Hiv And Aids Program Pakistan Health And Social Care Essay

STIs including HIV & A ; AIDS are planetary public wellness issues which are responsible for important ill-health universe broad. It is the fact that largely, immature population is affected ( WHO, 2007 )[ 1 ]. It is estimated that each twelvemonth about 340 million of curable STIs are predominating along with 1000000s of incurable STIs and 5 million new HIV infections ( WHO, 2007 ) . About 85 % of the estimated 340 million instances recorded in developing states, highest rates are shown by immature population and histories for 17 % economic bead ( Mayaud & A ; Mabey, 2003 )[ 2 ].

There are several hazard factors in Pakistan that are doing immature population more vulnerable for STIs and HIV e.g. more than 78 % of refugee population in N.W.F.P, conservative society impeding manner to awareness, prevalence of homosexualism, sexual maltreatment, male harlotry. Aangan is a community plan working on consciousness of immature male sexual maltreatment and misconception sing sexual wellness ( khan, 2003 )[ 3 ]. There is no such apparent policy on consciousness of immature population on the subject of importance of consciousness sing safe sex and effects of insecure sexual activities.

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In my sentiment it is required to reexamine National HIV & A ; AIDS Policy of Pakistan to happen out intercession scheme for HIV bar through making consciousness in immature population of Pakistan, if any. Because I am the national of Pakistan and I am to the full cognizant about the stigma related to HIV and lack/avoidance of consciousness among general population. Furthermore to analyse the bing consciousness options and measure different service bringing approaches to beef up it.

2.1: Background

We discussed above some of the precedence identified jobs, adding to Pakistan HIV & A ; AIDS epidemic. This subdivision proceeds with the outline reappraisal of National HIV & A ; AIDS policy Pakistan. National HIV & A ; AIDS policy Pakistan concluding bill of exchange was launched in 2007. Policy papers focal points on a clear vision. After designation of precedence focal point countries National HIV & A ; AIDS Policy stresses on different policy attacks to care and forestall approaching HIV & A ; AIDS epidemic ( National HIV & A ; AIDS Policy, 2007 ) .

The National HIV and AIDS Strategic Framework guide the Pakistan ‘s HIV and AIDS plan, was reviewed in 2006 and a new model has been developed for twelvemonth 2007 – 2011. The model contains a monitoring and rating program to supervise advancement alongside the precedence countries and measure the effectivity of the HIV and AIDS plan ( National HIV & A ; AIDS Policy, 2007 ) .

Following is the brief lineation of the Policy papers ( National HIV & A ; AIDS Policy, 2007 )

2.1.1: Vision

Overall focal point of the policy is on bar of HIV, intervention, attention and support of people affected by HIV & A ; AIDS.

2.1.2: Main Focus Areas

Following are the chief focal point countries of Pakistan HIV & A ; AIDS Policy


Unprotected sex

Sexual spouses and households of septic people

2.1.3: Policy Approachs

As we discussed above that HIV & A ; AIDS policy purposes to forestall and bring around HIV epidemic. To transport on this battle efficaciously different Torahs and policies are made to back up communities and persons to avoid HIV and to assist persons affected by HIV. Following are the cardinal policy countries. Reducing HIV and AIDS stigma and favoritism

This has to be done through

Treating HIV positive people with self-respect

Patients will be encouraged to portion at that place experiences

Health services will come frontward to cut down barriers coming Forth in HIV positive persons for guidance and intervention

Health suppliers will be trained for geting non judgmental intervention attitude

Anti favoritism Torahs will implemented

Media will be used as beginning of information and encouragement for cut downing stigma to the disease and accurate information about HIV & A ; AIDS Establishing a supportive legislative and policy model

Laws and policies will be reviewed ( both authorities and other bureaus ) to work in line with the chief focal point and aims of this policy Policy and plan based on accurate informations, grounds and Knowledge

Surveillance, operational/social research, monitoring/evaluation systems will be strengthened to guarantee at that place effectual response. Integration of HIV and AIDS enterprises and consciousness into bing plans

Integration of this policy with other bing plan and services for illustration sexual and generative wellness services, maternal and child wellness services, STIs services, household wellness, hepatitis, national TB control plans, public assistance plans, lodging and work force plans, societal economic support and drug intervention plans Promoting a whole of authorities attack aˆ? across all authorities sections and at all degrees of authorities

All authorities sections ( both provincial and territory ) will be encouraged to analyze there policies for effectual response to National HIV & A ; AIDS plan Guaranting a multiaˆ?sectoral attack that includes the full engagement of civil society and community groups, spiritual leaders and the private sector

