The orders to terminate the HIV/AIDS Surveillance Project (HASP), which aims to cover the lapses in the past when a World Bank-funded project to provide services to injecting drug users (IDUs) in 12 cities of the province, originated from the office of the secretary of health, Punjab, in May 2009, sources said.
An alternative mechanism was proposed to be put in place to prevent the spread of the deadly disease through sharing of syringes by the drug users, who were previously being supplied new syringes on a daily basis in exchange for used ones.
While the World Bank expressed serious reservations over the termination of the contract, attempts for revival of the project failed, and the World Bank and Department for International Development (DFID), United Kingdom pulled out funding from Punjab and subsequently from Sindh.
This resulted in closure of services to over 14,000 individuals and families in 12 cities of Punjab and an additional 6,000 individuals in Sindh.
Since June 2009, there is nothing blocking HIV transmission among people sharing drugs or sex workers, the main drivers of the HIV prevalence in the country.
Under the project’s fourth phase, 20 selected cities in the four provinces, with half of them in Punjab, were to be surveyed, sources added.
Project director for HASP Dr Simon Azariah said that the survey in Sindh, Balochistan and Khyber-Pakhtunkhwa will start by mid-March.
Downplaying the problem in Punjab, he said that a survey in the province will be allowed after meeting some procurement formalities.
Punjab has the largest number of street-based IDUs and the highest burden of the growing HIV epidemic. Punjab also needs the largest resources for HIV prevention services to halt the growing menace of AIDS.
Experts say termination of the programme in Punjab in the absence of an alternative mechanism has reversed the achievements gained after spending over Rs600 million.
The project was launched in 2005 for monitoring and reporting high-risk behaviours which led to HIV transmission in addition to inform policy makers about the incidence of HIV in Pakistan.
HASP has so far conducted a pilot study and three surveillance surveys in Pakistan in 2007, 2008 and 2009.
Data collected and analysed from these surveillance rounds has demonstrated that the HIV prevalence in Pakistan is concentrated among high-risk populations, including people who use drugs and share syringes, and sex workers.
As a result of these studies, programmes were initiated under the Enhanced HIV programme, supported by the government through the support of the World Bank and DFID, UK.
In cities where HIV prevention services were established (Lahore, Sargodha and Faisalabad), round 3 data showed that sharing of infected syringes among street-based IDUs was below seven per cent against 45 per cent where services were not available.
The data also showed that in Faisalabad and Sargodha, the provision of services resulted in the stoppage of HIV transmission and the prevalence of the disease was reversed from 52 to 22 per cent. This reporting of effectiveness of programming and services won Pakistan round nine of the Global Fund support of $43 million.
Under the proposed third round of surveillance, a survey was to be conducted in Lahore, Faisalabad, Sargodha, Multan, Dera Ghazi Khan, Gujrat and Rawalpindi in Punjab, Karachi, Nawabshah, Larkana, Sukkur, Hyderabad and Mirpurkhas in Sindh, Quetta and Turbat in Balochistan and Peshawar and Haripur in Khyber-Pakhtunkhwa.
Since 2004, HASP has collaborated with national and provincial AIDS control programmes to develop a sustainable second generation surveillance system.
Published in The Express Tribune, February 21st, 2011.
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