Beyrer, ChrisSingh, SonalAmbrosio, MarcoSemini, Iris2017-06-152017-06-152012-11https://hdl.handle.net/10986/27222Pakistan has made strides over the last decade in its Acquired Immunodeficiency Syndrome (AIDS) response, with active surveillance, considerable research, both governmental and non?governmental prevention and care activities, and treatment since 2005 to 2006. However, the Human Immunodeficiency Virus (HIV) prevalence among People Who Inject Drugs (PWID) has not declined, coverage of current prevention and treatment programs remains limited and the gains made to date are threatened by internal and external factors. This report attempts to review and synthesize available data on HIV in Pakistan and to use these data to suggest strategic priorities for the next phase of the HIV response in an effort to improve the allocative efficiency of resources and effective and efficient implementation of the response. This report presents an integrated model for HIV services delivery that depicts a continuum of care from prevention outreach to treatment with a focus on evidence based interventions and strong linkages. It describes three potential models for Volunteer Counseling and Testing (VCT) services for most at risk populations that increase outreach and engagement with PWID, hijra communities, and Male Sex Workers (MSWs), and their clients. It also places heavy emphasis on evidence based approaches to prevention including expanding treatment for High Risk Groups (HRGs) and improving the linkages for HIV positive and HIV negative PWID for drug treatment services, such as Methadone Maintenance Therapy (MMT), and outlines the steps for an evidenced based, effective and efficient policy response at a time of shrinking resources for HIV in overall low prevalence settings. This report is organized as follows: chapter one gives introduction; chapter two presents epidemiology methods; chapter three gives country context; chapter four presents status of HIV epidemic; chapter five gives summary of key findings; chapter six deals with systems response to HIV and AIDS in Pakistan; chapter seven gives key policy recommendations; and chapter eight gives conclusion.en-USCC BY 3.0 IGOADDICTIONADULT LITERACYADULT PREVALENCEAIDS PROGRAMSANAL SEXANTENATAL VISITSANTIBODIESARMED CONFLICTAT RISK GROUPSBASIC HEALTHBEHAVIOR CHANGEBLOOD DONORSBLOOD PRODUCTSBLOOD SUPPLYBLOOD TRANSFUSIONSBOTH SEXESCIRCUMCISIONCIVIL CONFLICTCIVIL RIGHTSCLINICSCOHORT STUDIESCOMMERCIAL SEXCOMMERCIAL SEX WORKCOMMERCIAL SEX WORKERSCOMMUNITY PARTICIPATIONCONDOMCONDOM AVAILABILITYCONDOM USECONDOMSCOST EFFECTIVENESSCRIMEDEMOGRAPHIC TRANSITIONDEVELOPING COUNTRIESDISASTERSDISEASEDISEASE OUTBREAKSDOCTORDOCTORSDRUG ABUSEDRUG DEPENDENCEDRUG OF CHOICEDRUG TRAFFICKINGDRUG TREATMENTDRUG USEDRUGSEFFECTIVE PREVENTIONEMERGENCIESEPIDEMICEPIDEMICSEPIDEMIOLOGIC TRENDSEPIDEMIOLOGYFAMILIESFEMALEFEMALE SEX WORKERSFEMALESFERTILITYFERTILITY RATEFEWER PEOPLEGENDERGENDER GAPGENDER GAP IN LITERACYGENDER IDENTITYGENDER INEQUITIESGENDER ROLESGLOBAL HIV/AIDSHARM REDUCTIONHEALTH CARE PROFESSIONALSHEALTH INDICATORSHEALTH PROFESSIONALSHEALTH SECTORHEALTH SERVICESHEALTH SYSTEMHEPATITISHEPATITIS BHEPATITIS B SURFACE ANTIGENHEPATITIS CHEROIN USEHIGH RISK GROUPSHIVHIV INFECTIONHIV INFECTION RATESHIV INFECTIONSHIV POSITIVEHIV PREVENTIONHIV PREVENTION INTERVENTIONSHIV TESTINGHIV TRANSMISSIONHIV/AIDSHOSPITALHOSPITALIZATIONHOSPITALSHUMAN DEVELOPMENTHUMAN RIGHTSHUMANITARIAN CRISESINFECTION RATESINFECTIOUS DISEASEINJECTING DRUG USEINJECTION DRUGINJECTION DRUG USEINTERCOURSEINTERVENTIONLARGE CITIESLAWSLEVELS OF CONDOM USELEVELS OF EDUCATIONLIFE EXPECTANCYLIVE BIRTHSLOW PREVALENCEMALE CIRCUMCISIONMALE SEXMALE SEX WORKERSMATERNAL MORTALITYMATERNAL MORTALITY RATEMEDICAL SCIENCESMETHADONEMIGRANTMIGRANT WORKERSMIGRANTSMIGRATIONMINISTRY OF HEALTHMINORITYMORTALITYNATIONAL AIDSNATIONAL AIDS CONTROLNATIONAL POLICYNATIONAL SURVEILLANCENATURAL DISASTERSNEEDLE SHARINGNEW INFECTIONSNUMBER OF ADULTSNUMBER OF CHILDRENNUMBER OF WOMENNURSESPATIENTSPHARMACEUTICALSPHARMACISTSPOLICY RESPONSEPOLITICAL INSTABILITYPOPULATION REFERENCE BUREAUPOPULATION SIZEPOPULOUS COUNTRYPRACTITIONERSPREGNANT WOMENPREVALENCEPREVALENCE RATEPREVALENCE RATESPREVENTION EDUCATIONPREVENTION INTERVENTIONSPRIMARY HEALTH CAREPRIMARY HEALTH CARE SYSTEMPRISONSPROGRESSPUBLIC HEALTHPUBLIC HOSPITALSPUBLIC LIFERANDOMIZED CONTROLLED TRIALSRATE OF CONDOM USERATES OF INFECTIONREFUGEESREMITTANCESREPRODUCTIVE LIFEREPRODUCTIVE RIGHTSRESOURCE ALLOCATIONSRESPECTRISK BEHAVIORRISK BEHAVIORSRISK EXPOSURERISK FACTORSRISK GROUPSRISK POPULATIONSRISK REDUCTIONRURAL AREASRURAL POPULATIONSSCREENINGSERVICE DELIVERYSERVICE PROVIDERSSERVICE UTILIZATIONSEXSEX BEHAVIORSEX WITH MENSEX WORKSEX WORKERSEX WORKERSSEXUAL ACTIVITYSEXUAL ENCOUNTERSSEXUAL NETWORKSSEXUAL PARTNERSSEXUALLY TRANSMITTED INFECTIONSKILLED ATTENDANTSOCIAL SUPPORTSPECIALISTSTDSTISSTRATEGIC PRIORITIESSTREET OUTREACHSURVEILLANCE DATASURVEILLANCE PROJECTSYPHILISSYRINGESTBTHERAPYTREATMENTTREATMENT SERVICESTUBERCULOSISUNAIDSUNFPAUNITED NATIONS POPULATION FUNDURBAN AREASURBAN CENTERSURBANIZATIONVAGINAL INTERCOURSEVIOLENCEVIRAL LOADVIRUSVOLUNTARY COUNSELINGVULNERABILITYWOMANReportWorld Bank10.1596/27222