title: Second-generation surveillance for HIV/AIDS in Pakistan: results from the 4th round of Integrated Behavior and Biological Survey 2011-2012.
abstract: OBJECTIVE
  In an effort to fully analyse and understand the HIV situation and its epidemiology in Pakistan, a bilateral collaboration between the National AIDS Control Program and the Canadian International Development Agency resulted in the establishment of an effective second-generation surveillance (SGS) system for HIV/AIDS between 2004 and 2012 in accordance with the published guidelines. This paper presents findings from the 4th round of SGS.
  
  
  METHODS
  A mapping exercise was initially conducted for size estimations of the key vulnerable populations: people who inject drugs (PWIDs), male sex workers (MSWs), hijra sex workers (HSWs), and female sex workers (FSWs), followed by an Integrated Behavioral and Biological Surveillance in 20 selected cities across Pakistan.
  
  
  RESULTS
  The estimated sizes of the four key populations mapped in the 20 cities were 89 178 FSWs, 46 351 PWIDs, 23 317 HSWs and 19 119 MSWs. The HIV sero-prevalence among PWIDs was the highest among all key populations surveyed at 37.8% (CI 37.3 to 38.3) nationally, followed by a prevalence of 7.2% (CI 6.8 to 7.5) among HSWs, 3.1% (CI 2.8 to 3.4) among MSWs and 0.8% (CI 0.4 to 1.0) for FSWs. Various key risk behaviours, that is, sharing of syringes by PWIDs and inconsistent use of condoms by sex workers, were documented.
  
  
  CONCLUSIONS
  Pakistan's HIV epidemic that once was characterised primarily by transmission among PWIDs is now increasingly characterised by significant sexual transmission, and all types of sex workers (male, hijra and female) exhibit epidemiological proportions of infection. There is a need to develop concrete strategic plans for each vulnerable subpopulation, initially focusing prevention resources on those with a higher risk or vulnerability.
authors.affiliation: Centre for Global Public Health, University of Manitoba, , Winnipeg, Manitoba, Canada.
authors.forename: Faran
authors.initials: F
authors.lastname: Emmanuel
authors.forename: Momina
authors.initials: M
authors.lastname: Salim
authors.forename: Naeem
authors.initials: N
authors.lastname: Akhtar
authors.forename: Salwa
authors.initials: S
authors.lastname: Arshad
authors.forename: Tahira Ezra
authors.initials: TE
authors.lastname: Reza
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D003625:Data Collection; D005260:Female; D017408:Guidelines as Topic; D006679:HIV Seropositivity / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D018571:Sentinel Surveillance; D060386:Sex Workers / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*
keywords: Epidemiology (General); HIV; Surveillance
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