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HIV-AIDS PAKISTAN

HIV-AIDS PAKISTAN. Dr. Naeem uddin Mian. Overview. Introduction Global Snapshots Course of Disease National Context and Response Health and Media Conclusion. Introduction Key Concepts. What is HIV? Human Immunodeficiency Virus What is AIDS? Acquired Immune deficiency Syndrome.

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HIV-AIDS PAKISTAN

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  1. HIV-AIDS PAKISTAN Dr. Naeem uddin Mian

  2. Overview • Introduction • Global Snapshots • Course of Disease • National Context and Response • Health and Media • Conclusion

  3. IntroductionKey Concepts • What is HIV? Human Immunodeficiency Virus • What is AIDS? Acquired Immune deficiency Syndrome

  4. IntroductionTypes • HIV – 1: • Common worldwide • HIV – 2: • Primarily in West Africa, Mozambique and Angola

  5. IntroductionTerms to Know • Endemic? • Epidemic? • Pandemic: When an epidemic spreads throughout the world AIDS

  6. Global Snapshots • 60 Million people have been infected to date –more than 1/3rd have died • 2ndleading cause of death in 25-44 years old men • 2.5 Million victims are children < 15 years • Young people’s epidemic

  7. Global Snapshots

  8. Global SnapshotsTimeline of HIV

  9. Global SnapshotsHIV – Pandemic Source: UNAIDS 2008 Global Report

  10. Global SnapshotsRegional Funding Annual global expenditure on HIV/AIDS is 7,375 Million US $ approximately.* *UNAIDS – Knowledge Centre. Available at http://www.unaids.org/en/KnowledgeCentre/HIVData/Tracking/

  11. Global SnapshotsImpact of HIV Pandemic • Negative economic impact on countries • Overwhelmed healthcare system • Human Capital Loss • Decreasing life expectancy • Deteriorating child survival rates • Increasing numbers of orphan

  12. Course of DiseaseStages of HIV Infection HIV can be transmitted during EACH stage… START HIV Infection HIV multiplying in the body HIV -ve 3 to 6 months HIV +ve DEATH AIDS Up to 10 years Symptomatic Asymptomatic

  13. Course of DiseaseModes of Spread

  14. Course of DiseaseMisconceptions–Spread • Eating together • Hugging, kissing • Insect and mosquitoes bites • Handshake

  15. Course of DiseaseMisconceptions –Spread • Coughing, sneezing • Work, school contact • Playing together • Sharing toilets

  16. “HIV does not make people dangerous to know, so you can shake their hands and give them a hug: Heaven knows they need it !” Princess Diana

  17. Course of DiseaseDiagnosis • Laboratory Investigation • ELISA • Confirmatory Tests • Culture for HIV • Clinical • Diagnose AIDS

  18. Course of DiseaseWindow Period for Testing

  19. Course of Disease Diagnosis • One should wait at least 12 weeks (3 months) from the time of possible exposure before taking the test. VCT Centers • Available • Affordable • Rapid • Reliable

  20. Course of DiseasePrevention Preventable –No Cure • Screen all blood and blood products • Identify and treat STIs • Treat drug dependence • Universal precautions on safe sex

  21. Course of DiseasePrevention UNIVERSAL PRECAUTIONS* • Abstinence or delaying first sex • Being faithful to one partner • Correct and consistent use of condoms *UNAID/WHO 2004 Report on the Global AIDS Epidemic

  22. National Context • 97,400 population having HIV/AIDS* • Registered 5,592cases of HIV* • Registered 506 cases of full blown AIDS* • Less than1% HIV-Infected people receive Antiretroviral Therapy *NACP Statistics. Available at http://www.nacp.gov.pk/library/newspaper_clippings/the%20news%20april%2021-2010.pdftill December 2007

  23. National ContextHIV Transmission Pakistan is having less than 0.1% prevalence of HIV • Heterosexual intercourse 67% • Contaminated blood and blood products 18% • Homosexual or bisexual sex accounts 6% • Injecting drug use accounts 4% • MTCT 1.3%

  24. National ContextCore Groups • Female Sex Workers (FSW) Less than 1 % • Men having Sex with Men (MSM) Approx. 1.5% • Intravenous Drug Users Approx. 16,000 (15.8%)

  25. National ContextBridging Population • Clients of FSWs and MSMs • Spouses of core group members • Long-route Truck Drivers • Jail Inmates • Repatriating Labor Force

  26. National ContextProjections

  27. Pakistan’s Response • National AIDS Control Program established in 1986-87 • Support from International Agencies for coordinated action • UNAIDS, World Bank, UNICEF, WHO, DFID, GFATM, GTZ, UNODC, CDC, UNFPA • Preventive and support projects for: • Core Groups • Bridging Population (except Clients)

