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The size and distribution of key populations at greater risk of HIV in Pakistan: implications for resource allocation for scaling up HIV prevention programmes.

Emmanuel F, Thompson LH, Salim M, Akhtar N, Reza TE, Hafeez H, Ahmed S, Blanchard JF - Sex Transm Infect (2013)

Bottom Line: Cities were prioritised according to key population size.The total cost varies according to the local needs and the purchasing power of the local currency.By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada.

ABSTRACT

Background: With competing interests, limited funding and a socially conservative context, there are many barriers to implementing evidence-informed HIV prevention programmes for sex workers and injection drug users in Pakistan. Meanwhile, the HIV prevalence is increasing among these populations across Pakistan. We sought to propose and describe an approach to resource allocation which would maximise the impact and allocative efficiency of HIV prevention programmes.

Methods: Programme performance reports were used to assess current resource allocation. Population size estimates derived from mapping conducted in 2011 among injection drug users and hijra, male and female sex workers and programme costs per person documented from programmes in the province of Sindh and also in India were used to estimate the cost to deliver services to 80% of these key population members across Pakistan. Cities were prioritised according to key population size.

Results: To achieve 80% population coverage, HIV prevention programmes should be implemented in 10 major cities across Pakistan for a total annual operating cost of approximately US$3.5 million, which is much less than current annual expenditures. The total cost varies according to the local needs and the purchasing power of the local currency.

Conclusions: By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

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Relative HIV prevalence in various cities in Pakistan, 2005 and 2011. FSW, female sex workers; HSW, hijra sex workers; IDU, injection drug users; MSW, men sex workers.
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SEXTRANS2013051017F1: Relative HIV prevalence in various cities in Pakistan, 2005 and 2011. FSW, female sex workers; HSW, hijra sex workers; IDU, injection drug users; MSW, men sex workers.

Mentions: Pakistan's HIV epidemic is concentrated among key populations at greater risk of HIV. In 2011, the HIV prevalence was estimated to be 37.8% among injection drug users (IDUs), and 7.2%, 3.1% and 0.8% among hijra (transgender; HSW), male (MSW), and female (FSW) sex workers, respectively.1 These HIV prevalence estimates are considerably higher than those of the general population (0.1%)1 and of pregnant women attending antenatal clinics (0.05%).2 Given the observed trajectory of the HIV epidemic among these key populations13 (figure 1), evidence of potential injection and sexual routes of transmission between IDUs and sex workers, and alarming model projections of prevalence surpassing 70% among IDUs by 2025 in some cities and continuing to increase among sex workers,4 it has become apparent that the window of opportunity to prevent HIV from exploding within IDU populations and becoming firmly established among sex workers and clients may be closing.5 It is therefore imperative to implement effective HIV prevention programmes targeting key populations at high population coverage in Pakistan, and with consideration given to HIV transmission dynamics6–9 within geographically defined areas. Priorities include surveillance, analysis of data, investments in prevention and interventions implemented at high population coverage (table 1).


The size and distribution of key populations at greater risk of HIV in Pakistan: implications for resource allocation for scaling up HIV prevention programmes.

Emmanuel F, Thompson LH, Salim M, Akhtar N, Reza TE, Hafeez H, Ahmed S, Blanchard JF - Sex Transm Infect (2013)

Relative HIV prevalence in various cities in Pakistan, 2005 and 2011. FSW, female sex workers; HSW, hijra sex workers; IDU, injection drug users; MSW, men sex workers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756450&req=5

SEXTRANS2013051017F1: Relative HIV prevalence in various cities in Pakistan, 2005 and 2011. FSW, female sex workers; HSW, hijra sex workers; IDU, injection drug users; MSW, men sex workers.
Mentions: Pakistan's HIV epidemic is concentrated among key populations at greater risk of HIV. In 2011, the HIV prevalence was estimated to be 37.8% among injection drug users (IDUs), and 7.2%, 3.1% and 0.8% among hijra (transgender; HSW), male (MSW), and female (FSW) sex workers, respectively.1 These HIV prevalence estimates are considerably higher than those of the general population (0.1%)1 and of pregnant women attending antenatal clinics (0.05%).2 Given the observed trajectory of the HIV epidemic among these key populations13 (figure 1), evidence of potential injection and sexual routes of transmission between IDUs and sex workers, and alarming model projections of prevalence surpassing 70% among IDUs by 2025 in some cities and continuing to increase among sex workers,4 it has become apparent that the window of opportunity to prevent HIV from exploding within IDU populations and becoming firmly established among sex workers and clients may be closing.5 It is therefore imperative to implement effective HIV prevention programmes targeting key populations at high population coverage in Pakistan, and with consideration given to HIV transmission dynamics6–9 within geographically defined areas. Priorities include surveillance, analysis of data, investments in prevention and interventions implemented at high population coverage (table 1).

Bottom Line: Cities were prioritised according to key population size.The total cost varies according to the local needs and the purchasing power of the local currency.By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada.

ABSTRACT

Background: With competing interests, limited funding and a socially conservative context, there are many barriers to implementing evidence-informed HIV prevention programmes for sex workers and injection drug users in Pakistan. Meanwhile, the HIV prevalence is increasing among these populations across Pakistan. We sought to propose and describe an approach to resource allocation which would maximise the impact and allocative efficiency of HIV prevention programmes.

Methods: Programme performance reports were used to assess current resource allocation. Population size estimates derived from mapping conducted in 2011 among injection drug users and hijra, male and female sex workers and programme costs per person documented from programmes in the province of Sindh and also in India were used to estimate the cost to deliver services to 80% of these key population members across Pakistan. Cities were prioritised according to key population size.

Results: To achieve 80% population coverage, HIV prevention programmes should be implemented in 10 major cities across Pakistan for a total annual operating cost of approximately US$3.5 million, which is much less than current annual expenditures. The total cost varies according to the local needs and the purchasing power of the local currency.

Conclusions: By prioritising key populations at greatest risk of HIV in cities with the largest populations and limited resources, may be most effectively harnessed to quell the spread of HIV in Pakistan.

Show MeSH