Editorial

RutgersWPF Pakistan News

Second Regional Learning Forum under PSO

As part of the Learning Work Trajectory, a PSO funded project, it was planned that three Regional Learning Forums (RLF) will be conducted in the year 2011-12 in the Asia region. The second RLF took place in Indonesia (Yogyakarta) and was hosted by Rutgers WPF Indonesia Field Office. RLF II participants included staff from Headquarters, Vietnam, Indonesia and Pakistan Field Offices and their partner organizations. Delegation from Pakistan included eleven representatives of Rutgers WPF Pakistan, PIDS, Aahung, BRSP, KK, Awaz CDS, NATPOW, and HANDS. The objective of the RLF was to share personal, organisational, country and cross-country learnings in relation to the global learning question of how to build and capacitate a SRHR movement of Rutgers WPF and partner organisations and to incorporate the learnigs for improved practices and future actions. At the end of the RLF the participants observed that significant progress has been made in relationship building and reaching a level of shared understanding. Various participants expressed the wish to allocate more space for sharing between countries, also on specific SRHR topics, as well as movement building across countries. It was decided that the way forward is to carefully document the learning in the coming period, to create ‘learning history’. Organisation staff members should also raise issues that they are struggling with and these issues might than be picked up in peer assist sessions in third RLF. This will help bonding and the feeling of added value of being part of a larger network of experts in the movement for change.

National Assembly adopts resolution supporting UN resolution on maternal mortality and morbidity

The National Assembly has unanimously adopted the resolution supporting United Nation’s Human Rights Council’s Resolution on Preventable Maternal Mortality and Morbidity and Human Rights on November 23, 2011. Rutgers WPF Pakistan, as part of its efforts for the Safe Motherhood campaign, has been working strenuously for the past two years for the adoption of the United Nation’s Human Rights Council’s Resolution by the national and provincial assemblies. The hard work of the Policy Advocacy team of Rutgers WPF Pakistan has borne fruit with the adoption of this Resolution by the National Assembly. Of the 14 Parliamentarians who moved the resolution, most occupy important positions in the Parliamentary System, which gives us strong basis to get their commitment in this regard including financial allocations and special initiatives to achieve the set targets under MDG5 which is to improve maternal health.

Dance4life Training Workshop

A five day training workshop was organized in Islamabad by the RutgersWPF Pakistan in collaboration with Red Zebra team under Dance 4life Pakistan initiative. The Red Zebra team, comprising of Peter Schaupp and Mark Dotsworth, came from South Africa to train volunteers to build a ‘Heart Connection Team’. The five-day training program was conducted from 20th November to 24th November, 2011 and the participants included four volunteers from Islamabad, Lahore, Multan and Quetta respectively, representing the four regions where the dance4life project will be implemented, along with the project coordinator from each implementing partner, Pakistan Integrated Development Society-PIDS, Bedari, Awaz CDS and Idara Taleem o Aaghai-ITA. The participants were given 4 days special training to carry out ‘Heart Connection Tours’, under which the Heart Connection Teams will visit different schools to inform students about HIV and AIDS, Life Skills Based Education, and to develop leadership skills and confidence among the students, in order to enhance the quality of life of these young people. On the fifth day, the dance4life team carried out a one-day live pilot with students of Roots School System, Millennium Campus (I 9/3), to interact directly with the students, to inform them about the global initiative, raise awareness among the students about LSBE and carry out numerous activities with the students for raising awareness about HIV and AIDS.

Para-counselling training under Hamara Kal

Para- counselling training under the Hamara Kal project was conducted on November 16th and 17th, 2011, at the office of HANDS, in Mitiari. There were 27 participants being trained as master trainers and the trainings were facilitated by Ms. Kawanal Qayoom, from Rutgers WPF. The participants were given an introduction of the Hamara Kal project and the objectives of para-counseling training were shared. During the trainings, the participants were educated about para-counseling and non-formal (NF) counselling and the skills & qualities of an effective non-formal counselor. They were given information regarding confidentiality, privacy, place for and duration of counselling; on how to begin and end NF session and the importance of the first NF counseling session. At the end of the two day training, the participants gave their reflection, stating that the training was very informative and well conducted.

