- Study results shared with the Ministry of National Health Services.
- HIV prevalence among PWID decreased dramatically to 27%.
- There is an urgent need to increase access to condoms, promote their use.
ISLAMABAD: The human immunodeficiency virus (HIV) has spread rapidly among specific populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender people (TGS) due to unprotected sex and an access limited to preventive measures.
A report presented at the sixth round of Integrated Biological and Behavioral Surveillance (IBBS) exhibited worrying developments and trends in HIV outbreak in Pakistan, The news reported.
Initial results of the study were shared with the Ministry of National Health Services, Regulations and Coordination on Tuesday. The study was conducted by the Health Services Academy (HSA) in partnership with the Progressive Development Initiative (PDI), UK, HIV/STI Surveillance Research Center and the WHO HIV Surveillance Center (HIVHUB), Iran, almost ten years after the last round.
The results present a mixed picture, showing the effectiveness of harm reduction programs for people who inject drugs (PWID) and the increasing prevalence of HIV in sexual networks, which act as a link between important groups and the public in general.
While MSM reports HIV prevalence at 7%, up from 5.6% in the most recent survey, prevalence among TG has risen to 10%, up from 7.2% in 2016. Prevalence among FSW has also increased, rising from 2.2% in 2016 to 3.8% now. HIV prevalence among PWID, on the other hand, has decreased dramatically from 38.4% in 2016 to 27%, thanks to harm reduction initiatives and a movement towards the use of non-injecting drugs, such as ice or methamphetamine.
The HIV prevalence rate of 4.7% among prisoners, a population tested for the first time in IBBS, is among the most alarming results. In correctional facilities, overcrowding, condom inaccessibility, and untreated drug use contribute to the spread of HIV among this underserved demographic.
One of the largest surveys to date to measure HIV prevalence in Pakistan, IBBS Round 6 surveyed and tested 28,377 people, including 6,500 PWID, 7,606 MSM, 6,670 FSW, 7,601 TGS and 5,000 inmates.
The study was conducted in 31 districts, ensuring wide geographical representation, including Karachi, Lahore, Islamabad, Peshawar, Quetta, Faisalabad, Multan, Sukkur, Hyderabad, Jacobabad, Larkana, Rawalpindi, Gujranwala and Gujrat.
Findings highlight significant barriers to condom use among TGS, MSM, and FSW. While more than 50% of TGS and MSM reported condom use, gaps in consistent use persist, particularly during high-risk encounters. Among FSWs, condom use remains at around 40%, hampered by limited availability of female condoms, client rejection, and stigma associated with carrying or requesting condoms.
These gaps underscore the urgent need for targeted interventions to increase condom access and promote consistent use. Harm reduction efforts for PWID have demonstrated success, with increased availability of needle exchange programs in the public and private sectors contributing to decreased HIV prevalence within this group. However, challenges such as unsafe injection practices, stigma, and substance abuse continue to pose risks.
The inclusion of prisoners as a vulnerable population in the IBB for the first time has shed light on the vulnerabilities of incarcerated people.
The findings emphasize the urgent need for comprehensive HIV prevention, testing and treatment services within correctional institutions.
Comparative analysis with 2016 data reflects a mixed result. While declining prevalence among PWID signifies progress, increasing rates among TGS, MSM, and FSW reveal serious gaps in prevention strategies. These gaps are further exacerbated by stigma, discrimination, and limited outreach efforts, which hinder access to care and protective measures for these populations.
The report also highlights educational disparities among key populations. A significant proportion of TGS, MSM, and FSW lack secondary education, limiting their awareness of HIV prevention and protective measures. Among PWID, education levels are even lower, and many are completely illiterate. The survey also assessed prisoners, revealing that while some had completed primary or secondary education, many lacked comprehensive knowledge about HIV prevention.
The IBBS study also assessed other vulnerable populations, such as truck drivers, migrant workers and street children, whose high mobility, low condom use and limited disclosure make them particularly vulnerable to HIV. These groups require focused interventions to address their specific risk factors.
The study also highlights a critical oversight: the lack of focus on HIV transmission through weak infection prevention and control measures in healthcare settings.
Previous outbreaks, such as the devastating 2019 Rato Deroo outbreak, highlight the role of unsafe medical practices in the spread of the virus. Future HIV prevention strategies should incorporate robust infection control protocols to mitigate these risks.
