Championing PrEP in Pakistan: Dareecha forges ahead

By June 29, 2020 Learning, Newsroom, Regional

Muhammad Usman 
Program Director, Dareecha Health Society, Pakistan

Dareecha has been working with the men who have sex with men and transgender community since February 2012. It got registered in 2015 and started working as an independent community-based organization from January 2016. It has been supported by the regional Global Fund Grant, and since March 2018 Dareecha has been working under the Pakistan National AIDS Control Program (NACP).

We strive for the advancement of the social and health rights of transgenders and males who have sex with males by strengthening community systems and developing community led interventions to focus on addressing discrimination and stigma. We also work on creating an enabling environment by advocating for equity, justice, safety, health and wellbeing of men who have sex with men and transgender communities and individuals.  

What are the services you were providing to MSM and transgender people in Pakistan before COVID-19? 

Dareecha has been implementing Global fund HIV program for the MSM/TG community in Rawalpindi that includes;

  • HIV testing and counselling services that include behavior change communication along with pre- and post-test counselling
  • Service delivery involves all five components such as Distribution of lubes/condoms, Information, Education & Communication (IEC) material for awareness and education, Pre-test and post-test counselling, Behavior change communication and Sexually transmitted infection’s diagnosis & treatment and Advocacy to reduce the Stigma & Discrimination towards the community, and referral to government medical facilities
  • Advocacy with stakeholders and liaison with National Aids Control Program in Islamabad and Punjab Aids Control Program
  • Facilitated several research projects awareness and sensitization for students and organizations
  • Community Mobilization, capacity building and empowerment events
  • Providing HIV interventions and advocacy in the face of severe discrimination
  • Providing awareness sessions on HIV-AIDS, STIs & Psychosocial issues twice in a month to the community throughout the year
  • Distribution of PrEP from the Government Hospitals to the key populations of Pakistan.
  • Providing psycho social counseling, career counseling, health counseling, family counseling and adherence to ARVs

How did it come about that PrEP was approved in Pakistan, and what is the role of Dareecha in the advocacy to be able to get PrEP to be dispensed to MSM and trans?

Basically, in the year 2018 we distributed PrEP among MSM & Trans community members with the help of Naz but it was only among 10 people. But later the project ended, so we were unable to continue the service. Then in 2019 with the help of WHO, Pakistan and their consultant on PrEP for Pakistan Dr. Rupa Patel, Dareecha mobilized community members regarding the use of PrEP in drop in centres or by going to their homes for spreading the word. After that Dareecha became the first organization nationwide who have distributed the PrEP among the MSM/Trans community members through Government Hospital in Islamabad.

Dareecha has attended many meetings with the National Program Managers which comes under the Ministry of Health in Pakistan, and advocated that PrEP and PEP should be included in the national Global Fund grant as part of its prevention indicator.

How were you able to advertise this new service? What was the initial uptake of PrEP like? And what are the worries about PrEP in the community? 

Initially we have had to do a lot awareness raising on PrEP and PEP in hot spots, Dera (where trans community lives), flats of MSMs and in the Drop-in Center of Dareecha as well. Then we used our Facebook page to spread the word and make the allies between community, CBOs, doctors and their paramedical staff.

There was a lot of community members who were asking questions regarding the side effects of the medicine.

What are the challenges to PrEP scale up in Pakistan? Will this be part of the Global Fund programming?

Challenges we have faced and still facing are funds to drive awareness and demand in the community, funding to meet the expenses of their travel has to be included as well, there needs to be budget for communication of PrEP at all levels. There should be a peer counselor who will be working on PrEP follow-up as under the national grant we only have two outreach workers and we are using them for multiple tasks.

We have requested the government to make PrEP and PEP a part of the national Global Fund grant and add it as an indicator. The distribution should be through CBOs as the community feel much more comfortable to access services there as they don’t feel good to go to the government hospitals. We are still waiting for a positive response from the government.

With the COVID-19 pandemic – how has that changed the way that you are providing PrEP services, and demand for PrEP? What services are you still able to deliver to the community?

Unfortunately, clients are not able to follow-up on their PrEP medicine during this pandemic due to lockdown measures. People were in their native areas or stuck in different cities, as travel is was restricted, and many places were closed.

We have been able to link community members with the nearby HIV treatment centers and for their HIV medicines. However, prevention and those that are on PrEP are not prioritized, and the lockdown measures makes it difficult, and two treatment centers were closed due to COVID-19.

What are the worries of the staff and volunteers of Dareecha that are providing PrEP services during COVID-19? 

The biggest challenge that we have faced is our health, if we are healthy then we can provide some services to our community. Unfortunately, five staff members of Dareecha were found to have COVID-19. All survived, fortunately, but it does hamper our ability further to serve our community. It is a very difficult time, but we managed to distribute food packages to our community.

How do you think COVID-19 will affect the landscape of HIV, sexual health and other community-led service provision in the future?

Indeed yes, this pandemic is affecting essential HIV services, and affecting the most vulnerable. We cannot stop our services at any cost because of this fear of COVID-19. We are continuing our services as like before but with limited interactions and providing our community with medical and nutritional support. In the future, they are looking to us as their companion in terms of health, nutrition, and other services as the first point of contact to our community, and we are able to reach those most vulnerable.

There was recent news about long-lasting injectable PrEP – do you think this will be more acceptable by the community in Pakistan? 

This term is new for Pakistani context and not applicable for now in Pakistan. But we believe it would be very fruitful for the community and it gives relief to have a daily pill and fear of its side effects. If there is any injection for that then it would be quite workable.

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