Providence/Boston Center for AIDS Research (CFAR)

HIV/AIDS Awareness and Education Project in Pakistan

Fizza S. Gillani, MSc, MAPE, PhD, CPHIMS

Associate Professor (Research), Alpert Medical School of Brown University
Informatics Director, Ryan White Program at the Miriam Hospital
Sr. Research Scientist, The Miriam Hospital

Director: HIV In Pakistan Project
Chair: APPNA-MERIT HIV Committee
Member: APPNA-MERIT Research Committee

Contact information:

Additional Resources

Agencies

YouTube Channel

Web Page Designed by:

Corinne Wahlberg, Prov/Bos CFAR
Musa Chughtai, Syracuse University
Yaheya Irfan, University of Connecticut
Isra Hussain, University of Chicago

HIV/AIDS Awareness and Education Project in Pakistan

The Providence-Boston Center for AIDS Research (CFAR) is currently leading an international education and capacity-building program on HIV in Pakistan. CFAR is partnering with several organizations for its 2021-2022 project, “HIV Awareness, Prevention, and Education Project in Pakistan.”

Partners include the Association of Physicians of Pakistani Descent of North America through its “Medical Education, Research, International Training and Transfer of Technology” program (APPNA-MERIT); the Association of Pakistani Physicians of New England (APPNE); the National AIDS Control Program in Pakistan (NACP); the Medical Microbiology and Infectious Diseases Society of Pakistan (MMIDSP); and, the Pakistan Society of Internal Medicine (PSIM).

This 2021-2022 project builds on the success of the 2019 “HIV Communications Project in Pakistan”, which was led by the same CFAR team and was in collaboration with the Jinnah Sindh Medical University Alumni Association of North America and the Jinnah Sindh Medical University. There are also ongoing efforts to develop similar capacity-building projects in Pakistan's HIV care sector through partnerships with other medical colleges in Pakistan.

Overview

In the 40 years since HIV/AIDS emerged as a global health crisis, HIV/AIDS continues to affect millions of people around the world. Despite incredible advances in medical care and treatment, there are still an estimated 38.4 million people living with HIV in 2021, 1.7 million of them children (Source: UNAIDS). HIV/AIDS affects not only individuals, but also their families, communities, and countries. Low and middle-income countries bear the largest burden in the current HIV/AIDS epidemic. These countries often have limited resources to test and treat people living with HIV and lack the infrastructure or financial means to build additional resources.

The HIV/AIDS outbreak in Sindh, Pakistan in 2019, which became the impetus for starting the HIV in Pakistan Project, is an example of this issue. In April 2019, over 600 people tested positive for HIV in Sindh, nearly 500 of these children and 90 pregnant women. These new diagnoses stretched the already limited HIV treatment options in the region. Additionally, without assistance in identifying and eliminating unsafe medical practices that caused this outbreak, future outbreaks became more likely to occur. Efforts to train physicians to treat HIV, increase access to HIV testing and treatment, and improve the sanitation of medical practices are critical to address this outbreak and future outbreaks throughout Pakistan.

World AIDS Day Report

Projects and Publications

Build capacity: Adopt an ART Center to enhance HIV care in Pakistan

For 2022-2023, the APPNA MERIT HIV Committee introduced the “Build capacity: Adopt an ART Center to enhance HIV care in Pakistan” project. This project focused on ART (antiretroviral treatment) Centers, which are the hub of HIV care delivery in Pakistan that provide free antiretrovirals for people living with HIV. The committee's aim has been to help develop and strengthen the skills, processes, and resources needed by healthcare providers at these centers to improve the quality of HIV care services in Pakistan, ensure more people are virally suppressed, and ultimately control future HIV transmissions in Pakistan. ART Centers across Pakistan have been invited to the 2022 webinar series to discuss issues specific to each center. An overview and key conclusions of 2022 activities will be summarized in the annual HIV in Pakistan report, which will be released in early December for World AIDS Day 2022.

2022 Webinars

Webinar 16: Building HIV Services Capacity in Pakistan: An Innovative Approach - Nov 7, 2022

The main focus of this webinar is the outlining of a proposal that addresses the HIV situation in Pakistan. The idea behind this proposal is to improve the quality of care regarding HIV cases. An example of a successful HIV treatment program from the United States is mentioned and serves as a model for the proposal. Three goals are held in mind for this project: assess HIV care; ensure proper treatment and support; and create integrated HIV care programs. The main idea of the "Build Capacity: Adopt an ART Center'' Project is to link medical colleges with local ART centers. The roles and benefits for the medical colleges, ART centers, and HIV Committee members (and others) are outlined. Finally, each party is given a series of future steps towards the implementation of this project.

View Webinar on YouTube View Summary

Webinar 15: Current HIV Treatment and Care Delivery Model in Baluchistan - Sep 18, 2022

In this webinar, Pakistan's approach to HIV is discussed with emphasis given to the current situation in the province of Baluchistan, Taking Pakistan as a whole, only 50,000 of 240,000 people are aware of their positive HIV status. The core issue is the provincial structure of Pakistan, which divides up information and treatment between the various provinces. This results in certain provinces declining to support or help the HIV response. Baluchistan specifically does not even focus on treating common diseases, and so HIV treatment is behind other parts of the country. In Baluchistan, the Quetta district has around 48% of the province's HIV cases, and other statistics are also discussed. There are a total of two ART centers in the province, with 6 more being built.

