By Yusra Qadir
The situation concerning Pakistan and HIV is indeed very precarious. The country lies at a very crucial junction. HIV has as yet not exploded. Most of the populace remains safe, as for now. However, concentrated epidemics have emerged, which means that very little time is left before a steep rise in infections occurs.
Vulnerability Due to Social and Economic Disadvantages: Restrictions on women’s and girls’ mobility limits access to information and preventive and support services. Young people are vulnerable to influence by peers, unemployment frustrations, and the availability of drugs. In addition, some groups of young men are especially vulnerable due to the sexual services they provide, notably in the transport sector. Both men and women from impoverished households may be forced into the sex industry for income.
The situation concerning Pakistan and HIV is indeed very precarious. The country lies at a very crucial junction. HIV has as yet not exploded. Most of the populace remains safe, as for now. However, concentrated epidemics have emerged, which means that very little time is left before a steep rise in infections occurs. The battle against HIV/AIDS in Pakistan has to be fought on a number of fronts: not just the afflicted population, but also on changing peoples’ perspectives and ushering in the proper government policies and response measures. Neighboring China serves as a good example to follow as regards formulation of a national policy about HIV/AIDS.
The data which supports the report has been collected by focus group discussions, informal in depth interviews, case studies and interviews with representatives of organizations working on HIV. Youth (both in and out of school was contacted and their inputs and views about the issues, their participation, their vulnerability and their understanding of policy was discussed. The case studies were taken from various projects and in those projects youth represented many high risk groups i.e. injecting drug users, female sex workers and men having sex with men. The report presents data which is very diverse and has been collected solely for the purpose of this report. This data aims at bringing forth the perspective of Pakistani youth on the issue of HIV and AIDS who are not only highly vulnerable to the epidemic but also the potential key actors possessing the capacity and fervor to control the epidemic and change the course of epidemiology for the entire nation.
Major results indicate that:
- Pakistani youth is not included in terms of representations at many forums, if the inclusion is present then there is limited follow up in terms of feedback, suggestions and inputs of youth
- Youth awareness level is very low in terms of knowledge about HIV and related issues
- The rigid socio-cultural norms restrict the services to a certain group of people and youth cannot easily access services due to heavy stigma and discrimination towards HIV
- Many practices of the youth indicate risks which increase their vulnerability to HIV
- Government and non state actors are committed to the cause and are making active efforts to combat and control the epidemic generally and in youth specifically.
The National Strategic Framework of Pakistan addresses young people but as the epidemic is focused on injecting drug users and the incidence amongst injecting drug users is very high, most resources have been allocated for injecting drug users and men having sex with then. Youth definitely has been addressed in the National strategic framework but it is not the priority for being addressed according to the current epidemiological state of the epidemic in the country.
Pakistan’s expanded response to HIV/AIDS is implemented through NACP under the leadership of the Ministry of Health, Government of Pakistan. The main program control is at the Federal level with a budget of Rs.2.85 billion for a five-year program14 with already positive signals from other interested donors. Although the provincial implementation units are independent programs with separate PC-Is (government program documents including budgeting) for their respective programs, however, NACP has the responsibility of coordination, regulation and overall supervision plus the disbursement of funds. As NACP is not an implementing agency, implementation and service delivery are done through the NGOs and public sector facilities. However, no sound data is available on the utilization of funds concerning youth related HIV/AIDS issues. In Pakistan, youth related HIV/AIDS programmes are mostly funded by international organizations such as the World Bank, European Commission and UNAIDS.
Young people have very limited access to information and services on issues like HIV. The following should be considered in order to improve the present situation:
Integration of HIV and AIDS initiatives and awareness into existing programs
Wherever possible, HIV and AIDS information and prevention and care initiatives will be integrated into existing programs and services. In health, this will mean integration into sexual and reproductive health services, maternal and child health, services for sexually transmitted infections, family health and other mainstream services and programs, such as the Hepatitis Control Program and the National TB Control Program. In other areas this will mean the development of strategies to ensure access for people with HIV and AIDS and people at risk of HIV infection to welfare, housing and socio-economic support programs, drug treatment programs, workforce development programs and other appropriate programs and services. The focus will be on breaking down access barriers and on avoiding the need for a range of unnecessary and unsustainable HIV-specific services and programs.
