HIV in PAKISTAN The National Response National AIDS Control Program Ministry of Health, Pakistan

Cities reporting HIV epidemics among IDUs in Pakistan Peshawar Bannu Sialkot Lahore Sargodha Faislabad Gujranwala Multan Quetta Larkana Sukkhur Hyderabad Karachi

INJECTION DRUG USERS - Estimates Total Drug users in Pakistan : 3.01 million* Opium & Heroin users in Pakistan : 500,000** Injection Drug users : 60,000 to 100,000** Punjab : approx 35,000 to 50,000 Sind: approx 30,000 to 40,000 Balochistan: approx 3,000 to 5,000 NWFP : approx 2,000 to 3,000 * PNCB 1993 ** UNODC 2005 & Surveillance Data 2006

PROVINCECITYSPOTS Estd Nos. SINDKarachi ,700 9,700 Hyderabad ,200 2,200 Sukkhur ,250 2,250 Larkana ,450 1,450 PUNJABLahore ,200 3,200 Faisalabad ,400 6,400 Multan ,90 8,90 Gujranwala ,100 2,100 Sargodha ,050 2,050 NWFPPeshawar Bannu BCHISTANQuetta IDUs - Estimates

IDUs : Coverage Estimates City Estimated No of IDUs Sample Size Ever utilized services % Utilization Faisalabad5, % Hyderabad1, % Lahore2, % Multan*800400NA- Peshawar % Karachi12, % Quetta % Sukkur*2,234402NA-

Services provided to IDUs - DIC’s and Mobile DICs  Social services  Behavior change  Peer outreach through motor bikes  Primary Health Care / STI’s : ASD & Refrerrals  Provision of condoms and lubricants  VCTC  ART  Detoxification and Rehabilitation.

Opportunities for scaling up  Commitment : Government (MoH, MNC, ANF, MoSW) NGOs, Community  Capacity available at local level  Availability of skilled Human resource  Data base available for planning targeted interventions  Comprehensive surveillance system available for monitoring

 Rapidly changing drug scenario  Resources : financial  Legal barriers Challenges for scaling up

Scaling up of existing services Mapping Mapping New sites included New sites included 80% coverage 80% coverage Government initiative Inclusion of Oral Substitution Therapy Next Steps