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Webinar 14: Iatrogenic transmission of HIV - poorly regulated transfusion of blood products in Pakistan - August 21st 2022

In this webinar, issues with blood screening and transfusion practices within the context of HIV are first discussed. In Pakistan, there is a lack of pre-donation screening for disease, which allows for them to be transmitted via transfusion. Blood transfusion reactions and grouping are also not documented properly. While Pakistan's blood bank system has been reformed, reforms have begun to stagnate recently and there is a risk for the blood bank system to completely fall back to its unsafe practices. Finally, a testing recommendation for screening blood donors is recommended in order to reduce HIV transmission.

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Webinar 13: Iatrogenic Transmission of HIV – Unsafe Reuse of Needles and Syringes in Pakistan – A Public Health Crisis - 7/31/2022

This webinar describes the history of reported HIV outbreaks in Pakistan, the sheer volume of HIV-positive people (PLHIV) in Pakistan who are unaware of their HIV status, and the role of unsafe injection practices in fueling the HIV epidemic. While there has been significant improvement in safe injection practices globally since 2011, unsafe injections in Pakistan did not improve at the same rate. While approximately 1.5 billion syringes are being used in Pakistan each year, the current manufacturing capacity in Pakistan is less than 600 million syringes; this discrepancy results in syringe reuse, which is a major cause of HIV transmission in Pakistan. Improving injection practices in Pakistan requires a multifaceted response, including empowering the community to question the need for injections and instituting the use of reuse prevention syringes (RUP) in the therapeutic sector.

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2022 Publications

HIV in Pakistan – Report published in the APPNE Magazine May 2022 (PDF)
This report summarizes activities of the APPNA-MERIT HIV Committee before and after its inception in January 2021. It details the committee’s planned activities for 2022 based on its findings, with the aim of helping Pakistan’s HIV care-providing sector build capacity by creating networks with local educational institutions.
HIV Awareness, Prevention, and Education in Pakistan, JPSIM Short report (PDF)
From the Journal of Pakistan Society of Internal Medicine, this report summarized the state of HIV Awareness, prevention, and education in Pakistan along with future steps. Challenges identified include gaps in knowledge, attitude, and practice. Finally, a number of solutions to the HIV situation in Pakistan are presented.

2022 Project Team & Partners

Dr. Fizza S. Gillani, PhD (Associate Professor (Research) at Brown University; Prov-Boston CFAR), HIV Committee Chair
Dr. Saima Abbas, MD (ID Physician, Space Coast Infectious Diseases care, Florida, USA), HIV Committee Co-Chair
Dr. Hammad Ali, MBBS, MPH, PhD (Adjunct Associate Professor, University of Queensland, Australia; Medical Epidemiologist, Georgia, USA), HIV Committee Co-Chair
Dr. Fozia Qamar, MD (ID Physician; Assistant Professor of Medicine and Infectious Diseases, UMASS)
Dr. Nida Arif, MD, (ID Physician, NH, USA)
Dr. Fizza Rafiq, MD, CCFP, FCFP (Family Physician; Clinical Lecturer, U-Calgary)
Dr. Taimur Khan, MD, (ID/HIV), MA
Dr. Aadia I. Rana, MD (ID Physician; Associate Professor of Medicine at UAB)
Dr. Yousaf Shaikh, MD, FACP (Assistant professor of Medicine at UMASS; President-APPNE)
Dr. Najam Zaidi, MD, FACP, FIDSA, Steward Medical Group, MA, USA
Dr. Syed I Hussain, MD, President, NRI Medical Services, RI, USA
Dr. Bushra Jamil, MBBS (Professor, Aga Khan University; President MMIDSP)

HIV Awareness, Prevention, and Education Project in Pakistan

In 2021, Dr Gillani joined the Association of Physicians of Pakistani Descent of North America (APPNA) and its Medical Education, Research, International Training and Transfer of Technology (MERIT) HIV Committee 2022. She initiated the creation of the APPNA MERIT HIV committee in January 2021, became the first Committee Chair, and led the design and launch of the 2021 project. This project aimed to reduce stigma, increase awareness, and increase knowledge about the HIV disease among healthcare providers in Pakistan using educational and research tools. The HIV committee organized educational webinars in collaboration with 35 institutions across North America and Pakistan, published a report highlighting key takeaways from the webinar series for Worlds AIDS Day 2021, and discussed critical action items with international funding institutions and stakeholders in Pakistan.

2021 Webinars

Webinar 1: HIV Disease: Myths and Facts - 5/23/2021

This webinar describes the ongoing epidemic in Pakistan and the initiatives of the APPNA MERIT HIV committee in raising awareness about HIV in Pakistan, which include collaborating with local healthcare institutions in Pakistan to help increase awareness about the HIV/AIDS disease. These activities aim to empower providers, patients, and communities with accurate knowledge about the disease, while decreasing stigma surrounding routine testing and HIV diagnoses. There is often miscommunication around how HIV is spread, and the largest barrier to controlling the HIV epidemic in Pakistan has been denial and stigma. Increasing access to accurate education about HIV, normalizing testing for HIV, and encouraging open and informative conversations in Pakistan would make a large difference in transmission control.

