HIV prevalence ranges from 2% in Rahim Yar Kahn, 7% in Rawilpindi and 9% in Gujrat to 10% in Multan. The average prevalence among the 400 respondents in this study is 7%. This prevalence is much higher than the average population in Pakistan, which is close to 0%. 

People who smoke heroin cannot easily access harm reduction services in Pakistan, which have traditionally always focused on the risks around sharing injection equipment. This report reflects a first health insight in a group of people in Pakistan who urgently need to be flagged as an at-risk-population. 

A striking 50% of the respondents started using heroin while still under the age of 18

In addition to the high HIV and HCV prevalence, the assessment looked into other characteristics of this group of people who smoke their heroin. A striking 50% of the respondents started using heroin while still under the age of 18. Nine per cent were younger than 12 years old when they first used. Out of all the respondents, a remarkable 65% had been to jail - a fact that might contribute to the health-risks these people have encountered.

Urgent follow-up to these new facts is required

Knowledge of HIV among the group of respondents is a major concern. Sixty three per cent of the respondents had never heard of HIV. Out of the 37% that did hear about HIV, 55% did not know how HIV spreads. The group of respondents who reported to be sexually active within or outside of marriage stated that they rarely or never use condoms. 

Urgent follow-up to these new facts is required: harm reduction services need to adjust to fit the needs of this group of people who use heroin. More research is needed to understand risk behaviours and vulnerabilities among this group.

Research is also needed to expose the possible trends in the HIV epidemic in Pakistan. HIV used to be considered as concentrated only among injection drug users and their wives and sexual partners. This assumption is now obviously under scrutiny.

This assessment was conducted by Nai Zindagi in Pakistan and supported by Mainline under the Bridging the Gaps Programme.

Read the full report here.