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Voluntary counseling and Testing in Pakistan

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Voluntary counseling and Testing in Pakistan

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    1. Voluntary counseling and Testing in Pakistan Mr. (Dr.) Nadeem Ikram MBBS, DCP, FCPS (IMMUNOLOGY) National HIV/STI Referral Lab NACP, NIH, Chak Shahzad Islamabad, Pakistan

    2. Country Profile Population (2005) 159,196,336 Provinces 4 Area 2 , AJK Languages - Urdu Area: 796,095 sq km Currency Pak Rupee Capital - Islamabad Ethnic composition - Muslims 97%

    3. Location: Southern Asia, India on the east, Iran and Afghanistan on the west, China in the north and the Arabian sea in the south.

    4. Epidemiological Profile Estimated Prevalence: 0.1% NACP/MOH (using WHO/UNAIDS EPI Forecast Model) estimates the number to be approximately 80,000

    5. Current epidemiological trends Shift from low prevalence into concentrated stage HIV prevalence among IDUs and MSWs more than 5% In 2004, 2005 & 2006 predominant mode of transmission is I/V drug use (IBBS data) Increasing number of individuals being reported with HIV; men who have sex with men, hijras, female sex workers Increasing numbers of individuals having signs and symptoms related to early HIV infection are being reported to health care facilities

    6. Round One Surveillance Results

    7. Implications of the change HIV transmission through injecting drug use is highly dynamic explosive spread Drug user population is highly mobile Drug user population is not isolated and has links with other vulnerable populations in addition to general population (are married) Donate blood for money (paid donors) Burden on health systems Poor infection control practices High risk groups to general population Youth vulnerability- high

    8. Key Risk Factors in Pakistani Scenario Low literacy rates Silence and denial High Poverty levels Low spending on health and education High prevalence of risky behaviors Large number of internal and external migrants A high proportion of adolescents and young adults Gender inequalities

    9. Laboratory networks Central level : National Referral Laboratory Secondary level: Provincial Laboratories Primary level : VCT, ANC,TB, STI clinics Strengthen communication and collaboration between all levels in the network

    10. STRATEGIES STRATEGY I : Single assay Screening STRATEGY II : 2 different assays Surveillance STRATEGY III : 3 different assays Diagnosis

    11. Strategy III Pre-requisites Informed consent: Mandatory Testing is optional & voluntary Pre- and post-test counseling: Prepare for possible emotional trauma Complete confidentiality: of the test as well as of the individual

    12. Achievements to date Establishment of 16 VCT centres (both community based and hospital based) for general population VCT is an integral component of service delivery package( SDP) of 20 projects currently being implemented for most at risk population IDUs, FSWs, MSW/Hijra, truckers, jail inmates. 46 surveillance Centers for general population Quarterly reports from surveillance centers and blood banks data.

    13. Achievements to date Operationalisation of nine ARV treatment centers. Strengthening of blood transfusion services. Guidelines for QC in blood banking Human resource development - doctors and nurses in management of STIs and AIDS patients Procurement of drugs for STIs, OIs and ARV Service delivery to HRGs - scaling up still remains a challenge Advocacy/sensitization sessions for parliamentarians, political influentials, religious leaders, district government and policy makers

    14. CHALLENGES Varying level of political commitment at provincial & district level Limited non health sector involvement Limited private sector involvement General lack of access to information and resources on HIV/AIDS Difficult accessibility of high risk groups Local data on specific behavioural vulnerabilities of HRGs Access to youth both in-school & out-of-school Large un-regulated private sector catering to 60% of population needs Strengthening of BTS infrastructure

    15. CHALLENGES Epidemiological modeling based on available data Stigma related to STIs and myths and misconceptions related to STIs pilot projects focusing on sexual and reproductive health for youth Further need for multisectoral involvement in HIV/AIDS prevention activities Stigma and discrimination of PLWHA Strengthening of M&E plans for Programme implementation Availability of all regimens of ARV and their regular supplies High cost of treatment, diagnostics and treatment monitoring.

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