Drug-Related HIV Epidemic in Pakistan: A Review of Current Situation & Response & The Way Forward Beyond 2015

Pakistan is among four countries in Asia where the estimated number of new HIV infections has been increasing year by year ever since 1990. The Asian Epidemic Modelling (AEM), conducted in 2015, reconfirmed that the use of contaminated injection equipment among people who inject drugs (PWID) remains the main mode of HIV transmission in the country. The estimated number of PWID ranges from 104,804 to 420,000 PWID. HIV prevalence in this population is above 40 % in several cities, including Faisalabad (52.5 %), D.G. Khan (49.6 %), Gujrat (46.2 %), Karachi (42.2 %) and Sargodha (40.6 %), respectively. Harm reduction service delivery is being implemented through a public-private partnership led by the National and Provincial AIDS Control Programmes and Nai Zindagi with funding support from the Global Fund. Current programmatic coverage of the needle and syringe programme, HIV testing and counselling and antiretroviral treatment among PWID remain insufficient to control ongoing transmission of HIV in the country. While opioid substitution therapy (OST) is yet to be introduced, significant progress and coordination among various ministries have taken place recently to register buprenorphine in the dosage required for treatment of opioid dependence, and possible introduction of OST will greatly facilitate adherence to antiretroviral treatment among PWID living with HIV...

The findings from the household survey indicated that an estimated 860,000 people, or 0.8 % of the population aged 15–64, used heroin regularly. Based on the findings from the problem drug use survey, an estimated 430,000 (range 190,000 to 657,000), or 0.4 % (range 0.3 to 0.5 %) people aged 15–64, inject drugs. Among these, 78 % injected heroin and the remaining injected pharmaceutical opioids, including morphine, pentazocine or pethidine, and tranquilisers for non-therapeutic purposes. Poly drug use was a common phenomenon with over 75 % of opioid users injecting a combination of substances. In this survey, the majority reported injecting two to four times a day…

Ensuring access to and adherence to ARVs among people living with HIV, especially those who inject drugs, has the potential to prevent much of the ongoing transmission of HIV in Pakistan. Given low rates of HIV testing and counselling overall, and among PWID in particular, there is a need to explore new approaches that will attract much larger numbers of PWID to test for HIV so that those who test positive can benefit from treatment. Eventual introduction of OST will greatly improve adherence to ART, leading to the suppression of viral load among HIV-positive PWID and consequently averting new cases of transmission of HIV from this population.

The voice of people who inject drugs is mostly silent in national policy making, planning, implementation, monitoring and evaluation processes. With support from the International Network of People who use Drugs (INPUD) and Mainline, The Association of People Living with HIV/AIDS (APLHIV) has in 2015 launched a Drug Users Network (“DUNE”). The mission of DUNE is to mobilise community leadership in order to influence laws, policies, programmes and funds through meaningful involvement of people who use drugs. It is anticipated that the formation of such a national network will enhance the representation and voice of people who use drugs in relevant fora...

  

Full article at: http://goo.gl/AZOC6j

By: Anne Bergenstrom^1*, Baseer Achakzai², Sofia Furqan², Manzoor ul Haq³, Rajwal Khan⁴and Marc Saba⁴

¹United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic Enclave-II, G-4, Islamabad 44000, Pakistan

²National AIDS Control Programme, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan

³United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic Enclave-II, G-4, Islamabad 44000, Pakistan

⁴UNAIDS Country Office for Pakistan & Afghanistan, Level-5, Serena Business Complex, Khyaban-e-Suhrwardy, Islamabad, Pakistan

  

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