A multi-sectoral attack will be encouraged

to cut down the stigma related to HIV

to make to marginalise communities Acknowledging the peculiar function of Peoples Populating with HIV and AIDS

HIV & A ; AIDS patients will be encouraged to come frontward and assist side by side in the HIV bar and attention for illustration in raising consciousness among general population, assisting other HIV patients in acquiring intervention and sharing at that place experiences Health system beef uping

For safe, inter-co-related and incorporate attention of HIV persons

Health suppliers will be to the full trained to cover with this quandary HIV Prevention

HIV bar will be more emphasized on population largely at hazard

Government, NGOs, society public assistance, community and spiritual groups will be working in co-ordinated mode to cut down the hazard of HIV infection through

rubber publicity

coordination of HIV bar plan with sexual and generative wellness plan

run intoing with population most at hazard

needle exchange plan

drug supply services

proviso of information in local linguistic communications sing HIV infection, AIDS, HIV bar largely to marginalise groups

inclusion of HIV and AIDS information in school course of study

preparation of instructors HIV proving and reding

through voluntary and confidential HIV testing

positive patients will be helped for farther direction Entree to intervention, attention and support

HIV centres for diagnosing and direction will be established near to the communities most at hazard

Patients will be treated harmonizing to international criterions

Health suppliers will be trained to forestall and pull off timeserving infections

Antiretroviral therapy will be free of cost

Government will be working with UN bureaus to guarantee strong committedness to UN Universal Access by 2010 ends Prevention of motheraˆ?toaˆ?child transmittal of HIV

Pregnant adult females will be encouraged for voluntary and confidential HIV testing, reding and intervention

Womans largely at hazard and partner returning from abroad will be focused peculiarly Blood and blood safety

Public and private blood providers will be to test blood decently

Insecure patterns will be eradicated Coaˆ?ordination between the national HIV and AIDS response and the national response to cut down illicit drug usage

2.1.4: Analysis

In the reappraisal lineation above we briefly identified different policy attacks to undertake the job. As I mentioned above that there is demand for proper consciousness sing HIV and AIDS among general population. This is the ground I am taking to analyse HIV bar attack of National HIV & A ; AIDS policy for making consciousness among mark population. As we described in sub heading HIV bar that policy is nearing to forestall HIV through rubber publicity, aiming largely population at hazard, integrating with sexual and generative wellness, needle exchange plan and proviso of information in local linguistic communications. I personally believe that no clear medium of awareness tool is identified. There is a demand to place a proper manner to turn to mark population


As we discussed above that although National HIV & A ; AIDS policy of Pakistan is emphasizing on HIV bar through assorted ways yet there is a demand to beef up it by placing broader medium of consciousness to forestall HIV prevalence. In my sentiment Information, Education and Communication ( IEC ) is the right pick for making consciousness in targeted population, as National HIV & A ; AIDS policy of Pakistan opted for HIV bar. But it should non be merely focused on population at hazard merely, there should be mass consciousness sing HIV & A ; AIDS in order to diminish the stigma related to this disease and encouraging people to collaborate. Harmonizing to WHO ( 2000 ) , IEC means assortment of actions that aim to update, instruct and commune with the populations, and will hold a message, medium and wide audience. Following are two wide service bringing attacks of intercession scheme for IEC.

1: Medium

A: Radio

Bacillus: Television

Degree centigrades: Print Media ( newspapers, booklets, postings, magazines )

2: Interpersonal-Communication

A: Outreach-Services ( one to one treatments, equal instruction, school instruction )

Bacillus: Facility-Based ( clinics, workplaces, health-posts )

Degree centigrades: Group-Communication Workshops ( meetings, dramas ) .

Media and interpersonal communicating are two wide service bringing approaches for the above mentioned scheme. Media entirely can function efficaciously the propose of making mass consciousness still there is demand for interpersonal communicating to pattern the created consciousness in targeted population in a more incorporate manner. This scheme is already in the policy but dealt with a obscure mode that is why a elaborate reappraisal of different service bringing approaches for IEC will be of great importance. Under following header I am traveling to measure different option for IEC and will take best service bringing attacks.


