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Pakistan uses supervised injection sites to battle HIV epidemic

In Pakistan’s Punjab province, many users of illegal intravenous narcotics hire people to put the drugs in their veins. So when public health officials sought to fight an explosive outbreak of HIV they started with the professional injectors.

Did they round them up and put them in jail?

No, they worked with them to more safely inject their customers.

The result, as attendees of 7th International Conference on Urban Health learned, was the creation of multiple “supervised injection sites” operated by the professional injectors.

This happened after Punjab health officials sought the help of the Public Health Agency of Canada to carry out sophisticated surveillance of HIV transmission. The resulting data allowed epidemiologists to understand the complexity of local epidemics among drugs users, sex workers and their clients in five Punjab cities.

The most worrying outbreak was in Sargodha City, where surveillance pinpointed 216 injection “hot-spots”, each frequented by an average of 11 users. Surveys of injecting drug users showed that they often paid professional injectors to give them their fix, two or three times a day -- often with dirty needles and equipment.

Blood testing in Sargodha showed that between 2005 and 2007, this dangerous practice caused HIV prevalence among injection drug users to shoot up from 10 per cent to 50 per cent.

Health authorities could have called in the police, and had the middlemen sent to jail. Instead, as Dr. Naem Hassan Saleem, a Senior Provincial Surveillance Support Officer, told the Vancouver conference, they recruited the professional injectors -- mostly veteran injectors, with skill in finding accessible veins.

By offering small stipends, food and access to a drop-in centre, they were able to teach the professional injectors what they had newly learned about HIV transmission in Sargodha. They then established four “supervised injection sites”, near some of the “hotspots”, and got the professional injectors to agree to use only the clean needles and gear that they supplied.

“Almost 30 to 40 per cent of the injecting population is benefiting from this activity,” Dr. Hassan Saleem told The Tyee. He and others hope these “supervised sites” will help them control HIV in Sargodha and prevent a general epidemic.

Jim Boothroyd was spokesperson for the NAOMI project conducting prescribed heroin trials in Vancouver, and researches and writes for the World Health Organization and others. The views expressed here are his own.

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