The following guiding principles apply to all programmes:

• HIV infection is preventable;
• sustainability;
• access for the most vulnerable;
• equity and equality, with an emphasis on women;
• respect and inclusion of people living with HIV/AIDS;
• addressing needs both in emergencies and during times of stability;
• all programmes are evidence based, and conform with standards set by WHO and UNAIDS, and;
• monitoring and evaluation are integral.

The priorities in this Strategic Plan arise from defined areas of need and the nature of the epidemic in Pakistan, Government of Pakistan priorities, the capacity and scope of the National Society, and the Federation HIV/AIDS Policy (2002). This Strategic Plan focuses on capacity building, information dissemination, safe blood, voluntary testing and counseling, population movement and stigma. The rational for prioritizing HIV/AIDS, and taking this approach is as follows.

The impact of HIV in the world is enormous, with almost 25 million deaths up to the end of 2003, and 46 million infected people. There has been a reduction in life expectancy in many countries, especially in Sub Saharan Africa, and economic and development gains of the last 20 years eroded as the economically productive segment of the population is infected, disabled and killed by HIV. This has resulted in macro and micro level disruption to societies, families, economies and health care systems.

HIV prevalence in Pakistan is currently estimated 0.10 per cent of the adult population, or 70,000-80,000 cases. However, the potential for a rapid, widespread epidemic is high, with risk factors common to other countries with high HIV prevalence. These risk factors include, low literacy, poverty, high fertility, low contraception uptake, and poor access to health and education.

With low diagnosis and reporting rates in Pakistan mode of transmission is difficult to conclude. Of reported cases (the minority of estimated infections), heterosexual contact accounts for 40 per cent of cases, exposure to infected blood or blood products accounts for 19 per cent of cases, and for the remaining 35 per cent of cases the mode of transmission is unknown. Given the stigma and social rejection of injecting drug use (IDU), sex work (SW) and men who have sex with men (MSM), it is unlikely these modes of transmission will be reported accurately. In addition, there are a large number of unregistered health practitioners (quacks) who are re-using equipment, particularly needles and syringes.

All four provinces (Punjab, Sindh, Balochistan and North West Frontier), the Federally Administered Tribal Areas, and Azad Jammu and Kashmir have recorded HIV infections. Till September 2005, 2741 HIV cases and 332 AIDS cases have been reported.

There are several existing PRCS HIV/AIDS activities:

• Membership of the SARNHA; SARNHA was formed in May 2002 in follow up of SART (South Asia Regional Taskforce on HIV/AIDS). Its Headquarters is based at Kathmandu, Nepal and it comprises of six National Societies i.e. Afghanistan, Bangladesh, India, Nepal, Pakistan and Sri Lanka.


• Health talks at BHUs and MHUs (NWFP and Balochistan) are being delivered and main topics include personal hygiene, diarrhea, communicable diseases and seasonal diseases.

• Participation in World Aids Day; it is planned that PRCS will actively take part in World AIDS Days both at National and Provincial levels.

• Blood screening for HIV and provision of safe blood services (Islamabad, NWFP, Sindh and Punjab) is being carried out free of cost at National Headquarters and at no profit basis in Provincial Branches.

• SAPI – is a tri-lateral project between PRCS, Army Welfare Trust and Amson Farmaco Biologico, which aims at vaccinating the communities for Hepatitis-B at subsidized cost and creating awareness about Hepatitis B & C and HIV/AIDS.

• HIV/AIDS awareness and personal safety is integrated in CBFA and First Aid training programs. All training programs conducted through PRCS National Headquarters directly or through Provincial Branches include a compulsory session on communicable diseases, which includes HIV/AIDS as an integral part.

The prime modes of prevention address the most common routes of HIV transmission: Safer sex; reducing the transmission from mother to child; providing safe blood transfusion services; universal precautions in health care settings (and piercing or tattoo salons), and; harm reduction or minimization for injecting drug users. All forms of transmission are somehow embedded in social, emotional and cultural factors. In particular, sexual transmission has resulted in considerable stigmatization of HIV positive people, as there are assumptions that immoral behavior occurred which resulted in infection. These social and cultural factors need to be addressed in development of prevention and care programmes.

Information, education and communication (IEC) is the backbone of this Strategic Plan. To reduce stigma, modify risk-taking behavior and enable people to make choices about their own and their family’s health, people need knowledge and information. IEC is defined here as:

… strategies, approaches and methods that enable individuals, families, groups, organizations and communities to play active roles in achieving, protecting and sustaining their own health. Embodied in IEC is the process of learning that empowers people to make decisions, modify behaviors and change social conditions.

HIV challenges medical customs such as re-use of invasive equipment, blood transfusions, and disposal of waste. Successful prevention and care programmes must be grounded in and owned by the community. In order to achieve community ownership and prevent opposition by health practitioners and other individuals and groups, broad consultation must take place during the planning of any HIV programme. This consultation can include, but is not limited to:

• Community workers, including education, health, social service;
• Community leaders, including religious and political leaders;
• Health care staff in health units;
• PRCS volunteers;
• UN, NGOs and other organizations;
• Ministry of Health and other government bodies;
• ENACP at all levels;
• People living with HIV/AIDS (PLWHA);
• Medical practitioners;
• Blood banks, and;
• Pharmaceutical companies.

