Second-generation surveillance for HIV/AIDS in Pakistan: results from the 4th round of Integrated Behavior and Biological Survey 2011–2012
- 1Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
- 2Centre for Global Public Health, National AIDS Control Program, National Institute of Health, Islamabad, Pakistan
- 3National AIDS Control Program, National Institute of Health, Islamabad, Pakistan
- 4Centre for Global Public Health, Punjab AIDS Control Program, Lahore, Pakistan
- Correspondence to Dr Faran Emmanuel, Centre for Global Public Health, University of Manitoba, Community Health Sciences, R070 Med Rehab Bldg 771, McDermot Avenue, Winnipeg, Manitoba, Canada R3E 0T6;
- Received 8 April 2013
- Revised 25 June 2013
- Accepted 8 July 2013
- Published Online First 2 August 2013
Objectives In an effort to fully analyse and understand the HIV situation and its epidemiology in Pakistan, a bilateral collaboration between the National AIDS Control Program and the Canadian International Development Agency resulted in the establishment of an effective second-generation surveillance (SGS) system for HIV/AIDS between 2004 and 2012 in accordance with the published guidelines. This paper presents findings from the 4th round of SGS.
Methods A mapping exercise was initially conducted for size estimations of the key vulnerable populations: people who inject drugs (PWIDs), male sex workers (MSWs), hijra sex workers (HSWs), and female sex workers (FSWs), followed by an Integrated Behavioral and Biological Surveillance in 20 selected cities across Pakistan.
Results The estimated sizes of the four key populations mapped in the 20 cities were 89 178 FSWs, 46 351 PWIDs, 23 317 HSWs and 19 119 MSWs. The HIV sero-prevalence among PWIDs was the highest among all key populations surveyed at 37.8% (CI 37.3 to 38.3) nationally, followed by a prevalence of 7.2% (CI 6.8 to 7.5) among HSWs, 3.1% (CI 2.8 to 3.4) among MSWs and 0.8% (CI 0.4 to 1.0) for FSWs. Various key risk behaviours, that is, sharing of syringes by PWIDs and inconsistent use of condoms by sex workers, were documented.
Conclusions Pakistan's HIV epidemic that once was characterised primarily by transmission among PWIDs is now increasingly characterised by significant sexual transmission, and all types of sex workers (male, hijra and female) exhibit epidemiological proportions of infection. There is a need to develop concrete strategic plans for each vulnerable subpopulation, initially focusing prevention resources on those with a higher risk or vulnerability.
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