View Webinar on YouTube Download Report 1

Webinar 2: HIV Testing, stigma, patient-provider
communication, and the HIV Care Cascade – 5/30/2021

This webinar describes the need for increased awareness about the HIV disease, destigmatization, normalization of routine testing, and improvements in patient-provider communication to address the HIV epidemic in Pakistan. Current challenges in Pakistan to combat this epidemic include linking patients to treatment, retaining patients in care, managing data, and identifying donor funding. In addition, further efforts are needed to reach hidden key populations. By monitoring and improving these efforts, the public health community in Pakistan can help to combat the stigma and discrimination related to the HIV disease, ultimately leading to increased screening and treatment outcomes for HIV throughout Pakistan.

View Webinar on YouTube Download Report 2

Webinar 3: HIV Clinical Presentations and Treatment Options – 06/06/2021

This webinar identifies the HIV/AIDS presentation and describes the traditional, misinformed, and well-informed approaches to diagnosis. There is significant stigma around HIV testing and diagnosis, both of which have acted as barriers for prevention of further transmission. Primary HIV infections often go undiagnosed because there is not a high degree of clinical suspicion. Further, there are constraints with diagnosing patients and limited availability of treatment.

Clinical intervention can be managed at the primary care level and should include routine labs, ART clinic referrals, and counseling. Transmission reduction proposals including needle exchange programs, increased testing, and post-exposure prophylaxis should be introduced to prevent further spread of the concentrated epidemic.

View Webinar on YouTube Download Report 3

Webinar 4: HIV/HCV Co-infections, Clinical
Presentations and Treatment Options – 06/13/2021

This webinar outlines and describes the prevalence and features of HIV and Hepatitis C coinfection. Pakistan has one of the highest Hepatitis C infection levels worldwide, with many cases originating from healthcare-acquired transmission. Despite the availability of generic direct-acting antivirals and reduced treatment costs, the prevalence of Hepatitis C remains persistent, with no evidence of declining prevalence. There is a large gap between infection and treatment, with a lot of people unaware of their Hepatitis C status. Early intervention and treatment are important in co-infected patients because HIV is independently associated with Hepatitis C progression. Patients with coinfection require dual therapy, which includes many guidelines to prevent drug interactions and contraindications. Encouraging collaboration between specialists as well as training family physicians, simplifying guidelines by adapting them to local conditions, and empowering general practitioners to approach testing and treatment in an unbiased manner will help to promote a national movement to encourage treatment and prevent transmission for HIV and Hepatitis C coinfection.

View Webinar on YouTube Download Report 4

Webinar 5: HIV/TB Co-infections, Clinical Presentations and Treatment Options – 06/20/2021

Tuberculosis and HIV requires prompt management and treatment to prevent further transmission and minimize the development of opportunistic infections. It is especially important that anybody diagnosed with Tuberculosis should be tested for HIV, and vice versa. For mono infection with Tuberculosis, treatment is straightforward and should be started immediately to prevent spread. In patients with Tuberculosis and HIV co-infection, pharmacotherapy options are reduced. The NRTIs (nucleoside/nucleotide reverse transcription inhibitors) do not have significant interactions and may be used for treatment.

Clinicians must assess the most appropriate available therapy for their patient, as well as any necessary dose adjustments. HIV counseling and prophylactic treatment, as well as procedures for infection control, should be implemented. Ensuring patients have access to treatment and medication as well as a supportive healthcare staff can help to decrease the stigma behind HIV testing, and implementing more frequent Tuberculosis testing when appropriate will decrease the incidence of co-infection.

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Webinar 6: Caring for pregnant women with HIV disease and preventing HIV Transmissions - 6/27/2021

Education and the implementation of standard practices to help prevent and reduce maternal transmission of HIV to infants has been an ongoing topic of discussion. HIV transmission from mother to infant generally occurs during labor, delivery, and subsequent breastfeeding. Key prevention tactics include universal HIV testing for all pregnant women and the implementation of antiretroviral therapy and adherence to therapy after diagnosis. The Dolutegravir-based regimen is recommended as the preferred first-line treatment for people living with HIV. There is very low evidence of neural tube defects for women and adolescent girls of childbearing potential who begin therapy. For healthcare workers who are working with HIV positive women for the duration of their pregnancy, it is extremely important that they receive training on infection control, occupational post exposure prophylaxis policies, and the importance of testing and treatment with emphasis on decreasing healthcare stigma against the disease.

