title: Coverage to curb the emerging HIV epidemic among injecting drug users in Pakistan: delivering prevention services where most needed.
abstract: BACKGROUND
  HIV Surveillance data from IDUs is suggestive of an escalating epidemic in major cities of Pakistan. The relatively widespread presence and interlinking of IDU and high-risk sexual networks, combined with low levels of HIV knowledge and prevention methods, indicate that there is potential for a rapid spread of HIV to other high-risk groups and its further expansion to general population through bridging groups.
  
  
  METHODS
  We reviewed Second Generation Surveillance data which provides mapping, biological and behavioural information from IDUs in eight major cities across Pakistan. Geographic mapping provided information about the location and size of the population, which was followed by a behavioural survey, conducted with a representative sample of 2432 IDUs. In addition, blood samples were also obtained which were tested for HIV.
  
  
  RESULTS
  Despite availability of syringe and needle exchange programmes in larger cities, drug users continued to reuse syringes (78.1%), injected in groups (73.3%) where extensive sharing of needle and injecting paraphernalia took place (50%). 12.6% of the respondents reported to having sexual relationships with female sex workers and 14.7% had sex with males in the past 6 months. 65% never used condoms. In addition 5.3% reported exchange of sex for money and drugs. Fairly low levels of coverage were reported from most of the cities.
  
  
  CONCLUSIONS
  Despite an existing nationwide harm reduction programme, increasing rates of HIV infection among IDUs underscore the need to identify gaps in the existing prevention strategy. Data available on coverage shows that effective harm reduction activities are unable to reach a substantial number of IDUs to actually avert or delay the emerging IDUs epidemic. There is an urgent need to expand coverage, and to integrate harm reduction in the mainstream of public health.
authors.affiliation: HIV/AIDS Surveillance Project, National AIDS Control Program, Chak Shehzad Park Road, Islamabad 44400, Pakistan. drfaran@hotmail.com
authors.forename: Faran
authors.initials: F
authors.lastname: Emmanuel
authors.forename: Mehreen
authors.initials: M
authors.lastname: Fatima
mesh_terms: D017743:Equipment Reuse / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009313:National Health Programs; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D011159:Population Surveillance; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes / Q000600:supply & distribution; D047568:Unsafe Sex