In Pakistan the epidemic of HIV/AIDS is spreading rapidly among injecting drug users according to available data a concentrated epidemic has now developed among IDUs, and average prevalence of HIV effected IDUs is over 37 percent. Pakistan has the largest opiate consumer market in the South-West Asian region and estimated street based IDUs in Punjab are around 65000. Most of these IDUs are marginalized, highly stigmatized and discriminated with the result they have limited access to health facilities and they are difficult to reach. Needle sharing, lack of awareness of HIV and un-safe sexual practices are common factors for the rapid spread of HIV among them.
The HIV prevalence among (Injecting Drug Users) IDU’s in Punjab is around 38%. According to HASP round 4, the prevalence of HIV in different cities in ISU’s is Lahore (30.8%), Faisalabad (52.5%), Sargodha (40.5%), DG Khan (49.5%). In view epidemic dynamics, there is an urgent need to provide effective HIV prevention services among street-based IDU’s.
The purpose of this project is to halt the HIV prevalence in IDU’s at the current level or it does not increase by than 5% above current level. This includes the services for harm reductions, syringe exchange program, primary healthcare, STI infections, sexual and reproductive health and behavior change services that will be provided to all categories of IDU’s.
One static DIC/PIU (Program Implementation Unit) is established in Faisalabad and Sargodha. Where well trained staff is providing Harm Reduction and HIV preventive Services to street based IDU. Trained outreach workers (2 Out-reach in each team) are providing extensive services at different injecting spots at Faisalabad and Sargodha.
A registration form was designed to register IDUs for services and collect their relevant data. After registration every client was issued a registration card and number, which help them to access services. Registration of IDUs was done at Program Implementation Unit and as well as during outreach works.
Syringe Exchange Program is the core of the harm reduction services for HIV prevention. Despite difficulties due to police and community anti-drug abuse attitude at some spots, sterilized syringes are provided to IDUs at PIU and at various specified outreach spots including shooting galleries. Trained staff distributed two syringes per client every day along with a disinfectant material. Used syringes are being collected back to prevent sharing and reuse.
Condoms are distributed uninterrupted in the project area through various channels i.e. DIC and Outreach spots. Trained staffs at PIU, peer educators and Outreach workers provide education about condom use and disposal of used condoms also.
Anti-Septic Dressing is provided to IDUs who have wounds and abscess. Regular basic medical services are being also provided at DIC. Primary health care includes regular checkup, treatment of fever, chest infection, diarrhea, skin infection (scabies) and Syndromic treatment of STIs.
Outreach Workers motivate IDUs for Rapid Testing/VCT. We conduct rapid testing at DIC.
IDUs declared positive on Three Rapid Kits.
Behavior Change Communication methodology is adopted for effective behavior change. Behavior Change Communication is an effective intervention to motivate IDUs to adapt safer injecting and sexual practices, raise awareness about ways of prevention of HIV/AIDS and STIs; use and disposal of syringes and condoms and motivate IDUs to establish a regular contact at DIC or with Outreach Workers to access other services also such as ASD, PHC and referral to VCT and AMC.
Staff is well trained for BCC. Most of the Outreach workers are Recovering Addicts who themselves are a source of motivation for IDUs as Role Models. Peer Educators encourage IDUs to adapt safer injecting practices and return used syringes to outreach workers at the spots, shooting galleries and DIC and educate them that how by returning used syringes reduce harm to the community also. Condom use and Safer Sex is another integral part of BCC, to counsel prevention ways of HIV/AIDS to IDUs.
IDUs are marginalized and stigmatized community who lives in hostile environment. For HIV Prevention services it is essential to provide services to IDUs in their natural environment. It is therefore important to involve community and local stake-holders in HIV prevention services plan. HIV/AIDS awareness raising meetings held with local government officials, law enforcement agents, religious leaders and other local power brokers. Meetings with stake-holders and local leaders are conducted to ensure uninterrupted service delivery to target group (IDU).