View Webinar on YouTube Download Report 6

Webinar 7: Lifelong Care of Infants and Children Living with HIV – 7/18/2021

This webinar describes HIV infections and common clinical presentations of HIV in children, developmental effects, and pediatric HIV care in Pakistan. Though potentially preventable, most children are infected via mother-to-child transmission; these infections are compounded by poverty and challenges in access to healthcare, lack of HIV awareness, and limiting testing availability. HIV in children can lead to development delays, such as persistent weight loss, impaired brain growth, and/or motor defects. In Pakistan, 7 out of 50 ART centers are dedicated to pediatric care, while the remaining centers treat both adults and children. HIV medicine and diagnostic tests are provided free of charge in all pediatric ART centers. Regardless of this, challenges persist: there are very few Pediatric Infectious Disease Physicians in Pakistan, proper linkage between pediatric and adult ART centers do not exist, and accessing HIV children’s services can be challenging given remote locations. In the future, there is a need to expand pediatric HIV centers and care services as well as to extend medication and other services in highly burdened districts to care for HIV positive children in Pakistan.

View Webinar on YouTube Download Report 7

Webinar 8: Improving Quality of Care and HIV Education in Pakistan - A Brainstorming Session – 8/29/2021

Improving the quality of care and educating medical personnel and the general public about HIV is critical to addressing the current state of HIV in Pakistan. In this webinar, speakers and participants reflected on lessons learned from the previous six webinars delivered in 2021 and methods to improve HIV education and care in Pakistan moving forward. In general, webinar hosts and participants agreed that an increase in routine testing, implementing mandatory HIV courses in medical school, and increasing awareness about the disease in general were critical steps to addressing Pakistan’s HIV epidemic. Additionally, an interdisciplinary approach to health care more generally, such as developing an understanding of health care as medical sociology beyond just physician-patient relationships, would also help address health care challenges in Pakistan.

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Webinar 9: Sexually Transmitted Diseases STDs and HIV – 9/29/2021

This webinar describes important information on STI prevention, recommended treatments for specific STIs, and the relationship between most STIs and HIV. The Centers for Disease Control and Prevention (CDC) recommends the ‘Five P’ approach to STI discussions, involving dialogue on: Partners, Practices, Protection (i.e., condoms), Past history, and Pregnancy. Having any STI significantly increases one’s risk of acquiring HIV infection. In Pakistan, the most common STIs include gonorrhea, syphilis, chlamydia, HIV, fungal candidiasis, and trichomonas. Due to stigma, many individuals attempt to hide all signs and symptoms of STIs. In order to combat stigma and prevent STIs in Pakistan, It is critical that STI education is implemented for politicians, religious leaders, students, and teachers, covering topics such as sexual behavior, mental health issues, and drug abuse in order to reduce disease prevalence.

View Webinar on YouTube Download Report 9

Webinar 10: HIV Disease Among the Key Populations in Pakistan Part 1 – 10/24/2021

In Pakistan, there is significant stigma surrounding the HIV Disease and Key Populations (KP), including Pakistan’s Transgender population. Stigma and discrimination towards People Living with HIV (PLHIV) in Pakistan is pervasive, with fear and limited understanding of HIV transmission exacerbating this issue. Stigma is harmful to Pakistan’s health practice, families, and communities, and affects the ability for PLHIV to secure employment opportunities and live with dignity. In order to address these issues, Pakistan must ensure that the right to employment for PLHIV/KP is incorporated as an advocacy and human rights issue. Additionally, research institutions should undertake research to find evidence on employment-related stigma and discrimination so that targeted intervention strategies can be devised. Also, encouraging businesses and labor leaders to champion HIV anti-discrimination measures, deliver HIV education in work settings, and adopt other similar measures can help support the employment of PLHIV in Pakistan.

View Webinar on YouTube Download Report 10

Webinar 11: HIV Disease Among the Key Population in Pakistan Part 2 – 11/21/2021

This webinar describes the HIV situation for Injection Drug Users (IDUs) in Pakistan. Specifically in Balochistan, two HIV/AIDS Centers provide HIV treatment to all registered patients free of cost, including IDUs. CoPCs (Continuum of Prevention and Care Services), funded by the Global Fund, were established in 2014 to provide comprehensive services to IDUs in Pakistan’s 30 districts. However, challenges for addressing HIV infection in IDUs remain, including the need for new syringes/needles, a limited budget for basic medical care, a need for increased detoxification and rehabilitation centers, and a need for general social services to support IDUs. The Dost Foundation in Pakistan provides services for IDUs, serving a population of approximately 4.4 million drug users in KPK/FATA and adjoined Punjab districts. The Dost Foundation focuses on drug demand reduction, HIV prevention and care, human rights, human resource development, and community development. Organizations such as the Dost Foundation can provide vital support to the public health sector in Pakistan and address the growing HIV epidemic.

View Webinar on YouTube Download Report 11

Webinar 12: Vision for HIV in Pakistan for 2022 – 12/19/2021

An update on the HIV Awareness, Prevention, and Education Project in Pakistan Report was published on World AIDS Day on December 1, 2021. This webinar described several key themes from the World AIDS Day report. These included: (1) Treatment as Prevention and measurement of Key Performance indicators to understand the percentage of patients who are newly diagnosed with HIV, those who are on ART, those who are virologically suppressed, and those who have died from HIV/AIDS-related deaths; (2) the Knowledge, Attitude, and Practice Gap, describing how HIV transmission is no longer confined to Key Populations, the general population is becoming infected due to unregulated use of contaminated needs and unscreened blood products, and discrimination and stigma is affecting HIV management and treatment adherence; and (3) Infection Prevention and Control, whereby external teams began training healthcare staff and managing treatment activities after the initial HIV outbreak in Pakistan. These trainings and management were not implemented in Pakistan's internal structures, and therefore, have not been fully adopted into Pakistan’s HIV prevention practices. Moving forward, these key themes must be emphasized as tools for preventing future HIV transmission and curbing the evolving HIV epidemic in Pakistan.

