homosexuality, increase mobility and migration for job opportunities

7. © Aahung 2004 Proposed indicators 1 STIs/HIV/AIDS, Hepatitis B are all transmitted through the exchange of bodily fluids Research has shown that the most common mode of transmission is through heterosexual intercourse (37%) followed by blood products (18 %), homosexual and bisexual sex (6 %), drug use (4 %), mother and child transmission (1.3%) and unknown means (35%) The most important measure to prevent transmission is the use of a condom. Therefore, condom prevalence rate must be measured in order to determine protection/prevention efforts and adoption of safe behaviors Condom Prevalence rate

8. © Aahung 2004 Proposed indicators 2 There is currently no means of tracking prevalence There is significant under reporting due to the social stigma attached to STIs Research has shown that 70 % of HIV carriers are between the ages of 20- 49 year (30.87% - 30-39 years, 22.47 % - 20-29 years, 17.63% - 40-49 years) The male – female ratio is 6:1 per 100,000. It is imperative to monitor prevalence amongst the general population disaggregated by gender and age as opposed to only between the ages of 15-24 as recommended in the MDG framework The significance of heterosexual transmission increases the female vulnerability to STIs/RTIs and HIV/AIDS, especially among those of reproductive age It is imperative to have the appropriate data in order to design and implement strategic programmes HIV/AIDS prevalence rate in the general population disaggregated by gender and age

9. © Aahung 2004 Proposed indicators 3 Percentage of primary health care facilities providing free, voluntary screening, counseling and treatment services for Hepatitis B /STI/HIV AIDS for men, women and young people, regardless of marital and HIV status Primary Health care facilities should provide free voluntary screening, counseling and testing facilities for Hepatitis B, STIs/HIV/AIDS for men, women and adolescents, regardless of marital and HIV status Government of Pakistan needs to integrate provision of free VCT services into their existing primary health care system in order to effectively utilize already scarce resources and to reach maximum population Data shows that 60 % of the population has access to primary health care facilities Provision of this service needs to be integrated as an indicator for monitoring the progress on achievement of Goal 6 within formal government machinery

10. © Aahung 2004 Proposed indicators 4 Percentage of schools and non-formal education centers providing Life Skills education and safe behavior practices Life Skill Education equips young people with adequate and appropriate sexual and reproductive health knowledge and encourages them to adopt safe/preventive behaviors (30 million young people 10-19 years) Life Skill Education includes topics such as: negotiation skills, body protection, confidence building, puberty, actual information on HIV/AIDS and other STIs, etc Ignorance of basic sexual and reproductive health information increases vulnerability to disease and infection Ignorance enhances unsafe behavior especially amongst young people both male and female and encourages isolation

11. © Aahung 2004 Proposed indicators 5 Percentage of government service providers who have undergone training/sensitization on gender, HIV/AIDS, SRHR and quality care. It is imperative to measure the numbers trained in SHR issues amongst government service providers in order to ensure effective service delivery Without skilled service providers there can be no effective implementation of SRHR programmes aimed towards preventing the spread of HIV/AIDS in Pakistan It is recommended that SRHR concerns be integrated into the curriculum of Lady health workers, male motivators, family planning based community workers, etc.

12. © Aahung 2004 Thank you