1. General Background Information
a. There are an estimated 628,000 opioid users (heroin, morphine, opium, codine, pentazocine, buprenorphine etc) in Pakistan. Out of the total around 77 percent (484,000) are heroin users. There are an estimated 125,000 injecting drug users.
b. Pakistan has, at present, a concentrated HIV/AIDS epidemic country. WHO/UNAIDS estimates of 46,000- 210,000 adult HIV positive cases in Pakistan. The overall sero-prevalence of HIV among IDUs is 21%with high variability between cities. The highest prevalence was in Hyderabad (30.5%) Larkana (28.5%), Karachi (23.1%) and Sargodha (22.8%). Preliminary findings of another study (2007) conducted by an NGO in the city of Lahore to assess the risks of spouses of IDUs revealed that 15-20% of the spouses inject drugs. Sexual networking between commercial sex workers (i.e. FSWs, MSWs and HSWs) and IDUs will increase the potential for an HIV epidemic. The greater the overlap between high-risk population, the quicker the spread of HIV to other group, and subsequently to the general population.
c. There are approximately 85,000 people incarcerated in Pakistan’s 89 prisons. Prison facilities are under severe stress as they were originally designed for a prison population of only 35,000 and availability of educational, vocational training and recreational services is severely restricted. Female prisoners have separate barrack in each prison. However, there are four prisons exclusively for female (Multan & Karachi, Larkana, Hyderabad). The total number of female prisoners is 1,709. There are 355 female prisoners with drug use problems.
d. Harm reduction and drug treatment services are not gender responsive and the specific needs of female injecting and non-injecting drug users are not met. The lack of trained female service providers, for example, with adequate skills and appropriate attitudes often deters female injecting and non-injecting drug users from accessing services. Female injecting and non-injecting drug users with children may also not seek services due to a fear of hostility from practitioners or of having their children taken away from them. Many HIV/AIDS prevention and care services, including those for drug dependence treatment, do not admit women clients, particularly if they are pregnant, HIV positive, or if they have children. The reasons for restrictive admission policies include lack of sex-segregated accommodation and child-care facilities. Females may also encounter barriers in accessing services because of household responsibilities, lack of family support, lack of social networks and lack of financial resources, lack of privacy and confidentiality, the threat of or experience with domestic violence and fear of being stigmatized.
i. The objective of the Consultancy is to develop short guidelines—1-3 pages each, to support the projects of UNODC-funded NGOs working with female IDU, spouses of male IDU and women in prisons.
i. Thirteen separate guidelines developed.
i. The NGOs receive the guidelines and use them to build their own capacity and the capacity of their organisations to implement UNODC-supported project.
2.4. Target audience
i. NGO Staff responsible for the provision of Service Delivery to Female IDUs/DUs, Spouses of male IDUs/DUs & Families of HIV Positive Injecting Drug Users.
ii. Female staff of prisons and NGO staff working in the female prisons.
3. Tasks: The Guidelines should cover the following topics:
i. Clear steps for offering drug treatment to pregnant drug users when methadone is not available, with a special focus on home-based detox for pregnant women.
ii. Clear steps for delivering HIV services to pregnant drug users, including for supporting pregnant drug users' access to VCT and PMTCT, and for supporting adherence to ARVs for pregnant drug users receiving PMTCT and after giving birth.
iii. Clear steps on supporting spouses' access HIV services including VCT, PMTCT, and adherence to ARVs.
iv. A basic fact sheet on ARVs and interactions with drug use.
v. Simple steps to support women—IDU or spouses, who test positive but cannot access ARVs.
vi. Simple and clear guidelines on disclosure of HIV status for men (to their spouses), for women (to their spouses), to include, importantly, information for sero-discordant couples, safe sex, and child conception options.
vii. Basic information on prevention of sexual transmission for FIDU and spouses of male IDU, with a focus on condom negotiation.
viii. Basic information on prevention of parenteral transmission for FIDU, including simple instructions on safe-injection techniques offered to women in a gender-sensitive manner.
ix. Fact sheet on sex work and (I)DU.
x. Simple guidelines on case management—what is it and how to do it.
xi. Guidelines on case management for female prisoners including post-release.
xii. An M&E framework focused on female IDU and spouses of male IDU.
xiii. Resource list for NGOs including links and short description of materials.
Total estimated days is 17.
4. Duration of Assignment;
Total duration of consulatancy - 17 days
HIV Second Generation Surveillance in Pakistan National Report Round III 2008