View Webinar on YouTube Download Report 12

2021 Publications

HIV Disease Burden – Editorial published in Journal of Dow University Health Sciences – Jan 2021 (PDF)
This report was published in the Journal of the Dow University of Health Sciences Editorial. It highlights HIV Disease Burden and Stigma in Pakistan, specially mentioning the role of local institutions. It stressed the single most important way for these institutions is to educate people in both the medical field and in the general population. A basic overview of the stages of HIV progression is presented, along myths/facts related to the disease.
2021 World AIDS Day Report – (PDF)
This report was published on World AIDS Day 2021 and summarizes findings of a yearlong HIV educational campaign arranged by the APPNA-MERIT HIV Committee. The report states that the existing infrastructure and available framework is inadequate for increasing treatment uptake and reducing the number of new HIV infections, HIV transmissions, and mortality in Pakistan. This report presents key recommendations made during a series of webinars attended by more than 700 HIV care providers and HIV experts from the USA that aim to eliminate these issues.

2021 Project Team & Partners

Dr. Fizza S. Gillani, PhD (Associate Professor (Research) at Brown University; Prov-Boston CFAR), HIV Committee Chair
Dr. Saima Abbas, MD (ID Physician, Space Coast Infectious Diseases care, Florida, USA), HIV Committee Co-Chair
Dr. Hammad Ali, MBBS, MPH, PhD (Adjunct Associate Professor, University of Queensland, Australia; Medical Epidemiologist, Georgia, USA), HIV Committee Co-Chair
Dr. Fozia Qamar, MD (ID Physician; Assistant Professor of Medicine and Infectious Diseases, UMASS)
Dr. Nida Arif, MD, (ID Physician, NH, USA)
Dr. Fizza Rafiq, MD, CCFP, FCFP (Family Physician; Clinical Lecturer, U-Calgary)
Dr. Taimur Khan, MD, (ID/HIV), MA
Dr. Aadia I. Rana, MD (ID Physician; Associate Professor of Medicine at UAB)
Dr. Yousaf Shaikh, MD, FACP (Assistant professor of Medicine at UMASS; President-APPNE)
Dr. Najam Zaidi, MD, FACP, FIDSA, Steward Medical Group, MA, USA
Dr. Syed I Hussain, MD, President, NRI Medical Services, RI, USA
Dr. Bushra Jamil, MBBS (Professor, Aga Khan University; President MMIDSP)

HIV Project activities in 2020

Dr. Gillani attended a one-day conference in Islamabad - “National Consultation Conference” organized by The Association of People Living with HIV (APLHIV) in collaboration with APCASO, NACP, UNAIDS, & CCM Pakistan – March 3rd, 2020. The conference was represented by many Key Populations groups representatives who represented different social, cultural, and economic issues face by their communities in Pakistan.

Consultation Conference

Dr. Gillani visited the HIV ART center located at the Pakistan Institute of Medical Sciences, in Islamabad, Pakistan March 2^nd, 2022. She interviewed and discussed the HIV patient’s issues with the main HIV care provider at the center.

HIV Clinic Pic 1 HIV Clinic Pic 2 HIV Clinic Pic 3

Dr. Gillani attended a Three-day long conference on “Building Primary Care Capacity: Pakistan’s Critical Need” held at the Rawalpindi Medical College in Rawalpindi, Pakistan, March 4-5, 2020. She advocated for the HIV awareness topics to be included in the newly designed primary care curriculum in Pakistan.

APPNA Conference

Dr. Gillani joined APPNA delegate to meet with the Prime Minister of Pakistan Mr. Imran Khan to advocate for the Primary Care Specialty programs establishment in Pakistan.

Conference

Dr. Gillani and CFAR team planned a three-day conference on “HIV In Pakistan” to be held in Rhode Island, USA. The conference was planned for April 6-8, 2020, but due to COVID outbreak, all conferences were canceled. All further attention was diverted to COVID-19.

HIV AIDS Communications Project HIV in Sindh, Pakistan

In April 2019, an HIV outbreak affecting primarily children in Larkana, Sindh, Pakistan left local healthcare providers overwhelmed and in shock; these providers required extensive knowledge to address the outbreak. Dr. Gillani was contacted by Larkana's healthcare providers to provide training and HIV education. In response, she designed and deployed this project, inviting her colleagues at Lifespan/Tufts/Brown CFAR to join. This project, academic in nature, was geared towards creating an educational campaign to reduce stigma and increase awareness about HIV/AIDS by empowering healthcare professionals with the latest knowledge about HIV in the affected area.