4.1.1: Medium

“ If medical specialty can handle HIV/AIDS, the media is capable of forestalling it with an ultimate end to bring around it through its capablenesss to impact instruction through amusement ” . ( Singh J, 2007 )

complete mass-media plan are of import in HIV-education, as initiated in Uganda. ( Bertrand and Anhang, 2006 ; Nakityo and Mugyeny 2000 )

A: Television and Radio

Harmonizing to Rahman and Rahman ( 2007 ) , Study showed that population whom watched Television had 8.6 % excess opportunity of consciousness about AIDs. They provide good coverage ; and effectual both for literates and nonreaders. Skilled staffs for TV/radio Stationss are required. Feedback could be a job. Programs need to be in local linguistic communications and within cultural-norms. In instance of Television, initial investing is high but subsequently cost per individual is low. Evidence emphasizes importance of Television in HIV instruction but fiscal barrier puts restraints on utilizing this signifier of media in refugee scenario.

Bad-reception, inaccessibility of electricity/batteries can be job. Radios are cheaper and there is opportunity that most of targeted population might already have them, can be donated by organisations. Plans can aim vulnerable groups e.g. adult females, kids, commercial sex workers ( CSWs ) etc. As compared to Television, wirelesss seem more appropriate for usage in refugees.

( Walley J et al. , 2006 )

Degree centigrades: Print Media

Provides broad coverage, can be delivered to risk-groups and influential people but nonreaders may non derive sufficiently from it. ( Walley J, 2006 ) .

It needs staff for distribution and skilled people to come-up with right messages, otherwise messages will be non-interesting and non-informative, e.g. in Nepal print-media battle against HIV was non really effectual because of deficiency of dept and fact-finding nature of study.

( UNDP and UNAIDS, 2007 )

The International Federation of Journalists, in research conducted into, “ media describing about HIV ” from November, 2005-March, 2006 found that out of 356 narratives, 281 ( 79 % ) were from print-media and 75 ( 21 % ) from broadcast-media. ( Pollard and Walter, 2006 )

In refugees print media can play of import function as it gives chance for audience-segmentation and is relatively inexpensive, can be given free in signifier of cusps, booklets.

2: Interpersonal-Communication:

“ Viva-voce ” , has been shown to be one of the most effectual communication-channels for geting cognition and promoting desired alterations in behavior ” ( UNFPA, 1999 )

A: Out-Reach Servicess ( ORS )

ORS gives chance to present instruction to specific groups harmonizing to their demands. Peer-education is most helpful in altering behavior and believes, as equals are people from same community, person whom locals can swear. Requires trained-staff, clip, conveyance, stuffs etc. ( UNFPA, 1999 ; Walley J, 2006 ) .

Feasible for under-privileged people, e.g. adult females, CSWs. ( Pinknews, 2006 ; International HIV/Aids confederation, 2007 ) . Street-dramas, puppet-shows, theaters are powerful media to distribute consciousness. ( Gurung N, 2007 )

It gives chance for feedback. Resources like forces, stuffs, conveyance and clip are required.

Bacillus: Facility-Based

Facility-based instruction takes into history special-needs of community, instruction is delivered at clip as intervention, effectual in altering believe, attitudes. There can be time-limitation, merely those utilizing services will profit, instruction is dependent on communicating accomplishments of staff. Need to be done along with other agencies of instruction.

( Walley J et al. , 2006 )

School based sex instruction can diminish hazardous sex behavior. ( Kirby D et Al, 2006 )

Showing pictures in STD clinics has shown to be really effectual in raising consciousness.

( Cohen DA et al. , 2004 )

Degree centigrades: Group-Communication Workshop

They are of import in conveying community together ; more is achieved with less-time and resources but without readying and followup, will non take to durable alteration. ( Walley J et al. , 2006 )

Culture may forestall commixture of genders ; young person may experience diffident in-presence of seniors.

Delivery Strategy

Technical Effectiveness



Social-Cultural Feasibility





Large-coverage, easy both for literate and nonreaders, no feedback

trained professionals required, electricity

Plans have to be in local-language, and with-in cultural/social norms ;

Initial investing is high, subsequently cost per individual is low

Equitable, plans for

mark groups e.g. pregnant-women


Very high-coverage, apprehensible to literates and nonreaders ; no video-dimension ; no feedback ; quality of response may be bad

Needs radio-station, skilled-staff ; electricity/ batteries

Same as Television

There is opportunity that refugees might be transporting their wirelesss ; are low-cost, can be donated by givers

Equitable, plans for mark groups like CSWs


Good coverage ; can be distributed to target-groups and influential-people ; illiterate people ca n’t profit ; make can be limited

