Sindh has become the first province in Pakistan to formally initiate an oral medicine programme called pre-exposure prophylaxis (PrEP) to prevent 'high-risk populations' from developing HIV infections, The News reported on Wednesday, citing officials.

"We are initiating the pre-exposure prophylaxis (PrEP) programme in Sindh to prevent persons from high-risk populations from becoming HIV positive, in response to an increase in new HIV infections. Sindh has always been a leader in making early decisions in the field of health, and others will undoubtedly follow suit," Dr Jumman Bahoto, Director General of Health Sindh, said at the introduction of the PrEP programme in Karachi.

Health experts said, according to research, when taken daily as directed, oral medicines called PrEP can reduce the risk of HIV infections by more than 90 percent.

UNAIDS Country Director Pakistan and Afghanistan Ms Yuki Takemoto, Additional Director CDC Sindh Dr Ershad Kazmi, Ms Heather Doyle, Programme Manager for the HIV Global Fund grant at UNDP, Dr Rajwal Khan, Strategic Information Adviser, UNAIDS Pakistan and Afghanistan, Fahmida Khan from UNAIDS, WHO’s country representative to Pakistan, Dr Sara Salman, and other officials were also present.

Dr Jumman Bahoto stated that despite the fact that the first evidence of the efficacy of daily oral pre-exposure prophylaxis (PrEP) was published more than ten years ago, much of the PrEP scale-up is still concentrated in a small number of countries.

"Sindh health department, in partnership with the United Nations in Pakistan, has set a precedent in the country today by launching community-based-Priep PrEP for key populations and sero-discordant couples. PrEP offers an additional HIV prevention choice along with other preventive measures," he said, adding that following the launch event, training will be held with ART Centre staff from around the Sindh province on ensuring effective and evidence-based PrEP services.

According to Dr Ershad Kazmi, Additional Director, CDC Sindh, Pakistan saw an 84% increase in new HIV infections between 2010 and 2020, and new HIV infections cannot be stopped unless bold steps are taken today."PrEP is a step in the right direction because it offers a significant strategic opportunity to precision target prevention programmes for key populations. For administering PrEP to sero-discordant couples and key populations, "formal linkages have been established between ART Centres and the outreach component of the current program," he said.

Yuki Takemoto, UNAIDS Country Director for Pakistan and Afghanistan, congratulated the Sindh health department for formally launching the PrEP programme and added that they were 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," she said, adding that community outreach workers and counsellors have the advantage of being able to reach key populations, including hard-to-reach communities.

She also said that putting community-led HIV prevention programmes together with meaningful community participation is important to make sure that policies and services meet the needs of the community.

UNDP official Ms Heather Doyle said they were working closely with Sindh CDC, UNAIDS and the community partners to push this initiative forward. "We look forward to continuing that partnership so that everyone who needs PrEP has access," she added.

Several members from the community-based organisations and representatives from key populations participated in the launch and expressed hope that chances of new HIV infections will get reduced through PrEP uptake.

One community representative said, "Since we don’t have vaccination for HIV as we have for COVID 19, PrEP is a gift of medical science to the communities that can help prevent HIV among those who are at higher risk. While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the HIV epidemic in Pakistan in the coming years."

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