HIV IN PAKISTAN PROJECT PROGRESS REPORT

2019 Webinar Summaries

Webinar 1: HIV Disease: Myths and Facts
Date & Time: May 19, 2019, 12:00-1:30 PM EDT
Host & Speaker: Fizza S. Gillani, PhD

This webinar introduced details about the HIV disease to the medical community in Sindh. Key topics discussed include:

HIV definition and disease progression
Various modes of HIV transmission in general and those specific to Pakistan
Myths and facts about HIV disease to reduce HIV stigma in Pakistan
The importance of providing effective provider- patient encounters

The webinar was attended by medical school faculty, medical students, physicians, and health administrators from the Sindh Province in Pakistan. Concerns raised by the audience included: the lack of availability of diagnostic equipment across the interior Sindh region, limited availability of HIV drugs, unethical practices of blood transfusion, re-use of syringes and lack of sufficient resources to address the province’s 2019 HIV outbreak.

View Webinar on YouTube

Webinar 2: HIV Testing, Stigma and Patient- Provider Communication
Date & Time: May 26, 2019, 12:00-1:30 PM EDT
Guest Speaker: Phillip Chan, MD

This webinar provided information on the importance of establishing and sustaining an HIV testing system, one that will ensure early treatment and normal life expectancy, prior to dealing with an HIV outbreak. The following topics were discussed:

Different types of HIV tests
HIV tests and treatments available in Sindh, Pakistan
HIV diagnostic tests for newborns and infants
How to address HIV outbreak
How to address HIV stigma specific to Pakistan

Webinar participants, representing members of the healthcare community in Sindh, Pakistan, raised numerous concerns during the discussion, such as the effectiveness of different HIV diagnostic tests in newborns, different HIV drug regimen therapies, and the long-term side effects of HIV therapy.

View Webinar on YouTube

Webinar 3: The HIV Care Cascade: An Example from Rhode Island
Date & Time: June 2, 2019, 12:00-1:30 PM EDT
Guest Speaker: Joseph M. Garland, MD

This webinar provided information about the HIV-Care Continuum, a treatment cascade which frames the treatment of HIV with the goal of viral suppression, and featured the following key points:

The three components of the HIV-Care Continuum
UNAIDS’ 90-90-90 campaign globally and in Rhode Island
The importance of educating patients and family members about HIV

Webinar participants raised questions about the average cost of treating HIV in the U.S., standard precautions to follow in HIV clinics, and application of the 90-90-90 model in Pakistan. The discussion also included information about living at home with an HIV infected person, training medical staff, HIV post exposure prophylaxis guidelines, and the health insurance system in Pakistan.

View Webinar on YouTube

Webinar 4: Preventing Mother-to-Child HIV Transmission and Caring for Infected Infants & Children
Date & Time: June 9, 2019, 12:00-1:30 PM EDT
Guest Speaker: Susan Cu-Uvin, MD; Jerome Larkin, MD; Sabina Holland, MD

This webinar provided comprehensive knowledge about the presentation of HIV in children and the prevention of mother-to-child HIV transmission. Speakers discussed the following key features during this webinar:

Acute HIV infection in children and adolescents
Clinical presentations of HIV in children
Life-threatening opportunistic infections in children with HIV
Management of HIV infection in children in resource-limited countries
Prevention of mother-to-child HIV transmission

Webinar participants, including medical staff and students from Sindh, Pakistan, asked questions on how to manage side effects of ARV therapy in children, the monitoring of HIV medicine toxicity in children, the best modes of delivery for HIV positive mothers, and concerns about performing invasive procedures on HIV positive pregnant women.

View Webinar on YouTube

Webinar 5: Caring for Co-Infected Patients (HIV-TB, HIV-HEP C, HIV-HEP B)
Date & Time: June 16, 2019, 12:00 – 1:30 EDT
Guest Speaker: Martha Sanchez, MD; Natasha Rybak, MD

This webinar provided information on HIV co-infections and covered the following topics:

The similarity between modes of transmission for HIV, Hepatitis B, and Hepatitis C
HIV-HEP B presentation, prevalence, diagnosis, and treatment
HIV-HEP C presentation, diagnosis, and treatment
HIV-TB presentation, diagnosis, and treatment for HIV infected children
The importance of open communications between healthcare providers and patients about HIV disease

Webinar participants raised concerns about managing infants with HIV co-infections, management of HIV positive children with complications of TB, and the interaction of various drugs for co-infected children.

View Webinar on YouTube

Webinar 6: Fostering Hope: The Role of Mental Health Care in HIV Treatment from Start to Finish
Date & Time: June 23, 2019, 12:00 – 1:30 EDT
Guest Speaker: Jamie Kenney, PhD; Aziz Soomro, MD

The final webinar in this series discussed the association between mental health care and HIV infection and treatment. Speakers addressed the adverse effects of antiretroviral therapy on patients’ quality of sleep, stress levels, and mental health, which can affect patients’ compliance towards HIV treatment. Key features discussed during this webinar included:

Interventions prior to testing for HIV to address fears, social practices and beliefs
Post-testing intervention and counseling
Incorporation of psychological evaluations at each HIV appointment to prevent emergence of mental health symptoms
Maintaining communication between healthcare providers and patients about HIV disease progression

Webinar participants discuss the limited availability of facilities for pre- and post-testing counseling in Pakistan. The discussion covered factors such as raising awareness of mental health issues associated with HIV infection to doctors, nurses, and educators who encounter HIV infected patients, as well as instilling hope into patients to ultimately improve treatment compliance, decrease suffering, and improve patients’ quality of life.

