National Consultation
By Jawaid Ali
A 2-day National Consultation on the HIV Situation and response among MSM titled, “Progress to-wards universal access on HIV prevention, treatment, care and support” was organized by NACP & UNAIDS Pakistan in collaboration with Interact Pakistan recently at a local hotel in Karachi. The purpose of this consultation was to review the current situation and response to HIV epidemic among MSM and to discuss various issues around definitions and build consensus for a standardized approach by all stakeholders.
Dr. Nasir Jalbani, Provincial Program Manager, Sindh AIDS Control Program in his opening remarks said that sex between men occurs in every culture in the society though its ascent and public acknowledgment varies from place to place. Sex between men though accounts for between 5 – 10% of global HIV infections. Although the proportion of cases attributed to the mode of this transmission varies considerably between countries, it is a pre-dominant mode of HIV transmission. There is potential for rapid transmission of HIV within this sub population, especially if unprotected sex is highly prevalent. Although IDUs are the main drivers of HIV epidemic in Pakistan, however, MSW and Hijra sex workers are emerging as the second most vulnerable group in Pakistan for HIV infection. Results from the last round of second generation surveillance reported high pre-valence of HIV among Male and hijras sex workers in several cities including Karachi, Larkana etc. He said that, specific policy measures are crucial for making prevention, care and support services available to men who have sex with men.
Dr. Hassan Zaheer, National Program Manager, NACP on the occasion said that latest result of mapping shows that this epidemic is now spilling over from IDUs to MSWs and especially to Hijra sex workers. We have included in our revised PC-1 significant component of intervention for MSWs. An estimate shows that there are around 1,00,000 MSW/HSW in the country and in the PC-1 we have provision of services for about 32600 of them, including 19,000 in Sindh, 12,000 in Punjab, 1,000 in NWFP and 600 in Balochistan.
These targets have been set on the basis of mapping carried out in round 2 surveillance carried out in 2007 and in order to achieve universal access target of 80% coverage, more resources both financial and human are required. He said that this meeting will be very useful for chalking out future strategy and plan for the intervention in this sub population. It will also help us in standardizing Service Delivery Packages and in addition help us to learn from each others experiences.
Dr. Ali Razzaque, Provincial Program Manager, Provincial AIDS Control Program Punjab on the occasion said that, need based services must be provided to men who have sex with men. He stressed the need for standardization of tools for data collection in order to ensure uniformity in the data collection across the country while scaling up.
Oussama Tawil, Country Representative, UNAIDS Pakistan and Afghanistan said that, UNAIDS is a co-sponsored program of the UN system with ten co-sponsor agencies. The mandate of UNAIDS is to support the national response to HIV/AIDS and coordinate the response of the UN agencies in support of the national response to HIV epidemic. This national consultation will help in critically reviewing the present situation of HIV among MSM and in further refining the strategy to address the needs of this subpopulation and identifying obstacles in achieving Universal access targets. He stressed the need for strengthening prevention efforts in order to contain the epidemic among MSWs/HSWs.
Regarding vulnerability and vulnerable population, we have to address the challenge of how to extend information and services to the general population on these issues.
We should be careful, and should focus on the evidence being available through the Second generation surveillance in Pakistan through the efforts of National and Provincial AIDS Control Program. MSM issue, needs to be focused in their own rights. The social context with marginalization, discrimination, need to be addressed. We also need to focus on how to ensure the uptake of services to these populations who because of marginalization are not accessing the available preventive services.
He said that it is a sensitive issue and we should take it into consideration and this consultation will give the stakeholders an opportunity to express themselves on the issue.
Dr. Muhammad Saleem, Monitoring and Evaluation Adviser, UNAIDS Pakistan elaborating the objectives of the consultation said that the consultation has five objective i.e.; to review the current situation and response to HIV epidemic among MSM; to discuss various issues around definitions and build consensus for a standardized approach by all stakeholders; to discuss the interventions/service packages for various categories of MSM and mechanisms of delivery; to identify obstacles in service provision and scaling up towards Universal Access national targets and define strategy to address those obstacles. He also shared the expected outcomes of the consultation.
