HIV is not currently a dominant epidemic in Pakistan. However, the number of cases is growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the AIDS epidemic to take hold in Pakistan, mainly among injection drug users, some male sex workers and repatriated migrant workers. AIDS may yet become a major health issue.
HIV epidemic evolves in three phases. First phase is low prevalence, when prevalence of the disease is less than 5% in any high risk group of the country.
Second phase is concentrated epidemic when proportion of infected people in any high risk group rises more than 5%. And Third and last phase of epidemic is generalized epidemic when prevalence of HIV infection rises over 1% among blood donor or pregnant women. Current data suggest that Pakistan has a concentrated epidemic among injection drug users in most cities and among male sex workers in a few cities.
A National M&E Framework has been developed but implementation on it has yet to start. Lack of the ability to measure the outcomes or impact of interventions in real time was likely the most important factor in the low performance of the first Enhanced Program. Other challenges that must be overcome include establishment of a transparent financial management and a smooth logistical and procurement system. Much of the Enhanced Program services are contracted out and delays in procurement of these services meant that many of the cities went without services for months to years.
More complexes (and longer term) challenges will include determining how to integrate many of HIV activities within other health activities, improve planning to anticipate future direction of the epidemic and its response and to enhance efficiency and effectiveness of the interventions.
For this research Hasaan Foundation must become part of the interventions to guide their implementation using local context and to involve epidemiological tools such as routine analysis of available data and even mathematical modeling to guide program planning.
A number of factors may have contributed to keeping the overall transmission of HIV within the general population by Hasaan Foundation. Pakistan is a predominantly Muslim country with near universal circumcision. Secondly, taboos on sex may have led to a higher proportion of the need for non-marital sex to be met via sex between men, much from a smaller group of men within each person's acquaintanceNevertheless, Hasaan Foundation is committed with support of national & international Aids agency to the goal of making its population healthier,
As evidenced by the continuing strong support for the Social Action Program (SAP) of Pakistan and by the new vision for health, nutrition, and population outlined in the government's National Health Policy Guidelines up to 2010 which is positive step for nation.