View Webinar on YouTube

Playlist of 2019 Webinars Download 2019 Flyer Download 2019 Summaries

2019 Publications

HIV In Pakistan Project Summary - 3 July 2019
This document highlights the aims for the HIV Communications Project in 2019: Create an educational campaign to reduce stigma and increase awareness about HIV/AIDS; Help develop and enhance the existing HIV lab systems in the affected areas; Work with local medical schools to train new generations of healthcare providers; Work with colleges to include more HIV awareness courses; and Work with local institutes and government to provide guidance in HIV treatment.
HIV In Pakistan Summary for APPNA - 18 June 2019
This document highlights the aims for the HIV Communications Project in 2019: Create an educational campaign to reduce stigma and increase awareness about HIV/AIDS; Help develop and enhance the existing HIV lab systems in the affected areas; Work with local medical schools to train new generations of healthcare providers; Work with colleges to include more HIV awareness courses; and Work with local institutes and government to provide guidance in HIV treatment.
HIV in Pakistan: Past, Present and Future, APPNA CME Presentation - 5 July 2019
A presentation given at the 42^nd Annual APPNA Convention in Orlando, Florida. This presentation works to help attendees understand facts about the HIV disease in general and history of the HIV disease specific to Pakistan. It discusses different aspects of HIV/AIDS disease including disease progression, stages, and transmission modes. Finally, this presentation aims to help people realize the importance of open communications between healthcare providers and patients regarding HIV.
HIV Epidemic in Pakistan, APPNE Magazine Report - 17 April 2019
From the 2019 APPNE Magazine, this report highlights the severe effects of HIV disease if left untreated and how it leads to AIDS, stressing the importance of Antiretroviral Therapy (ART) for patients. And stresses the lack of an effective response to HIV in Pakistan when compared to the rest of the world. HIV Education for the general population is stressed in order to reduce the rate of infection.
Do we know enough about HIV in Pakistan?, KMU Editorial- 13 September 2019
Pakistan has been facing an upward trend in HIV cases, but knowledge about this disease is almost non-existent throughout the country. This paper works to provide basic information on HIV, such as what this disease is, global responses to HIV, and the April 2019 outbreak in Sindh, Pakistan. HIV Awareness is heavily stressed, and future steps towards solving the HIV crisis in Pakistan are presented.
WHO: Emergencies preparedness, response, HIV cases–Pakistan - 3 July 2019
This report by the World Health Organization outlines the 2019 Sindh outbreak in Pakistan. It provides background (numbers) including the outbreak, the public health response, WHO’s risk assessment of the outbreak, and finally WHO recommendations on how to proceed in the future.

The Providence/Boston Center for AIDS Research in collaboration with the Jinnah Sindh Medical University Alumni Association of North American (JSMUAANA), the Jinnah Sindh Medical University (JSMU), Association of Physicians of Pakistani Descent of North America (APPNA), and the Association of Pakistani Physicians of New England (APPNE) have developed the HIV/AIDS Communications Project Part I: HIV in Sindh, Pakistan. This project aims to teach and train healthcare providers on HIV disease to reduce stigma and increase awareness about HIV, and develop HIV treatment protocols given the limited resources available in Pakistan.

2019 Project Team & Partners

Dr. Fizza S. Gillani, PhD (Associate Professor (Research) at Brown University; Prov-Boston CFAR, TMHIC)
Dr. Syed I Hussain, MD, President, NRI Medical Services, RI, USA
Dr. Rizwan Naeem, MD
Dr. Aziz Soomro, MD, NY, USA
Dr. Farooq Soomro, MD, Pakistan

HIV Research in Pakistan

Collected as of 2022

Rehan, Muhammad, et al. "Knowledge, Attitude, Practices and Awareness Regarding HIV/AIDS among University Students of Islamabad and Rawalpindi, Pakistan." Ann. Pak. Inst. Med. Sci. 12(2), 86-89 (2016). Link to Full Article

Shafique, A. Ahad, et al. "Evaluation of knowledge and awareness of HIV/AIDS among medical, dental and nursing students of healthcare institution in Karachi, Pakistan." Pak. J. Surg. 35(2), 114-19 (2019). Link to Full Article

Raheel, Hafsa, et al. "Knowledge and beliefs of Adolescents regarding Sexually Transmitted Infections and HIV/AIDS in a rural district in Pakistan." J. Pak. Med. Assoc. 57(1), 8-11 (2007). Link to Full Article

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Maan, Muhammad Arif, et al. "Prevalence and risk factors of HIV in Faisalabad, Pakistan – A retrospective study." Pak. J. Med. Sci. 30(1), 32-35 (2014). Link to Full Article

Tahir, Nafisa Batool, et al. "Assessment of different modes of transmission of HIV in patients with HIV/AIDS." Gomal J. Med. Sci. 13(3), 162-65 (2015). Link to Full Article

