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Despite having an HIV prevalence of less than 0.1% among its general population, Pakistan’s HIV epidemic has transitioned from low to a concentrated one as the overall prevalence among IDUs has steadily increased from 10.8% in 2005 to nearly 21% in 2008.

There are an estimated 91, 000 injecting drug users in Pakistan of which nearly one in four in large urban settings are infected with HIV.

The connections and overlap between drug use and sex work coupled with high prevalence of unsafe sexual practices and low self risk awareness indicate that there is potential for rapid spread of HIV infection among key populations.

Syringe Exchange Programs and Drug Harm Reduction including detoxification programs for IDUs are a priority in light of the epidemic trends among IDUs. Substantial scale-up of harm reduction and HIV prevention services started around 2002-2004 and the country is now set to pilot drug substitution among drug users.

Harm reduction services are being implemented by partner NGOs which can play a pivotal role in reaching out and expanding the provision of such services.

Behavioral surveillance studies have shown an increase in knowledge regarding HIV, increase in condom use and decreased sharing of syringes/needles among IDUs exposed to risk reduction program activities.

However, coverage of these programs is still low as only 17.000 injecting drug users are reached by HIV prevention services in the country.

Despite having a thorough plan of action built upon evidence-based recommendations, the country is facing a shortage in resources that could jeopardize an effective and timely response to the epidemic.

An increase in resources available would expand the provision of risk and harm reduction services that are producing positive results mitigating the spread of HIV among populations at higher risk.