1. 1 HIV and AIDS Data Hub for Asia-Pacific Review in slides Pakistan

2. HIV and AIDS Data Hub for Asia-Pacific Content Basic socio-demographic indicators HIV prevalence and epidemiological statusHIV prevalence and epidemiological status (2001-2008) Vulnerability and HIV knowledgeVulnerability and HIV knowledge (2004-2008) Risk BehaviorsRisk Behaviors (2003-2008) Economics of AIDSEconomics of AIDS (2001-2008) National ResponseNational Response (2005-2008) 2

3. HIV and AIDS Data Hub for Asia-Pacific 3 Basic socio-demographic indicators Source: 1a 2007 UN Population Division cited in WHO, UNAIDS and UNICEF. Epidemiological Fact Sheet on HIV and AIDS: Pakistan, July 2008 1b World Health Statistics 2008, cited in WHO, UNAIDS and UNICEF. Epidemiological Fact Sheet on HIV and AIDS: Pakistan, July 2008 1c UNESCO 2006, cited in WHO, UNAIDS and UNICEF. Epidemiological Fact Sheet on HIV and AIDS: Pakistan, July 2008 2 UNDP. Human Development Report, 2007/2008 3 World Development Indicators database. September 2008; http://ddp-ext.worldbank.org/. Data refers to the percentage of girls to boys enrolled at primary and secondary levels in public and private schools. UNESCO Institute for Statistics Total population (in thousands) 163,902 (2007) 1a Annual population growth rate 2.1% (2005-2010) 1a Population aged 15-49 (thousands) 85,305 (2007) 1a Percentage of population in urban areas 36% (2007) 1a Crude birth rate (births per 1,000 population) 27 (2007) 1a Under-5 mortality rate (per 1,000 live births) 97 (2006) 1b Human development index (HDI) - Rank/Value 136/0.551 (2005) 2 Life expectancy at birth (years) 63 (2006) 1b Adult literacy rate 50% (2006) 1c Ratio of girls to boys in primary and secondary education (%) 78 (2006) 3 GDP per capita (PPP, $US) 2,370 (2005) 2 Per capita total health expenditure (Int.$) 49 (2005) 1b

4. HIV and AIDS Data Hub for Asia-Pacific 4 Risk behaviours

5. HIV and AIDS Data Hub for Asia-Pacific % of IDUs who used sterile injecting equipment at the last time they injected by age group, 2007 Vs 2008 5 Sources: Pakistan_UNGASS Country Progress Reports, 2008 and 2010

6. HIV and AIDS Data Hub for Asia-Pacific IDUs with selected characteristics of injecting drug use, 2008 6 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

7. HIV and AIDS Data Hub for Asia-Pacific % of IDUs with selected injecting behaviors, 2008 7 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

8. HIV and AIDS Data Hub for Asia-Pacific % of IDUs sharing syringes/needles at last injection by city, 2008 8 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

9. HIV and AIDS Data Hub for Asia-Pacific 9 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008 % of IDUs who always used a new syringe for injection in the last month by city, 2008

10. HIV and AIDS Data Hub for Asia-Pacific Percentage of IDUs who reported the use of a condom at last sexual intercourse, by age group, 2007 Vs 2008 10 Sources: Pakistan_UNGASS Country Progress Reports, 2008 and 2010

11. HIV and AIDS Data Hub for Asia-Pacific % of IDUs having had sex with SWs in last six months by city, 2008 11 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

12. HIV and AIDS Data Hub for Asia-Pacific Trends of injecting alone and needle sharing behaviors among IDUs, 2005-2008 12 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

13. HIV and AIDS Data Hub for Asia-Pacific Trends of condom use in last commercial sex among IDUs, 2005-2008 13 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

14. HIV and AIDS Data Hub for Asia-Pacific Selected sexual behaviors among IDUs in the last 6 months, 2008 14 Source: Ministry of Health, HIV Second Generation Surveillance in Pakistan, National Report Round 3, 2008 Regular female sex partner Sexually active with regular female sex partner38.8% Condom use at last sex33.5% Had sex with FSWs Mean number of paid female partners2.9 Condom use in last sex with paid female sexual partner 31.0% Had sex with a MSW or HSW Condom used in last sex with MSW or HSW13.8% Lubricant use in last sex with MSW or HSW60.3%