Nafees, Muhammad, et al. "Jail Population; a survey for HBV, HCV and HIV infections." The Professional Med. J. 18(4), 697-702 (2011). Link to Full Article

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Mehr, Muhammad Tariq, et al. “Is universal screening of individuals for HBV, HCV and HIV before endoscopy justified? An audit of the current practices.” J. Med. Sci. 23(2), 100–104 (2015). Link to Full Article

Kumar, Ameet, et al. "Knowledge practice gaps about needle stick injuries among healthcare workers at tertiary care hospitals of Pakistan." J. Ayub Med. Coll. 24(3-4), 50-52 (2012). Link to Full Article

Maroof, Saira, et al. "Maintenance of Anti-Retroviral Therapy (ART) to HIV Patients and their Preventative Practices Against COVID-19 Pandemic - A Syndemic Perspective from a HIV Center in Pakistan." Pak. Armed Forces Med. J. 71(5), 1769-1773 (2021). Link to Full Article Link to Official Website

Ashraf, Tariq, et al. "The frequency of HBV, HCV and HIV in patients undergoing percutaneous mitral valvuloplasty." Pak. Heart J. 38(1-2), 3-7 (2005) Link to Full Article

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Mujeeb, Syed Abdul, and Mir Rehman All Hashmi. "A Study of 11W-Antibody in Sera of Blood Donors and People at Risk." J. Pak. Med. Assoc. 38(8), 221-222 (1988). Link to Full Article

Ghani, E., et al. "Trends in human immunodeficiency virus seroprevalence in blood donors in northern Pakistan." Public Health 131, 71-74 (2016). Link to Full Article

Qadir, Hira, et al. “Seroprevalence of Hepatitis B, Hepatitis C, Human Immunodeficiency Virus, syphilis, and malaria among blood donors at tertiary care hospital blood bank.” J Pak Med Assoc. 71(3), 897-899 (2021). Link to Full Article

Ghafoor, Muhammad Bilal, et al. "Major Transfusion-Transmissible Infections Among Blood Donors in Rahim Yar Khan, a District of Southern Punjab, Pakistan." Isra Med. J. 8(4), 246-248 (2016). Link to Full Article

Luby, Stephen, et al. "Evaluation of blood bank practices in Karachi, Pakistan, and the government's response." Health Policy Plan. 15(2), 217-22 (2000). Link to Full Article

Altaf, Arshad, et al. "A Second Major HIV Outbreak in Larkana, Pakistan." J. Pak. Med. Assoc. 66(12), 1510-1511 (2016). Link to Full Editorial

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Riaz, Rizwana, et al. "Malpractices in Syringe Disposal by Paramedical Staff." Rawal Med. J. 34(2), 176-79 (2009). Link to Full Article

Altaf, Arshad, et al. "Determinants of Therapeutic Injection overuse among Communities in Sindh, Pakistan." J. Ayub Med. Coll. 16(3), 35-38 (2004). Link to Full Article

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Altaf, Arshad, et al. "High prevalence of HIV infection among injection drug users (IDUs) in Hyderabad and Sukkur, Pakistan." J. Pak. Med. Assoc. 59(3), 136-40 (2009). Link to Full Article

Maqsood, M. Haisum, et al. "Prevalence of HIV/AIDS Among Injection Drug Users (IDUS) in Pakistan." Pak. J. Public Health 5(3), 12-17 (2015). Link to Full Article

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Altaf, Arshad, et al. "Size estimation, HIV prevalence and risk behaviours of female sex workers in Pakistan." J. Pak. Med. Assoc. 62(6), 551-57 (2012). Link to Full Article

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Future Activities

Build Capacity: A project to enable medical institutions to adopt an ART Center to enhance HIV care in Pakistan will be introduced in early 2023, with the goal of helping Pakistan’s ART centers serve people living with HIV more effectively.
Free Consults: A future project will offer Free Consults for complicated HIV cases in Pakistan. Members of the HIV Committee team will devote at least an hour each month to guiding Pakistani HIV care physicians as needed. Any ID physician is welcome to offer his/her expertise on this platform.
Knowledge dissemination: The vast knowledge and information compiled from the HIV in Pakistan project will be published in different reports, manuscripts, and editorials.

About Pakistan

Country Icon of Pakistan

Pakistan is a region with both a rich culture and history dating back thousands of years. The modern state of Pakistan emerged as a sovereign state on the 14th of August 1947. With its capital at Islamabad, Pakistan is divided into four provinces: Punjab, Khyber Pakhtunkhwa, Baluchistan, and Sindh.

A census conducted by the Pakistan Bureau of Statistics in 2017 concluded that Pakistan has a total population of about 214.2 million people. The largest province, Punjab, hosts a population of about 110.0 million people followed by Sindh at 47.9 million, Khyber Pakhtunkhwa at 35.5 million, Baluchistan at 12.3 million, and Islamabad at 2.0 million.

In recent years, Pakistan has launched onto the forefront of the world stage. With a rich populace encompassing a diverse area of skills, Pakistan is the perfect place for future investment and a welcoming place for all peoples.