Summary:

UNDP Pakistan is the Principal Recipient of Global Fund to implement its HIV project in Pakistan for the period of July 01, 2021, until Dec 31, 2023. UNDP established a Programme Management Unit (PMU) which is responsible for programme management and overall implementation of the grant. UNDP Pakistan works closely with sub-recipients in the implementation of the grant which includes community-based organizations (CBOs), National and Provincial AIDS Control Programme, the national Association of Persons Living with HIV, UN and academic partners. Additionally, we work in close partnership with other government and partner organizations including UNAIDS, WHO, UNICEF, UNODC to assure alignment with international and national guidance and best practice. 

The grant contributes to the achievement of the overall, strategic goals of the Pakistan AIDS Strategy IV - PAS-IV on addressing low prevention and testing coverage among key populations by scaling up community-based interventions, improving treatment access for all, and by challenging stigma and discrimination through training for health care workers and others, and to strengthen the national M&E system for improved cascade monitoring. 

Background :

Pakistan has received investments from the Global Fund in the HIV response since 2003 for a cumulative amount of nearly 750 million USD. Despite significant progress of the accelerated response to HIV through effective prevention, treatment, care and support interventions for Key Populations (KP),  access to HIV prevention, care and support services are limited. Available data indicates that the country has a concentrated HIV epidemic among KP, namely: men having sex with men (MSM), people who inject drugs (PWID), transgender populations (TG), male sex workers (MSW) and female sex workers (FSW) with prevalence less than 0.1% in the general population, based on Integrated Biological and Behavioural Surveillance (IBBS) Round V 2016-17. As per Spectrum estimates for the year 2020, the country has an estimated 183,705 people living with HIV (PLHIV), of which 91% live in Punjab and Sindh, the most populous and highest HIV burden provinces in the country. The highest proportions of the estimated population of PLHIV are to be found among PWID (22.9%) and MSM (17.2%). Disease progression trends show an escalating epidemic in KP with a faster rate among sexual networks especially MSM and sex workers. Overall, the KP prevention and testing programme coverage remains among the lowest in the Asia Pacific region. It was estimated that in 2018 only 14% of PLHIV in Pakistan knew their status; clearly well below the 95% target set by UNAIDS.

Major Achievements:

With the critical support of government, CBO and UN partners the HIV response programme implemented by UNDP has seen important successes. Prevention efforts in Pakistan have seen for the first time the introduction of PrEP (pre-exposure prophylaxis) and HIV self-testing for key populations in Pakistan. While the roll-out and expansion is still underway, these prevention technologies will play a large roll in averting new HIV infections in Pakistan. UNDP will continue to work with the National AIDS Control Programme and Provincial AIDS Control Programmes on innovative ways to ensure that the communities that most need all HIV prevention services can access them. Since July 2021, prevention services to key populations has increased by more than 125%, and 2023 will see an expansion of prevention services to 18 new cities in Pakistan, including Quetta and Peshawar.

Having the right skills and knowledge to effectively delivery HIV services is critical to improving the quality of care, and ensure that people start and stay-on HIV treatment if needed. UNDP, in partnership with provincial AIDS control programmes, has supported trainings for all ART centre staff across the four provinces. In 2023, UNDP will work with partners to delivery an updated training to gynecologists working with women living with HIV to safely delivery babies. Working with UN partners such as NACP, UNAIDS, WHO and UNICEF has seen the delivery of a wide range of trainings and support to community-based organizations delivering HIV services such as on HIV self-testing, clinical management of sexually transmitted infections, and improving counselling and outreach support for key populations. 

Knowing the epidemic is the only way Pakistan will end HIV in the country. UNDP engaged an expert in the Health Management Information Systems to provide support to the government to improve the system that the country uses to collect and monitor HIV related data and make the data more accessible to decision makers. UNDP also supported provinces to assess their data monitoring and use plans, and give tangible support to overcome challenges identified. 

Project Outcomes:

1. Increased coverage of the prevention services for MSM by 39% (of Population Size Estimates - PSE) by 2023 from the 2019 baseline.

2. Increased coverage of the prevention services for FSW (of PSE) by 44% by 2023 from the 2019 baseline.

3. Increased coverage of the prevention services for TG (of PSE) by 56% by 2023 from the 2019 baseline.

4. Increased coverage of the treatment services for PLHIV by 35% (of the estimated PLHIV) 

   
    

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