APN+ Monitoring Access to Treatment in Asia (MATA) Community service providers: A review of community friendly services in Pakistan

(For policy review work of APN+)

HIV epidemic in Pakistan is concentrated among key affected populations. People Who Inject Drugs (PWID) have highest HIV prevalence rate at (27.2% /2011) followed by transgender sex workers and male sex workers (MSWs) (5.2% and 1.6%, respectively). HIV prevalence among Female sex workers (FSWs) is at 0.6%.

The Bio-behavior surveillance suggests that 71.5% PIWD reported having 2-3 injections per day with only 39% using a new syringe (2011). 14% and 7.1% of PIWD reported paying for sex with FSWs and M/HSW respectively in the past six months. Among those only around 16% used condom in their last sexual act. In Pakistan, as elsewhere, contextual and structural changes are occurring in sex work. An increase in availability and use of cell phones has resulted in reduction of street-based sex work. As clients are increasingly making more direct contacts, sex workers are more dispersed and are more in accessible for HIV programs.

Pakistan has an estimated 98,000 people living with HIV by the end of 2009, with 5,256 PLHIV registered in 17 ART centers by end of 2011, including 189 children, 1,018 and 4,049 adult females and males, respectively. Out of these, 2,491 PLHIV are on ART of which 105 are children, 646 adult females and 1,740 adult males. Looking at recent trends there has been a gradual increase in the number of PLHIV registered at ART centers and on ART. On average, in 2011 there were around 40-45 new PLHIV starting on ART per month. (Pakistan Country AIDS Report-2012)

Major community actors in Pakistan:

APLHIV Pakistan The APLHIV-Pakistan was established in 2006 and got operationalized in 2008. In April 2006, the government of Pakistan and the UN Agencies under UNAIDS got together in Islamabad and decided to launch a nationwide network for the HIV community to form a strong national response to the epidemic while ensuring the involvement of the community members. The major purpose was to ensure that PLHIVs have equal rights and live with dignity and peace. Major achievements include expansion of APLHIV to provincial levels, maintaining 1st position in GFATM Round-10, community based monitoring of services, provision of toll free helpline services on 24/7 bases, running of two Global Fund projects and having project based funding from EU.

In addition to many successes in last one and half years, the biggest achievement that the APLHIV had is “community based monitoring of the services being provided to the community across the country”, this includes the monitoring of the services being provided both by the public and private sectors. It was proposed to the Global Fund that unless the feedback and the supervision of the services being provided to the community is not monitored by the people from within the community chances of improvement would be minimized. The view point of the APLHIV was acknowledged and it was decided that the APLHIV being a national network is the best placed to carry out the monitoring of services being provided. Thus the proposal was included in Phase II of GFATM Round-9 and same is being implemented in true spirit and litter. As a result the services have improved remarkably and the role of the APLHIV is being acknowledged by all the stake holders. In last three (3) months a total of 101 complaints were received which were adequately addressed to ensure the access of community to treatment, care and support services.

The APLHIV provides a respectful and safe venue where a wide range of organizations with differing missions come together to share HIV related information , engage themselves at the policy level, discuss best practices and engage in partnerships that increases the quality and impact of their work. For the first time since its inception the APLHIV gathered important central / Federal stakeholders including UN Agencies, INGO, NGOs, Government departments and CCM at its Federal secretariat in Nov 2013. The participants highly appreciated the impressive work of the APLHIV.

ART ADHERENCE UNIT (AAU): Nai Zindagi is one of the leading NGO’s working in Pakistan for HIV Community and the Injecting drug users across Pakistan. In early 2014, Nai Zindagi opened a new facility for people who used drugs (PWIDs) and are also HIV+. The facility is known as ART Adherence UNIT (AAU) and focuses on HIV treatment Adherence, stay healthy and live longer. This is the first Unit/ service of its kind in Pakistan. Here clients stay for 2 months, during which they receive counseling, education about HIV treatment, Physiological support, how to replace risks, managing emotions and find a new place in Community and within their families. The Unit has a capacity of 60 individuals, where complete package of therapeutic lectures and Medical Care is also offered. In house Programme, physical activities, confidence building activities like sharing the personal experiences, singing songs and writing personal diaries are major activities in the unit. The set of pictures under AAU, replicates the activities.

PIMS TREATMENT CENTER-ISLAMABAD: Pakistan Institute of Medical Sciences (PIMS) is one of the modern, leading and well equipped health facilities located in the capital city of Islamabad. Through an MOU this hospital also houses an HIV treatment Center, which was established in 2006. The center has over 1500 register HIV patients from across the country. The most experience, learned and highly qualified doctor, Dr. Rizwan Qazi, heads this center. Almost all the doctors dealing with HIV across the country have been trained by Doctor Qazi. This center also houses a PPTCT center, a VCT room and testing lab. All the services from diagnosis to treatment are offered here. Hundred of Patients get follow-up checkups every week. A delectated team of doctors including Dr. Naila and Dr. Mona, Male Counselor Mr.Nadeem and Miss Mussarat female Counselor assist Dr. Qazi in his work. Treatment Center is equipped with all basic facilities to have detailed checkup of the patients, VCT room which not only is used for counseling but posses all basic information about HIV, written in English & URDU. Medicines are kept here on slandered temperature. Various activities in the treatment center are attached in photo documentation.