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

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

4. 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

5. PROVINCECITYSPOTS Estd Nos. SINDKarachi 693 693 9,700 9,700 Hyderabad 225 225 2,200 2,200 Sukkhur 332 332 2,250 2,250 Larkana 375 375 1,450 1,450 PUNJABLahore 736 736 3,200 3,200 Faisalabad 940 940 6,400 6,400 Multan 281 281 8,90 8,90 Gujranwala 431 431 2,100 2,100 Sargodha 245 245 2,050 2,050 NWFPPeshawar 84 84 430 430 Bannu 53 53 100 100 BCHISTANQuetta 47 47 190 190 IDUs - Estimates

6. IDUs : Coverage Estimates City Estimated No of IDUs Sample Size Ever utilized services % Utilization Faisalabad5,2444006316 % Hyderabad1,0033983910 % Lahore2,56040020852 % Multan*800400NA- Peshawar30028311641 % Karachi12,282--32% Quetta1511452114.5% Sukkur*2,234402NA-

7. 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.

8. 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

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

10. 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