5.1 Objective. To develop internal competence

5 .1.1. Strategy
All PRCS staff and volunteers will be knowledgeable about HIV/AIDS. HIV/AIDS information will be integrated into existing orientation and training programs for staff and volunteers, and literature will be made available (eg pamphlets).

A focal person in the Health Unit is identified for HIV/AIDS.

Staff responsible for HIV/AIDS activities will be recruited in accordance with the knowledge and skills required to work within this area, including knowledge of (or potential to acquire) HIV/AIDS, peer education, community development, sexual health and sexuality, and gender issues. Ongoing professional development will be provided to ensure staff working in HIV/AIDS is able to do so sensitively and effectively.

Policies and procedures will be developed that institutionalize the goal of reducing the impact of AIDS. PRCS will not discriminate against members, staff, volunteers or beneficiaries who are HIV positive. Staff who are at risk of HIV infection, or who are HIV positive, will receive confidential support from their managers if they choose to disclose their status. The development of a Human Resource Department will include policies that address the specific issues related to HIV positive staff, members and volunteers.

As pledged in The Manila Action Plan, peer education will be used in all health programs, through the use of volunteers.

5.2. Objective. PRCS will increase its working partnerships with government and non-government organizations.

5 .2.1. Strategy
PRCS will be an active member of the South Asian Regional Network on HIV/AIDS (SARNHA).

PRCS will pro-actively network and develop links with other agencies working in HIV/AIDS, including NGOs, government departments and private bodies.

5.3. Objective. HIV/AIDS programs will be based on available evidence, and be community / beneficiary focused.

5 .3.1. Strategy
Planning and development of HIV/AIDS programs will be undertaken using community based needs assessments, scientific evidence, models developed and evaluated elsewhere and consultation with stakeholders. Successful models used elsewhere, or by other organizations, will be explored and replicated where appropriate.

Management of HIV/AIDS programs will be evidence based, including a monitoring and evaluation system, mid-term and final evaluations as appropriate, ongoing consultation with beneficiaries, and in line with changing evidence and research.

Professional development will be facilitated to ensure staff provide & implement activities, which abide by Best Practice principles.

5.4. Objective. Identification of potential crises or population movements, which could result in, increased HIV prevalence.

5 .4.1. Strategy
• Refugee movements lead to economic stress, increased poverty for refugee populations and increased uptake of sex work as a form of income. This results in increased prevalence of HIV in this group.
• Refugee movements result in increased availability of drugs.
• Youth at risk (e.g. homeless youth)
• Urbanization results in urban slums, and an increase in HIV infection.
• If the Government is unable to address the issue of HIV/AIDS appropriately, prevalence will rise.
• If HIV cases are not detected, targeted prevention does not take place prevalence can increase.
• Westernization of Pakistan and a lack of basic information, or misinformation, result in changed sexual and other practices, putting people, especially youth, at risk.
• War (e.g. between India and Pakistan), alternatively peace would open the border and increase population movement between Pakistan and India.
• Poverty
• Unemployment results in economic migration
• Individual youth crises resulting from broken families, sexual frustration, peer pressure, developmental change.

6.1 Objective. HIV/AIDS IEC material developed and / or distributed is appropriate.

6 .1.1 Strategy.
IEC is provided that is culturally appropriate to the target communities. IEC material includes, but is not limited to, written material, print, radio and television media, health talks, training and education, puppet shows, street theatre, use of role models and famous people, dinners and other formal functions, role plays, interpersonal communication, clinic counseling and commercial advertising.

Traditional values are integrated in the development of IEC material, including religious beliefs. IEC materials are produced in local languages and use illustrations and language appropriate to the target group (this may include slang and other street language). IEC materials will be provided in all PRCS facilities, and made available to schools and colleges. Staff will be open in their discussion of HIV/AIDS, and include appropriate messages in their inter-personal communication. IEC material will be provided in all training and education sessions conducted by PRCS.

 

7.1. Objective. There is an increase in donor recruitment each year of approximately 10%.

8.1. Objective. A pilot voluntary testing and counseling (VCT) center for HIV.

VCT Center established in Lahore in 2004

8 .1.1. Strategy

Referral systems will also be developed for clients who are HIV positive. Referral will include medical, psychological and peer support as available and appropriate.

8.2. Objective. PRCS will be a provider of VCT training.

8 .2.1 Strategy
PRCS will progressively develop expertise in the area of VCT. PRCS will develop a training program for VCT for other organizations. This will enable income generation and provide some economic sustainability to the HIV/AIDS Unit. The availability of local, accessible training will encourage other health facilities to undertake HIV testing using a VCT model.

9.1. Objective. Integrate anti-stigmatization and non-discrimination principles in all HIV/AIDS programs undertaken by PRCS.

9.1.1. Strategy
As pledged in The Manila Action Plan, PRCS will ensure all PRCS programs highlight anti-stigmatization and non-discrimination. Culturally appropriate programs will be developed which emphasis safe behavior, healthy lifestyles and harm reduction.