Access to treatment, care and support
People with HIV and AIDS will have the same access to health services as other citizens of Pakistan. To improve access, health services will take steps to decentralize HIV treatment, care and support services so that they are located as close as possible to the people who need them. Standards of treatment and care will be set and monitored and the active participation of people with HIV and AIDS will be encouraged as a way of improving the quality of health services. Health services will work towards achieving increased access to anti-retroviral therapies and consistent access to the medicines that prevent or treat opportunistic infections. Anti-retroviral therapy will be provided free of charge to PLHIV and will be integrated into a comprehensive care and support program. The government will work with UN agencies and international foundations to ensure that PLHIV are able to access antiretroviral therapy, in line with Pakistan’s commitment to the UN ‘Universal Access by 2010’ goals.
Young people’s participation
Young people are citizens and service users and share the same fundamental rights to participation as adults but unfortunately young people’s participation in policy making is not recommended. There is no policy at the government level, to ensure that young people, especially those living with HIV/AIDS, are involved in planning implementation and evaluation of HIV/ AIDS prevention, care and support services. The government consulted some youth leaders and youth organizations in 2004 to draft the National Youth Policy. After that, no significant involvement of young people has taken place.
The participation of youth in response against HIV has been present but on a very low scale. Selective youth representatives were part of the drafting the youth policy however no consultation or discussion was carried out. Also, youth is not seen to be involved in design of interventions for them. Technically speaking the project interventions should come out of the needs of the target group i.e. youth rather than the project activities being imposed on the youth.
Some organizations like Pakistan AIDS Control Federation, World Population Foundation etc are involving youth in youth specific projects so as to keep the youth involved at all stages of the project cycle so as to make the youth own the intervention and ensure the sustainability of the project.
Summary of major achievements and gaps
- Lack of data available for planning/designing implementation
- Less involvement and participation of youth at all levels of project cycle.
- Rigid socio-cultural norms creating hurdles in making awareness about HIV common amongst the masses and for inclusion of sex education/life skills education in curriculums
- Strong stigma and discrimination making various high risk groups difficult to access
- Commitment of young people living with HIV/AIDS is just a concept reflected in National AIDS Control Programme but is not implemented by involving PLWHA meaningfully.
- People living with HIV/AIDS face a lot of stigma and discrimination within the society, so cases are mostly unreported and unaddressed.
- Information on HIV/AIDS among education providers is very low and in rural areas there is very little access to information related to HIV/AIDS
- There is a widespread lack of youth friendly services
Summary of major recommendations for action
- Out of school youth needs to be given much more focus than what is being doing for them in terms of interventions and service provision presently.
- Young people should be part of the decision making/policy level decisions. Youth emphasized that they did not even know about the existence of a youth policy in Pakistan
- Orientation on sex education and implications/consequences of unsafe sexual practices should be given to the youth
- There should be specific concentration on out of school youth and injected drug users; in Pakistan one of the most common modes of HIV/AIDS transmission is through the use of injected drugs.
- Federal and Provincial Government should be encouraged to formulate legal policies prioritizing youth participation in HIV/AIDS programmes.
- Young people need to be recognized as the most significant element in the fight against HIV/AIDS. The existing policies and programmes on HIV/AIDS should comprehensively address information, services and needs of young people. There is a need for a policy that would combat stigma and discrimination that prevail in Pakistani society and allow young people to access youth friendly services including access to condoms, abstinence, faithfulness, and the age of consent.
- Life skills-based education should be incorporated in all public and private schools.
- There should be more programmes for the out of school youth conducted by government at national level.
The Government has to come forward and face the truth about HIV in Pakistan. Embarking not only upon national-level mass awareness programs, practical steps including wide-spread screening for the high-risk populations has also to be instituted. Stigma and discrimination about HIV/AIDS in society could only be removed when prominent figures including politicians and sport stars start discussing about HIV/AIDS in public. As soon as this stigmatization barrier is overcome, a major chunk of the battle against HIV in Pakistan would be conquered. What has to be reiterated again is that the time to act is now. Timely steps taken at the present can go a long way in preventing a wide-spread HIV epidemic in Pakistan.