More than a training – supporting a quality HIV response in Pakistan

October 25, 2023

In the realm of global health challenges, the fight against HIV/AIDS remains a poignant and ongoing battle. In this struggle, the United Nations Development Programme (UNDP) has been a stalwart ally, including Pakistan where UNDP has played a pivotal role as the principal recipient (PR) of the Global Fund HIV Grant for HIV prevention, care, and treatment services. 

Pakistan has an estimated 183,705 people living with HIV (PLHIV), and only an estimated 12% of these people are receiving HIV treatment. At the same time, the number of people being infected with HIV continues to increase. 

Improving accessibility and quality of HIV health care services in Pakistan

There is an urgent need in Pakistan to enhance efforts to reach communities with life-saving HIV prevention, treatment, and care services. This is essential for preventing new infections and ensuring that individuals living with HIV initiate and continue treatment. Notably, ensuring the availability and accessibility of quality services is crucial.

Addressing these needs, the Government of Pakistan has recently expanded the number of HIV treatment centers from 50 to 93. In parallel, the UNDP, in collaboration with national and provincial partners, has significantly increased Pakistan's prevention services, expanding from 16 to 53 sites in 19 cities across all four provinces. It is essential to not only increase geographic availability but also to make healthcare services more accessible and tailored to the specific requirements of the populations they serve.

Furthermore, effective service delivery hinges on well-trained staff at government-run treatment centers and community-based organizations responsible for HIV prevention services. Recognizing this, UNDP, in collaboration with Oxford Policy Management (OPM), has designed a comprehensive training program to ensure quality services for all levels of CBO staff, including Project Managers, Outreach Workers, DIC supervisors, Paramedics, Counselors, DEOs, M&E officers, and Doctors. This training encompasses subjects such as HIV prevention, counseling, HIV testing, STI management, and PrEP, with a focus on addressing Stigma and Discrimination and PSEA in key sessions.

Moreover, as new technologies and approaches emerge, UNDP collaborates with partners to disseminate this knowledge to service providers. They have worked with WHO colleagues at both country and headquarters levels to conduct training on HIV self-testing. Additionally, in collaboration with the Common Management Unit, they have provided training for M&E and Data management staff to improve Health Information Systems.

One area that has been inadequately addressed in the HIV response in Pakistan is the integration of mental health services within the context of HIV care. In conjunction with UNAIDS, UNDP has conducted training for Counselors at Antiretroviral Therapy (ART) centers and CBOs to address not only the physical health but also the mental well-being of those affected by HIV.

UNDP has been very critical about inclusion of the marginalized especially when it comes to HIV which is severely impacted by prevailing stigma and discrimination at all levels. In Pakistan, the battle against the HIV epidemic not only involves medical interventions but also challenges a deeply rooted problem—stigma and discrimination tied to behaviors that carry HIV risks. These social prejudices pose a significant hurdle to effectively controlling and responding to the HIV crisis, impeding access to healthcare and support.

In collaboration with UNICEF, UNAIDS, and Provincial AIDS Control Programs, UNDP undertook a vital initiative in Pakistan encompassing all four provinces and the ICT. The primary objective of these training sessions was to bridge the knowledge gap among religious leaders, whose profound influence and guidance significantly shape community perspectives. Furthermore, as part of UNDP's comprehensive efforts, they engaged law enforcement agencies, working to sensitize them about HIV and the stigma linked to it. This approach lays a critical foundation for a more compassionate and supportive society.

UNDP further organized workshops focused on media sensitization, acknowledging the pressing need to combat misinformation and provide the public with accurate, well-informed insights regarding HIV. These workshops aimed to equip media professionals with the knowledge and tools necessary to effectively address HIV-related issues, dispel myths, and create a more informed and empathetic public discourse about the virus. By enhancing media's understanding of HIV, these initiatives contribute to a broader societal awareness and a more supportive environment for individuals affected by HIV.

Finally, training and building knowledge and skills is on-going, particularly in the field of health. While the HIV treatment guidelines were finalized in 2020 and disseminated, there had not been a consolidated training for all ART centre staff. To address this need, UNDP and WHO collaborated to train all medical service providers at government run centres on the comprehensive treatment guidelines.  Subsequently, a "train-the-trainer" session was conducted to ensure that government programs have the capacity to sustain and build upon the progress made. This training empowered government officials with the knowledge and skills necessary to continue the treatment of HIV as per the guidelines provided. 

Heather Doyle
Project Coordinator – Global Fund HIV Project, UNDP Pakistan