The first case of AIDS in a Pakistan citizen was reported in 1987 in Lahore.  Since then, the estimated number of adults and children living with HIV had steadily increased, from 38,000 in 2001 to 98,000 in 2009. Women comprised about 29% (or 28,000) of estimated HIV cases in 2009. Although the estimated prevalence among the general population is less than 0.1% [1], 2008 surveillance results clearly indicate that Pakistan is facing a concentrated epidemic among key affected populations, mainly among injecting drug users (IDUs) and Hijra sex workers (HSWs).

According to the 2008 Integrated Behavioural and Biological Survey (IBBS), HIV prevalence among IDUs was 20.8% (averaged over eight major cities)[2], an increase from 15.8% in 2007 and 10.8% in 2005 [3].  The 2008 IBBS combined male sex workers (MSWs) with HSWs as one surveillance group. It found that HIV prevalence was 0.9% among MSWs and 6.1% among HSWs [4]. There has been little documentation about the extent to which men engage in sexual activity with other men largely due to socio-cultural barriers. Nonetheless, the 2008 UNGASS report documented a HIV prevalence of 1.95% among men who have sex with men (MSM) [5] although much of the data relates to MSM only to the extent that male sex workers are part of the surveillance group. Amongst female sex workers (FSWs), a special IBBS round conducted in 2009 found that HIV prevalence among this group was 0.97% [6]. Other vulnerable groups include urban men, migrants (returnees and deportees), truck drivers and spouses of key affected populations.

Among vulnerability and risk factors include: low levels of HIV knowledge among key affected populations; internal and external mobility, with a substantial number of HIV & AIDS cases reported especially among returning migrants, their spouses and children; low levels of condom use; unsafe practice of injecting drugs; and overlapping risk behaviours such as the occurrence of sexual networking among IDUs and sex workers (FSWs, MSWs and HSWs).

Sources:

[1] UNAIDS, Report on the Global AIDS Epidemic, 2010

[2] Pakistan, NACP, MOH, HIV/ AIDS Surveillance Project, IBBS round III, 2008, cited in Pakistan, UNGASS Country Progress Report, 2010

[3] HIV/AIDS Surveillance Project, IBBS round I, II, III

[4] Pakistan, Integrated Biological and Behavioral Survey, National Report Round III, 2008

[5] Pakistan, UNAIDS, UNGASS Country Report, 2008

[6] Pakistan, NACP, MOH, HIV/ AIDS Surveillance Project, IBBS Special Round for FSW, 2009, cited in Pakistan, UNGASS Country Progress Report, 2010