Training of Teachers for Agahee se agay (EGTC)

After conducting a 3 days Master Trainers Training from 18- 20 Oct, 2011 at Islamabad, Implementing partner SAFWCO planned and organized series of Teacher trainings in district Sanghar under the Agahee se agay (EGTC) proejct. The training was intended to capacitate 100 teachers on life skills based education and enterprise/economic empowerment components of the newly designed workbook Khawaab se Tabeer Tak. To train 100 teachers, teachers were divided into 4 clusters and trainings were planned to do in two rounds i.e 2 clusters in each round. Cluster trainings were facilitated by 2 trained Master Trainers and the project staff SAFWCO.

These trained educators will then implement the same curriculum in the schools with students of class 8th, 9th and 10th. The training contents were designed by ECI, the consultant engaged by Rutgers WPF for the development of new workbook particularly enterprise sessions. The ECI Master trainers took lead role in teachers training on Enterprise contents and Master Trainers of Rutgers WPF delivered life skills contents in each training cluster. The trainings were spread over duration of one month i.e started from Nov 29 till Dec 17, 2011.

The training arrangements were aptly made by SAFWCO despite of challenging situation in district Sanghar caused by floods. Facilitators were well versed and prepared for the training and both facilitators were well coordinated. The teachers appreciated the idea of involving out of school girls through board game and sensitizing parents on issues like harassment. The enterprise session added a charm for teachers and they showed their entrepreneurial skills by opening stalls of food items, hand bags, cosmetics, mehndi and face painting in a meena bazaar (fun fair) activity held in schools.

Pre-test of the Toolkit- Bano Chotay Ustaad for ‘Agahee se agay’

One day pre-test was carried out by Rutgers WPF with group of 15 girls students chosen from two schools of Sanghar on October 31, 2011. It was the same group of students representing class 8, 9 and 10 who also took part in the pre-test of the workbook held during the month of Oct 2011. It was a two hour activity in which first they were introduced with the idea of toolkit and its two significant components, board game and stories. Students were then divided into two groups to read out the instructions from the game manual and play the board game ‘Choti Ustani’ as per given instructions. The board game demo was given to observe if students come across any difficulty or confusion while playing ‘Choti Ustani’. Meanwhile their feedback was noted regarding quiz cards, game size, its design, game rules and the reporting format. After board game, students were taught about the stories objectives and the idea of parents’ involvement, why it is important to engage parents and how to tell these stories to parents etc. Stories were shared with students and later they were asked to give their feedback on stories themes, that are girls’ economic empowerment and harassment. Girl students admired the idea of toolkit and they particularly showed keen interest in playing ‘Choti Ustani’ with fellows and out of school girls. Students were also assigned a task to tell these stories to parents and fill in the close ended questions asked in the reporting sheet of two stories. The purpose of the reporting sheet was to assess the parents’ response and to evaluate the success of the parents’ involvement strategy. Rutgers WPF received the reporting sheet after 10 days time and it was encouraging to note that all parents appreciated the moral of the stories and the efforts of Rutgers WPF in promoting awareness on the issues of sexual harassment and girls’ role in income generation of their families.

Aga Khan University Advocacy Seminar

The Country Representative, Rutgers WPF Pakistan, participated in Aga Khan University Advocacy Seminar on ‘Post 18th Amendment Scenario for Family Planning and Reproductive Health Programs in Pakistan: Opportunities and Challenges for Public Sector and Civil Society Organizations’, on November 15, 2011. He gave a presentation on ‘Post 18 Amendment and Role of civil society in Reproductive Health and Family Planning’. His discussion centered on the opportunities provided by the 18th Amendment, of supporting Members of Parliament to draft and pass the legislation on FP and RH Health Bill, to influencing provincial policy frame to work on Population, Youth, Health and Education, , as well as the inclusion of Life Skills Based Education(LSBE) in Education and Youth Policies.

UNESCO Seminar on ADIS Prevention Education

The Country Representative, Rutgers WPF Pakistan, participated in the ‘National Seminar on Policy Framework for AIDS Prevention Education in Pakistan’, organised by UNESCO, from November 16th and 17th, 2011, at Margala Hotel Islamabad. Educationists and experts working with Provincial Education Departments, NACP, and Provincial AIDS Programmes and relevant NGOs were invited to discuss the Study Report on HIV/AIDS Prevention Education: Rationale and Findings, as well as good practices of HIV and AIDS Education in other Countries; and a presentation of Draft Policy Framework on AIDS Prevention Education. The participants split into groups and gave their recommendations regarding the Organizational Structure and Policy Framework; Integration of HIV/AIDS prevention Education in Curriculum and Textbooks; Integration of HIV/AIDS prevention Education in Teachers Training, and Guidance and Counseling on Adolescence.