  28. Pakistan’s ResponseSelected interventions • Harm reduction for injecting drug users; • Provision of comprehensive health care for male and transgender sex workers; • Provision of targeted behaviour change communication on reducing HIV risk; • Provision of comprehensive sexual and reproductive health care in public facilities which is accessible to female sex workers; • Use of public funds to support NGOs

  29. Pakistan’s Response • Focusing FSWs • Services for FSWs • Metropolitan area of Lahore • Public-Private Partnership • Quasi-legal Issue • Implementation • PHC coupled with outreach • Peer Educators

  30. Focusing FSWs • Vulnerability • Limited access to: • Health • Social, legal services • Sexual exploitation & trafficking • Lack of protective legislation & policies

  31. Focusing FSWs • Vulnerability • Gender related differences & inequalities • Stigmatization and marginalization • Exposure to lifestyles associated risks • Violence, mobility & substance abuse

  32. International Image of FSW In Pakistan FSW dresses and poses in a normal way. In most cases they wear a veil The only visible FSW the Dancing Girl

  33. Female Sex Workers in Lahore Number has increased and spread over the city Historically known Red Light Area

  34. Focusing FSWs • Approach • Drop in center Stakeholders Stakeholders • Facility Based • Clinic • Community linkages • Referral

  35. Focusing FSWs • Scope of Work • Safe and attractive drop in center • Identification of high risk groups • Provision of Primary Health Care (PHC) • Treatment of Sexually Transmitted Infections (STIs) • Sexual health education • sufficient availability of condoms and provide negotiation skills

  36. Focusing FSWs • Scope of Work • Behavior change communication (BCC) • Voluntary Counseling & Testing (VCT) • Create an enabling environment • Promote empowerment and social development activities among FSWs • Ensure that HIV+ FSWs receive appropriate care and support

  37. SHC Singpura SHCs for FSWs China Scheme Badami Bagh Bajwa chowk Medina coloney Gulbahar Coloney Railway station Hotels SHC Mecca Colony Shahdara Enhancing outreach Munshi Bagh Ladha Karim Park Data Darbar SHC Shahnoor SHC Tehsil Bazar, RLA Iqbal Town Jhugian Gulshan Ravi Samanabad

  38. Focusing FSWs • BCC at SHCs • IPC • Registration • 7500 FSWs • 4-5 education & counseling session Modes of transmission & prevention of HIV/AIDS Signs & Symptoms of STIs Negotiation skills for condom use Condom demonstration VCT

  39. Focusing FSWs BCC Campaign • Peer education • Mass Media • Print (Brochures, Souvenirs) • Electronic (Film shows, Cable TV) • Telephonic Helpline • Community events • Seminars and meetings A pictorial guide on STIs in Urdu

  40. Focusing FSWs • Drop-In Center • Provision of social gatherings • Dance classes • Counseling services • Provision of condoms • PHC, STIs care

  41. Focusing FSWs • Trends of STIs in FSWs Increased awareness and timely treatment Initial Increased detection

  42. Focusing FSWs • Achievements

  43. Focusing FSWs • Achievements

  44. Focusing FSWs • Challenges and Constraints • Illegality • Policy conflict • Multiple Partners, Male/ Female • High rates of STIs/ Complications • Stigma, discrimination and social exclusion • Sexual violence • Invisibility and denial

  45. Focusing FSWs • Challenges and Constraints • Sex workers on the move • Anal sex more risky • High turn over of Peer Educators • Low level of literacy • Poverty • police intervention

  46. Health and MediaRationale • In Pakistan only 44% of women have heard of word HIV/AIDS* • Less than 2% of vulnerable population is aware of VCT Centers** • Only 13% of FSWs consistently use Condoms** • Only about half of the IDUs know that HIV could be transmitted through sharing of unclean needles* * Rai M. A. Warraich H., Ali S. H., Nerurkar V. HIV/AIDS in Pakistan: the battle begins. Journal of Retrovirology. 2007: 4:22. ** Contech International’s FSW Program Report 2004-2009.

  47. Health and MediaSpecialized Health Media Shifting information into palatable, tuneful and appealing messages for target community Knowledge Creativity Key source of scientific, evidence based Information Medium Dissemination - Print & Electronic

  48. Health and MediaRole of Journalists • General Awareness • Prevention • Advocacy • Opinion leaders • Decision Makers • Highlighting the issue: • Reportage on HIV/AIDS • Sensationalism • Feature Writing

  49. Conclusion It is bad that people are dying of AIDS…………. But no one should die of ignorance!

  50. THANK YOU!

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