Focus on new HIV/AIDS prevention programme

A special programme launched in October to combat the spread of HIV/AIDS in Pakistan is the first of its kind and will be split up into four key components to help the most vulnerable populations defend themselves against the disease, according to an official. "It's the first time such a programme is being launched in Pakistan, with the primary assistance of the World Bank of about US $47 million," Dr Mohammed Imran, the acting programme manager of the National AIDS Control Programme (NACP), told IRIN in the capital, Islamabad on Wednesday. The project was also supported by the British government's Department For International Development (DFID), which works to alleviate poverty and promote sustainable development, and the Canadian International Development Agency (CIDA), Imran added. Finance Minister Shaukat Aziz announced the launch of the Enhanced HIV/AIDS Control Programme at a special ceremony in October, describing it as a project seeking key policy reform. "We believe that an efficient health services system helps in protecting the income of the poor and contributes to their greater self-reliance and social inclusion," he said. The new HIV/AIDS programme was a major undertaking and had generated a fair amount of apprehension among the NGOs which were to work in partnership with the NACP because of the sheer scale of the project, Dr Asif Aslam, a United Nations Children's Fund (UNICEF) official, told IRIN from the southern port city of Karachi. "The apprehension could be attributed to the fact that it's a fairly large programme, and there are a lot of imponderables that people have to consider. But this is a programme which has been needed for a while, it has a lot of activity focused on high-risk areas and cities, so it's definitely a step in the right direction," he added. Dr Sharaf Ali Shah, the head of the HIV/AIDS control programme in the southern province of Sindh, agreed, pointing out that the funding sanctioned for the campaign to stop the disease in its tracks was much greater than had ever been previously set aside, and this augured well for the programme's success. "Look at the budget: it's more than 10 times what we've had previously. Obviously, it's going to make a difference. But it all depends on the funds' utilisation and the level of commitment from the people supposed to be implementing it," he asserted. LOW PREVALENCE, HIGH RISK "Pakistan is a low-prevalence, high-risk country for HIV infections," a report, compiled by a special World Bank mission in the spring of 2001 said, adding that the most significant mode of transmission was sexual, identified in about 42 percent of the roughly 1,549 HIV cases and 202 AIDS cases reported by then. Most of the infections were among males, with a male-to-female ratio of 7:1, which was to be expected in the early stages of an HIV epidemic, the report said. "High priority should be given to interventions that seek to slow the transmission among high-risk groups, especially commercial sex workers and their clients," it stressed. The number of reported cases by 2003 had risen to 2,080 cases, both of HIV and AIDS, Imran said. "As far as the projections are concerned for unreported cases, we estimate that there are more than 80,000 such cases in Pakistan at present," he added. "The government has not always been so up-front about admitting the large number of people that have been identified as being HIV-positive, they've always been a bit careful about saying 'this is a problem', so just this means that things are moving ahead," Aslam said. At the end of September, the head of a private voluntary organisation working with AIDS and HIV-positive patients in the northwestern city of Peshawar warned of possible long-term ramifications if national authorities persisted with their apparent reluctance to acknowledge the large number of cases identified unofficially. "Instead of admitting to the constraints, the shortcomings within the system, they indulge in double-speak, quoting much lower figures than have been already ascertained at the nongovernmental level," Maimoona Masood Khan, the chief executive of All Women Advancement and Resource Development (AWARD), told IRIN from Peshawar. Meanwhile, social attitudes were a significant factor in dictating how people infected with the virus reacted to the thought of having to disclose the nature of their illness before seeking treatment, Haji Muhammed Hanif, the general secretary of an advocacy group called the AIDS Prevention Association of Pakistan, told IRIN in September from the eastern city of Lahore. FOUR COMPONENTS But things were now changing, with the introduction of the Enhanced HIV/AIDS Control Programme, Imran said. "The HIV/AIDS Prevention Programme has been split into four components to streamline its working, and the support of various NGOs will be enlisted to ensure that the project achieves its objectives," he added. Under the new programme, high-risk groups - sex workers, injecting drug users and long-distance truck drivers - would be focused upon, as health authorities sought interventions in the groups, as part of one phase, he explained. "The second component will also be dealing with similar groups, but focusing more on behavioural changes," he said, adding that the third and fourth components would focus on the prevention of HIV/AIDS through blood transfusions, as well as capacity building and an inbuilt surveillance programme. "If you look at the epidemiology surveys that have been conducted so far, there are no isolated cases. We have identified this in the early stages, which means that our surveillance system is working as well as it should," Shah stressed, pointing to his organisation's assessment of a sudden outbreak of HIV-positive cases in a prison located in a small rural town in Sindh. That particular outbreak yielded 17 HIV-positive cases in Larkana jail, which was always likely to happen because of a large population of injecting drug users, Aslam said. But, said Shah, it was still important for health authorities and the NACP to identify whatever trend existed before they could embark on measures to try and contain the damage. "How soon can this trend be identified? And how can it be reversed? We are already making an effort to arrest this trend. Once that is done, we will have to seek out measures to reverse it," he said. A case in point was the exceedingly large number of males identified as HIV-positive as compared to females, Shah argued. "It obviously has to do with the larger number of males that are tested, and then found to have the illness. If in a total of, say, 2,000 reported cases, only 10 percent are found to be women, it's only because there are fewer women that have undergone testing," he asserted. But inasmuch as the programme had just been launched, it would take some time before the effects of a renewed, more aggressive campaign to weed the illness out became apparent, Imran cautioned. "We have just launched this programme. It's still just in the initial stages of implementation. I should think we'll have to wait for a year before we can make any correct assessment of how much it has achieved and how much more it is likely to achieve," he said.