1. Scaling-up harm reduction services towards universal access in Asia Models of good practice ICAAP IX Bali, Indonesia Nai Zindagi, Pakistan

2. The Context 15% yearly shift to injecting Majority men of which 50% are married with 4 children 20% HIV prevalence among persons injecting drugs and up to 15% among their wives Mostly poor and uneducated Injecting drug use driven epidemic in Pakistan Potential future injectors

3. Coverage Government financed- Civil Society implemented partnerships 15-18% have access to HIV prevention services Services include SEP, minus OST Quality of services varies Mechanisms of engagement and monitoring in place Scale up is possible

4. Outcome and Impact Public-Private Partnerships work Uninterrupted, at scale and consistent availability of services reduces transmission and incidence of HIV Where programs exist coverage has been above 80%, resulting in a decrease and/or maintained prevalence Transmission of HIV among people using drugs can be reduced with appropriate targeted interventions if initiated timely

5. Some lessons Trust and time to build partnerships Ownership - essential to mobilize Compensate for weaknesses and strength Accountability and transparency Inclusion - not exclusion Avoid pilots if you know it works - go to scale

6. Proposed scale up 2010-2014 Province wide contracts to reach 60% coverage by 2012 Resource allocation expected from Government and Global Fund Round 9 Proposed program includes OST and services for wives and children Access to HIV and AIDS services included Evidence based workable plan, dependent on resources

7. Our approach HIV & AIDS Drug Use Poverty Client conceptualized and client driven Drug treatment services (40%) HIV prevention and AIDS related services (80%) Skills training and employment (20%)

8. Thank you