15. HIV and AIDS Data Hub for Asia-Pacific Risk practices according to HIV status of IDUs, 2008 15 Source: Ministry of Health, HIV Second Generation Surveillance in Pakistan, National Report Round 3, 2008 Drug and injection practicesHIV (+ve) (%)HI V (-ve) (%) Injected heroin Injecting > three times a day * Injecting with a used syringe/ needle 66.2 16.2 21.2 58.9 13.8 22.7 Shared (passed) syringe/ needle on last time *19.117.1 Injection by professional injector on last time31.432.5 Sharing injection equipments **37.830.8 Had sex with FSW16.818.1 Had sex with MSW/ HSW12.514.3 * Statistically significant p value < 0.05 ** Statistically significant at p < 0.1

16. HIV and AIDS Data Hub for Asia-Pacific % of key populations at higher risk with overlapping risk behaviors in past six months, 2008-2009 16 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008 and special round for FSW, 2009_cited in UNGASS Country Progress Report, 2010

17. HIV and AIDS Data Hub for Asia-Pacific 17 Networking between IDUs and other most-at- risk populations, 2006-2007 Source: National AIDS Control Program, MoH, HIV Second Generation Surveillance in Pakistan, National Report Round II, 2006-2007

18. HIV and AIDS Data Hub for Asia-Pacific Percentage of MSWs and Hijra SWs who reported injecting drug use in the past six months, selected cities, 2008 18 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

19. HIV and AIDS Data Hub for Asia-Pacific % of female sex workers who used a condom with their most recent client by age group, 2007 Vs 2009 19 Sources: Pakistan_UNGASS Country Progress Reports, 2008 and 2010

20. HIV and AIDS Data Hub for Asia-Pacific % of MSWs and Hijra SWs who always used a condom with their clients in the last month by city, 2008 20 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

21. HIV and AIDS Data Hub for Asia-Pacific Sexual behaviors and practices of male sex workers, 2008 21 Source: Ministry of Health, HIV Second Generation Surveillance in Pakistan, National Report Round 3, 2008 Sexual behaviors and practicesPercent Consistent condom use with Commercial sex partner Non commercial sex partner 24.0 22.2 Paid anyone for anal sex in the past month4.5 Paid a female in the past month42.7 Alcohol/ drugs during sex in the past 6 months33.2 Injected drugs in the past 6 months4.2 Had sex with IDUs in the past 6 months6.4

22. HIV and AIDS Data Hub for Asia-Pacific % of condom use practices among MSWs and Hijra SWs with paying and non paying clients, 2008 22 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

23. HIV and AIDS Data Hub for Asia-Pacific Mean number of clients per month among MSWs and Hijra SWs by age group, 2008 23 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

24. HIV and AIDS Data Hub for Asia-Pacific Mean duration in sex work among MSWs and Hijra SWs, selected cities, 2008 24 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

25. HIV and AIDS Data Hub for Asia-Pacific 25 Percentage of MSWs and Hijra SWs who carried along a condom at the time of survey by city, 2008 Source: Pakistan_NACP, MOH, HIV/ AIDS Surveillance Project, HIV Second Generation Surveillance in Pakistan, IBBS round III, 2008

26. HIV and AIDS Data Hub for Asia-Pacific Trends of consistent condom use with clients by MSWs/ HSWs, 2005-2008 26 Source: Ministry of Health, HIV Second Generation Surveillance in Pakistan, National Report Round 3, 2008

27. HIV and AIDS Data Hub for Asia-Pacific Sexual behaviors and practices of Hijra sex workers, 2008 27 Source: Ministry of Health, HIV Second Generation Surveillance in Pakistan, National Report Round 3, 2008 Sexual behaviors and practicesPercent Consistent condom use with Commercial sex partner Non commercial sex partner 19.7 19.6 Lubricant use during last anal sex78.7 Alcohol/ drugs during sex in the past 6 months62.4 Had sex with IDUs in the past 6 months6.3 Injected drugs in the past 6 months4.6

28. HIV and AIDS Data Hub for Asia-Pacific Risk practices according to HIV status of Hijra sex workers, 2008 28 Source: Ministry of Health, HIV Second Generation Surveillance in Pakistan, National Report Round 3, 2008 Risk practices and knowledgeHIV (+ve) (%)HI V (-ve) (%) Always use condom *11.288.8 Took drugs through injection **12.787.3 Had sex with an IDU **31.432.5 Knows HIV spread by sex5.994.1 Knows condoms protects HIV *8.291.8 * Statistically significant p value < 0.05 ** Statistically significant p value < 0.05 by fisher exact test

