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
Introduction
Ty p e s
HIV – 1:
Common worldwide
HIV – 2:
Primarily in West Africa,
Mozambique and Angola
Introduction
Te r m s t o K n o w
Endemic?
Epidemic?
Pandemic:
When an epidemic
spreads throughout the world
AIDS
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
Global Snapshots
Global Snapshots
Timeline of HIV
Global Snapshots
HIV – Pandemic
Source: UNAIDS 2008 Global Report
Global Snapshots
Regional Funding
Annual global expenditure on HIV/AIDS is 7,375 Million US $ approximately.*
Sub-Saharran Africa
5%
5%
5%
East and South Asia
5%
Middle East
North Africa
Carribean
55%
25%
Latin America
*UNAIDS – Knowledge Centre. Available at http://www.unaids.org/en/KnowledgeCentre/HIVData/Tracking/
Global Snapshots
Impact 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
Course of Disease
Stages of HIV Infection
HIV can be transmitted during EACH stage…
START
HIV
Infection
HIV multiplying in
the body
3 to 6
months
HIV -ve
HIV +ve
DEATH
AIDS
Symptomatic
Up to 10
years
Asymptomatic
Course of Disease
Modes of Spread
Course of Disease
Misconceptions–Spread
Eating together
Hugging, kissing
Insect and mosquitoes bites
Handshake
Course of Disease
Misconceptions –Spread
Coughing, sneezing
Work, school contact
Playing together
Sharing toilets
“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
Course of Disease
Diagnosis
Laboratory Investigation
ELISA
Confirmatory Tests
Culture for HIV
Clinical
Diagnose AIDS
Course of Disease
W i n d o w P e r i o d f o r Te s t i n g
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
Course of Disease
Prevention
Preventable –No Cure
Screen all blood and blood products
Identify and treat STIs
Treat drug dependence
Universal precautions on safe sex
Course of Disease
Prevention
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
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
National Context
H I V Tr a n s m i s s i o n
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%
National Context
Core 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%)
National Context
Bridging Population
Clients of FSWs and MSMs
Spouses of core group members
Long-route Truck Drivers
Jail Inmates
Repatriating Labor Force
National Context
Projections
New infections in a year
300000
250000
200000
150000
100000
50000
0
IDU
Sex worker
Client
Gen female
MSM/MSW
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)
Pakistan’s Response
Selected 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
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
Focusing FSWs
Vu l n e r a b i l i t y
Limited access to:
Health
Social, legal services
Sexual exploitation & trafficking
Lack of protective legislation & policies
Focusing FSWs
Vu l n e r a b i l i t y
Gender related differences & inequalities
Stigmatization and marginalization
Exposure to lifestyles associated risks
Violence, mobility & substance abuse
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
32
Female Sex Workers in Lahore
Number has increased
and spread over the city
Historically known
Red Light Area
33
Focusing FSWs
Approach
Drop in
center
Clinic
Facility
Based
Referral
Community
linkages
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
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
SHCs for FSWs
SHC
Singpura
Badami
Bagh
China
Scheme
Bajwa
chowk
Gulbahar
Coloney
Medina
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
37
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
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
Focusing FSWs
Drop-In Center
Provision of social gatherings
Dance classes
Counseling services
Provision of condoms
PHC, STIs care
40
Focusing FSWs
Tr e n d s o f S T I s i n F S W s
Number of STI Cases
250
Increased awareness
and timely treatment
200
150
100
50
Initial Increased
detection
0
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19
Project timeline (quarters)
Focusing FSWs
Achievements
Awareness on HIV/AIDS
120%
98%
100%
93%
91%
80%
60%
60%
46%
40%
32%
20%
0%
Through Sex
Infected blood
Before
Contaminated syringe
After
42
Focusing FSWs
Consistent use of condoms 10/10
Achievements
60%
70%
60%
50%
40%
30%
20%
13%
10%
0%
Before
After
43
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
44
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
45
Health and Media
Rationale
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.
Health and Media
Specialized 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
Health and Media
Role of Journalists
General Awareness
Prevention
Advocacy
Opinion leaders
Decision Makers
Highlighting the issue:
Reportage on HIV/AIDS
Sensationalism
Feature Writing
Conclusion
It is bad that people are
dying of AIDS………….
But no one should die of
ignorance!
Course of Disease
FA Q s
Do people with HIV have AIDS?
Do people with HIV always look sick?
Is there a vaccination against HIV infection?
Is donating blood safe?
Pakistan’s Response
Source and Spending
Expenditure in 1,000 US $
3500
3000
2500
2000
1500
1000
500
0
Domestic
International
Source: UNAIDS Pakistan’s Resource Tracking Available at: http://www.unaids.org/en/CountryResponses/Countries/Pakistan.asp
Pakistan’s Response
Categorical Expenditure
Prevention
1% 2%
Care and Treatment
4%
3%
Management
Enabling Environment
10%
OVC
Incentives for HR
Social Protection
8%
Research
1%
71%
Focusing FSWs
Enabling Environment
Empower target population
Discrimination
Harassment
Stigma
Knowing their rights
Refuse sex without using a condom
Understand legal issues and have legal support
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