Needs imperativeness, skilled -staff, staff for distribution

To be in apprehensible linguistic communication to both populations and acceptable to them

Quite inexpensive, can be provided free

Gives chance for audience-segmentation, e.g. different stuffs for

different age-groups

Table 1: HIV Health-Education Service-Deliveries Appraisal Table


Delivery Strategy

Technical Effectiveness



Social-Cultural Feasibility




Out-reach services

Can make vulnerable population, messages delivered to specific audience ; feedback obtained ; good coverage but requires clip

Staff, stuff, conveyance and clip required, staff demands good communication-skills ; locals and equals can be used

Locals and equals can pass on efficaciously

Needs forces, stuff, money, clip

Peers can be adult females, work forces and striplings, from different Fieldss so specific-groups targeted


Allows particular demands to be taken in history ; less coverage ; non really effectual alone

Merely reaches those who utilize service ; time-limitation, requires skilled-staff

Target-groups ( e.g. CSWs ) may non come from fright of stigma

Existing health-posts utilised

Education harmonizing to demands

Group -communication work stores

Can bring forth big sum of involvement, leads to community-participation

Less clip, greater population covered

Risk-population and target-groups may non go to

Less resource input, instruction is conducted at clip to large-masses

Less privileged groups possibly left out

Table 1.b: HIV Health-Education Service-Deliveries Appraisal Table



Out-reach services will be aimed to make targeted population.


Designation of risk-groups e.g.CSWs

Audience cleavage ( into groups of adult females, work forces, striplings )

Ad for peer-educators within each group ( with aid of community-leaders )

( Time-frame, who ‘s responsible, input, result, and outcome-indicators are given in table-2 )

Development of IEC-packages From bing national IEC-draft in local-language

Recruitment of Trainers From international, local or community

Training of Trainers By Public-Health-Co-ordinator

Post-Training appraisal

Recruitment of peer-educators ; will be Males, females, striplings equals from groups with which they will be working, from refugees and territory.

Meeting of Trainers with Joint-committee To be after and schedule training-session of peer-educators

First Work-Shop Provides basic-knowledge and initiates development of accomplishments

Continued-Training Comprising of periodic study-days, weekly-sessions, audit-cases

( WHO, 2000 )

Meeting of peer-educators with District-health-management-team ( DHMT ) To acquire schedule-of-activities

Meeting of peer-educators with DHMT every 15 yearss to describe advancement


It will be systematic, uninterrupted procedure collection and analyzing information. It will be done through

Periodic studies from peer-educators

Review and periodic audit of these records


Exit interviews to supervise community satisfaction

Facilitative supervisory-visits to detect reding and health-education accomplishments of peer-educators

Interviews with refugee and community leaders

Staff meetings


No. of people take parting in group-discussion ( quantitative )

No. of people educated ( qualitative )


Evaluation is assessment in one-point in clip.

It will be done yearly, initial-survey supplying base-line.

No. of people utilizing rubbers and using STIs clinics ( quantitative )

No. of people with changed behavior ( qualitative ) ( WHO, 2000 )

Table 2: Action Plan


Who is responsible

Time Frame

( hebdomads )




Surveillance to place risk-groups



District-staff and speedy questionnaires

Risk-groups identified and audience-segmentation into groups achieved

No. of groups identified right, Survey Record

Designation of peer-educators

PHC and MSF Rep.


District-staff, community-refugee leaders

Peer-educators identified

No. of peer-educators identified

Development of instruction bundles


1st -2nd

Time to develop

Learning stuff, course of study drafted

Course of study prepared

Recruitment of trainers

MOH HR -officer


International-organizations staff

No. of needed trainers recruited

Required trainers recruited

Training of trainers



Staff, stuffs, and money

Trained trainers

No. of trainers to the full trained

Meeting between trainers and Joint commission

DMO and MSF Rep.

End of 2nd


Training-schedule for wellness workers

Minutess of meeting

Recruitment of peer-educators

UNHCR project-Manager

1st -2nd

Time, record stuff

Peer-educators recruited

No. of peer-educators recruited

Training of peer-educators


3rd -4th

Trainers, instruction stuff, work topographic points


No. of skilled workers obtained

Meeting of trained workers with DHMT

Oxfam Rep.



Agenda of activities, job- distribution obtained

Minutess of meeting

Education of peer-groups


6th hebdomad onwards

Forces, IEC stuff, conveyance

Knowledge of STIs/HIV in both communities increased

Behaviour studies of communities




Time, forces, money

Impact Assessment

Evaluation Reports


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