ISLAMABAD: The Sindh government has formally launched community-based oral pre-exposure prophylaxis (PrEP) — a medicine taken to prevent getting HIV — for key populations and sero-discordant couples (those where one spouse is infected by the virus and the other is not).

In the launching ceremony on Tuesday, Dr Ershad Kazmi, deputy director general of the Sindh health department’s Communicable Disease Control (CDC) unit, said the number of HIV infections in Pakistan jumped 84 per cent between 2010 and 2020. “Unless we take bold steps today, we will not be able to halt further new infections, and PrEP is a step in that right direction,” he said.

The CDC has launched the medicine in partnership with the Joint United Nations Programme on HIV and AIDS (UNAIDS), the World Health Organisation (WHO), the United Nations Development Progra­mme (UNDP) and the United Nations Children’s Fund (Unicef).

PrEP does not replace condoms but offers an additional HIV prevention choice. Community-based PrEP dispensation is critical because community-based organisations working in Sindh have outreach programmes and can play a pivotal role in creating awareness and ensuring stigma-free access to PrEP programmes.

PrEP is considered a game changer in preventing HIV. However, even though it has been more than 10 years since the first evidence of the efficacy of daily oral PrEP was published, much of its scale-up is still highly concentrated in a small number of countries.

Mr Kazmi emphasised that PrEP offered a significant strategic opportunity to precision target prevention programmes for key populations. For administering PrEP to sero-discordant couples and key populations, formal linkages had been established between ART Centres and the outreach component of the current programme.

This approach utilises outreach workers at the frontline to engage individuals who are at risk for HIV. Their main task is to connect members from the community to public health services, so that they can be reached by HIV prevention programmes that will now include PrEP.

Outreach workers disseminate HIV prevention packages, provide safe sex education materials and support for behaviour changes, and most importantly, refer the community for HIV testing and counselling and created linkages with ART treatment centres.

Yuki Takemoto, the UNAIDS country director for Pakistan and Afghanistan, said the UN system was impressed by the political commitment and concrete actions by the government to address the needs of communities.

Ensuring a supportive, enabling environment free from stigma and discrimination will help achieve the targets of the Sindh AIDS Strategy 2021-2025 and contribute effectively towards ending AIDS as a public health threat by 2030.

UNDP Pakistan Officer-in-Charge Aliona Niculita said the HIV response in Pakistan required bold leadership and evidence-based approaches.

Published in Dawn, June 8th, 2022