29. HIV and AIDS Data Hub for Asia-Pacific 29 % of FSWs and MSWs reporting the use of a condom with their most recent client by age group, 2007 Source: UNAIDS, UNGASS Country Report Pakistan January 2006 to December 2007

30. HIV and AIDS Data Hub for Asia-Pacific 30 % of IDUs reporting the use of a condom the last time they had sex with various partners, Karachi and Rawalpindi, 2004-2005 Source: NACP, Integrated Behavioral and Biological Surveillance, A Pilot Study in Karachi and Rawalpindi, 2004-2005

31. HIV and AIDS Data Hub for Asia-Pacific 31 % of IDUs who adopted safe behaviors in Karachi and Lahore, 2005 Source: UNAIDS, UNGASS Country Report Pakistan, 2005 refers to National AIDS Control Program, Ministry of Health, Government of Pakistan, FHI, DFID. National study of reproductive tract and sexually transmitted infections: Survey of high risk groups in Lahore and Karachi, 2005. 2006 Safe behaviors include: - avoiding use of non-sterile injecting equipment - using condoms during sexual intercourse  Total IDUs sampled = 799  Lahore IDUs N= 397  Karachi IDUs N= 402

32. HIV and AIDS Data Hub for Asia-Pacific 32 % of IDUs who shared needles in the last week/year, 2005 Source: National AIDS Control Program, Ministry of Health, Government of Pakistan, FHI, DFID. National study of reproductive tract and sexually transmitted infections: Survey of high risk groups in Lahore and Karachi, 2005. 2006 28 6 48 21 28 35 82 51 0 10 20 30 40 50 60 70 80 90 Shared at last injection Share a needle at every injection last week Used an unsafe needle any time in the last week Injected in another city last year (%) KarachiLahore

33. HIV and AIDS Data Hub for Asia-Pacific 33 % of FSWs and MSWs who reported always using a condom with their clients in the last month, Karachi and Rawalpindi, 2004-2005 Source: NACP, Integrated Behavioral and Biological Surveillance, A Pilot Study in Karachi and Rawalpindi, 2004-2005

34. HIV and AIDS Data Hub for Asia-Pacific 34 % of FSWs who are exposed to injecting drug use in Karachi and Lahore, 2005 Source: National AIDS Control Program, Ministry of Health, Government of Pakistan, FHI, DFID. National study of reproductive tract and sexually transmitted infections: Survey of high risk groups in Lahore and Karachi, 2005. 2006

35. HIV and AIDS Data Hub for Asia-Pacific 35 % of MSWs reporting consistent condom use with different sex partners in Karachi and Lahore, 2005 Source: National AIDS Control Program, Ministry of Health, Government of Pakistan, FHI, DFID. National study of reproductive tract and sexually transmitted infections: Survey of high risk groups in Lahore and Karachi, 2005. 2006  Lahore MSWs N= 400  Karachi MSWs N= 407

36. HIV and AIDS Data Hub for Asia-Pacific 36 % of MSM reporting the use of a condom the last time they had anal sex with a male partner by age group, 2003-2005 Source: UNAIDS Report on the Global AIDS Epidemic, 2006

37. HIV and AIDS Data Hub for Asia-Pacific 37 % of truckers reporting commercial sex in Karachi and Lahore, 2005 Source: National AIDS Control Program, Ministry of Health, Government of Pakistan, FHI, DFID. National study of reproductive tract and sexually transmitted infections: Survey of high risk groups in Lahore and Karachi, 2005. 2006  Lahore Truckers N= 400  Karachi Truckers N= 402

38. HIV and AIDS Data Hub for Asia-Pacific 38 % of truckers who never used a condom with various partners, Karachi and Lahore, 2005 Source: National AIDS Control Program, Ministry of Health, Government of Pakistan, FHI, DFID. National study of reproductive tract and sexually transmitted infections: Survey of high risk groups in Lahore and Karachi, 2005- 2006  Lahore Truckers N= 400  Karachi Truckers N= 402

39. HIV and AIDS Data Hub for Asia-Pacific 39 THANK YOU slides compiled by www.aidsdatahub.orgwww.aidsdatahub.org Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge www.aidsdatahub.org if slides are lifted directly from this sitewww.aidsdatahub.org