Why Global Collaboration Matters : Lessons Pakistan Can Teach the World About HIV Outbreak Response

By: Mahwish Arif

Pakistan’s experience highlights how the world can better respond to an ongoing,
rapid expansion of HIV by building on shared resources, community engagement
and leadership.
Pakistan is noted for its rapid increase in new HIV cases. However, through the
collective efforts of the local community, international partners and local
leadership, the combined efforts of the local community, international partners
and local leadership have shown how they can contain and manage a crisis while
building a resilient health system for HIV.
The importance of early detection of HIV was highlighted in several of Pakistan’s
outbreaks, especially in the district of Ratodero in Sindh. Local authorities were
overwhelmed with the number of new cases and the lack of adequate HIV testing
facilities. However, through the quick response from their international partners
(including WHO, UNAIDS and the Global Fund), local authorities received a rapid
supply of HIV test kits, diagnostic equipment, technical assistance and support.
Through these efforts, thousands of individuals were screened for HIV in a short
time period and millions of HIV-positive individuals were identified who otherwise
would have remained undiagnosed. As well, this provides the best example of
how successful a nation can be when they receive help from global partners, who
have shared their resources, tools, expertise and funding to enable the local
health systems to respond quickly and effectively to the need for early detection
of HIV.
Pakistan’s Experience with Community Awareness Campaigns
The history of HIV outbreaks has shown Pakistan that awareness campaigns must
be culturally sensitive to the communities they target. There was much stigma
surrounding HIV in Pakistani society; therefore, silence can allow the virus to
spread faster than actual physical infection. In Pakistan, public education was
delivered most effectively by teachers, NGOs, social workers, and religious leaders
who understood local perceptions and fears around the disease.
Both the successes and failures of recovery campaigns in Pakistan have
emphasised the importance of adapting awareness campaigns to the local culture
instead of taking them from countries with different attitudes and beliefs about
HIV. Each individual country can adapt their awareness campaigns based on their
own cultural sensitivities while at the same time providing accurate and timely
information.

One of the primary drivers for transmitting HIV within Pakistan’s population is due
to the increased usage of unregulated and informal healthcare providers. Unsafe
practices during injections and a lack of sterilisation resulted in several outbreaks
(especially in rural areas). Within Pakistan, there have been efforts made by
government officials, local health workers and other stakeholders to provide
more regulatory oversight to informal healthcare providers, develop capabilities
through training, and provide stricter guidelines regarding the appropriate usage
of syringes.
This experience is relevant around the world as many developing nations depend
on informal health care systems. Pakistan’s experiences illustrate that rather than
trying to eliminate these providers, we can incorporate them into formal health
care systems by offering training and supervision, helping to greatly reduce the
transmission of infection.

Save Lives Through Collaboration at a Global and Local Level
The example of Pakistan illustrates how much potential exists to mount robust
efforts against public health crises by combining international resources and
knowledge with local resources and action. Global agencies provided knowledge
and technical assistance through testing supplies and selling products, while local
health care providers, community leaders, and volunteers performed screenings,
community awareness campaigns, and patient support.

The lessons learned through challenges faced by Pakistan, and solutions found,
are meaningful for the global community. It is clear from Pakistan’s response that
there are many areas from improving early detection of illness to improving
informal health care systems and the need to create culturally appropriate
awareness campaigns where global entities need to work together and provide
input at the highest levels of collaboration will help fewer countries contain
outbreaks and protect their most vulnerable.