Dr. Faran Emmanuel, Chief Technical Officer, HASP – NACP presenting some key points on ‘Mapping & Data Collection of Male and Hijra Sex Workers’ said that MSWs rather than MSMs are being mapped; there is a need to develop sampling frames for IBBS; To have a Geographical mapping approach; an element of Network assessment to be developed for trans-gender; Need for dividing target area into zones; Infor-mation is compiled within each zone; Information collected from Secondary and Tertiary Key Informants and validated by HRGs themselves. National estimates were created through extrapolation of available data from Mapping studies. Population parameters were also taken from FBS, Census division, GoP.
Dr. M. Rafiq Khanani, Pre-sident, Infection Control Society Pakistan said that preventive services should be given priority for control of spread of HIV and treatment and prevention of other sexually transmitted infec-tions (STIs) among Hijras & Men having sex with men (MSM) in cities of Karachi, Hyderabad & Sukkur need to be scaled up”.
The target populations of MSM include Male sex workers; Malshias; Chawas; Giryas; Hijras; Zenanas; Gays and others. He further said that services being provided by their orga-nization includes; behavior change communication (BCC); Condom education and distribution; Primary health care & sexually transmitted infections (STIs) services; Sexual health and STIs education; Voluntary Counseling and Testing services; Enabling environ-ment; Empowerment and monitoring of sex work locations.
He mentioned challenges in service provision which includes identification and access of MSM, Lack of trust, Countless reservations, Slang / MSMs’ terminology barrier, Spot timings, Stigmatization of staff members.
Andy Melendez-Salgado, Programme Manager – Asia, Interact Pakistan briefed the participant about homo-sexuality. He said that it is invented as a clinical term by Maria Karoly Kertbeny in 1869. It defines a person who fantasizes, eroticizes his sexual intercourse with a person of their own sex.
A transgender individual may have characteristics that are normally associated with a particular gender, identify elsewhere on the traditional gender continuum, or exist outside of it as other or third gender.
Hassan Zaheer, National Program Manager, NACP in his presentation on ‘HASP Round III results of Male & Hijra Sex Workers’ said that Pakistan has a concentrated HIV epidemic among IDUs, and is now progressing into Hijra Sex Workers and Male sex workers because of the overlapping among various high risk groups (HRGs) through unsafe injecting and sexual behaviours. There is a need to rapidly implement effective programs to reduce sexual transmission in the male and hijra sex work networks to curtail further expansion of the HIV epidemics in these groups.
Ms. Bettina Schunter, Project Officer (HIV/AIDS), United Nations Children’s Fund Pakistan speaking on ‘Vulnerability and Risk among adolescent MSM in Pakistan’ said that according to the NACP and UNICEF data 97,346 adolescents, 10-19 years were mapped in 7 districts in which 9.5 per cent of those adolescents mapped sleep on the streets 24/7.
Over 17 per cent were engaged either solely in commercial sex work or had been involved in a commercial sexual exchange in which 43 per cent were females. Over half of the adolescents i.e. 51 per cent had already had sex, 54 per cent had within the last week. 37 per cent of those who had ever had sex had paid for it in the last month. For 50 per cent their last sexual partner was a male friend. 43 per cent of those who had ever had sex had it for some kind of gain, be it monetary, in-kind, or favour.
Condom use is rarely practiced by sexually active adolescents i.e. <15 per cent. Sex with the gang leaders and/or bosses was 4 per cent. Percentage of adolescent injecting drug users (2 females) though not significant at 4% of those who have ever used drugs, is significant nevertheless given that 77% of those adolescents have shared needles.
In the end, Dr. Hassan Zaheer offered the vote of thanks.