1. Injecting Drug Users and HIV/AIDS in Pakistan
Zafar Fatmi
Associate Professor &
Head Division of Environmental Health Sciences
Department of Community Health Sciences
Aga Khan University

2. Acknowledgment
The information for this talk has been obtained from National AIDS Control Program website and published reports

3. Golden Crescent & Golden Triangle
(UN office on Drugs and Crime – UNODC, Pakistan)

4. Drug use in Pakistan
There has also been a shift towards injection drug use from inhalation or sniffing
National surveillance data indicate that injection drug users (IDUs) have been driving the HIV epidemic in Pakistan

5. Public health professionals from Pakistan recognize the importance of conducing research on IDU since the early 90s. The data for this publication was collected in 1996.

6. Results of IJID article - 1996
Cross sectional survey among IDUs in Karachi in 1996.
Of the 242 IDUs who consented to provide a blood sample “ONE (1)” was confirmed HIV positive. [Prevalence=0.4%]
47% had reported sharing needles.
22% reported indulging in unsafe sex.

7. IDUs in Pakistan (2011) Population 15-49 yrs No of IDUs
IDUs per 1000 Adult males
Both sexes
Male
Punjab total
9,303,044
4,781,942
15,932
3.3
Sind Total
12,286,980
5,917,679
27,040
4.5
KPK Total
2,004,646
1,047,911
2,343
2.2
Balochistan Total
914,103
498,125
1,034
2.0
All cities mapped total
24,508,773
12,245,657
46,349
3.7

8. Pakistan in a Concentrated Phase of HIV
Since 2004 Pakistan has been in a concentrated phase of the HIV epidemic.
HIV prevalence among IDUs in Pakistan has been consistently >5% for many years now.

9. HIV Prevalence in Risk Groups-2011
Ref: HASP National Dissemination January, 2012, Islamabad

10. Ref: Emmanuel, HASP National Dissemination January, 2012, Islamabad
HIV in Risk Groups 2004 to 2011
Ref: Emmanuel, HASP National Dissemination January, 2012, Islamabad

11. Comparison of HIV in Regional Cities

16. Pakistan’s Epidemic in Context
Asian epidemics often ignited by IDU epidemics and expanded and sustained by sex work networks.

17. “Concentrated” Epidemics – A Basic Overview
“Bridge” Population
“General” Population
Key
Population
(e.g. SW, IDU)

18. Model Development Observed levels and trends in HIV prevalence:
the start year of the epidemic
the rate of growth of the epidemic
the proportion of the population who are at risk at the start of the epidemic
the recruitment rate [or the rate at which at risk people who die due to AIDS or otherwise leave are replaced by new at risk individuals]

19. Estimated HIV Prevalence in Karachi

20. Estimated HIV Prevalence in Lahore

21. What should be Pakistan’s Strategic Priority?
Effective harm reduction programs for IDUs
Rehabilitation and drug substitution therapy immediately needed

22. Harm Reduction Program
Harm reduction services provided in Pakistan since 2000.
Services are interrupted due to administrative and bureaucratic hurdles
Some key services are:
Syringe and needle exchange program (SNEP)
Syndromic management of sexually transmitted infection (STIs)
Referral services to HIV positive IDUs to the ARV Center of Sindh AIDS Control Program
Primary health care services
Social services such as bathing, hair cut, nail clipping, occasionally providing clothes etc.
Wound dressing and abscess drainage

23. Harm Reduction Programs in Karachi
Three NGOs:
Pakistan Society
Al Nijat Welfare
Bridge Consultants Foundation
If their services reach optimum coverage level we can definitely see a reduction in HIV prevalence among IDUs