Meetings

Biannual National Programme Team Meeting (NPT) under Parwan

Parwan held its 1st Biannual Meeting of the National Programme Team on November 3, 2011, at Rutgers WPF’s office in Islamabad. Rutgers WPF’s Planning Monitoring & Evaluation (PME) department and the project managers of partner organizations, Awaz CDs & PIDS participated in the meeting and shared updates on the project progress; reflected on expected challenges; shared the planning for the rest of the quarter (2011) and planning for 2012; and discussed the project budget.

The 1st biannual meeting of the National Governing Body (NGB) under Parwan

The 1st biannual meeting of the National Governing Body (NGB) under Parwan was held on November 4, 2011, at Rutgers WPF office in Islamabad. NGB is the decision making body for Parwan and comprises of heads of all partner organisations in Pakistan and is supported by the secretariat at Rutgers WPF. In meeting, the three heads of partner organizations met to discuss project progress and milestones achieved, how to enhance the results chain and innovative strategies to overcome issues. Moreover the 2 project managers from multan and QUETTA also participated in the first half of the meeting to provide an update on the project progress.

Advocacy meetings on youth friendly services and national youth policy under Hamara Kal

Advocacy meeting on youth friendly services and national youth policy with District Project Steering Committee members of Mitiari was conducted on November 16, 2011. There were 15 participants, including District Health Officer (DHO) Mitiari and Executive District officer (EDO) Education Matiari. The DHO Health Mitiari decided to dedicate a space for youth friendly service in all health facilities in Mitiari. Furthermore, an advocacy follow up committee was also formed for advocating for youth friendly services in National youth policy and with the Government.

Advocacy follow up meeting was also conducted in Karachi, on November 18, 2011, in which it was decided that rigorous follow up will be carried out with the Health Department to ensure implementation of youth friendly services.

Expressions

Checking the spread of AIDS in Pakistan

By Haider Warraich and Eitezaz Mahmood

In Pakistan, you could probably live for years and never meet anyone with HIV/AIDS. Yet the fact that the virus is not often in the public eye does not mean that HIV/AIDS is not a problem in Pakistan. It is known to infect tens of thousands of Pakistanis, a figure that is certainly a gross underestimate due to both sexual taboos surrounding the disease and the often low social status of many of its victims. And while HIV/AIDS does not attract the kind of notice it once did in the developed world, in Pakistan the scourge has only recently been given more attention.

HIV/AIDS is believed to have been introduced to Pakistan by migrant workers returning from the Middle East. These workers, who went to the Gulf states on work permits, would frequently engage in risky behavior while abroad. Workers, however, needed medical screening in order to renew their work permits, and if one tested HIV-positive during screening, he was sent packing on the first flight back home -- in most cases without even being informed of his HIV status.

The first confirmed cases of HIV/AIDS were discovered in Pakistan in 1987. At that time, the public perception was that HIV/AIDS would not become endemic in Pakistan because of the country's strict religious and cultural norms. By 1999, three-fourths of HIV infections occurred among migrant workers returning from Arab Gulf states. In the late 1990s, however, cases of HIV/AIDS began to steadily increase among Pakistani sex workers, prison inmates, truck drivers (who frequently employ the services of prostitutes), and, especially, injecting drug users (IDUs). And in June 2003, after an IDU prisoner tested positive for HIV, local authorities found 27 percent to be HIV-positive. After the discovery of this outbreak, similar occurrences among IDUs were documented across the country. The unsafe injection practices of IDUs and their lack of knowledge regarding HIV helped fuel a steady rise in HIV-positive IDUs over the last decade. They remain, by most observations, the core group affected by the HIV outbreak in Pakistan.

HIV has also spread to other high-risk groups, particularly male homosexuals, categorized in public health terms as "men who have sex with men" (MSM). Many different groups in Pakistan qualify as being MSMs. Once occupying elite positions as jesters, advisors, and bodyguards in the courts of kings, hijras, or male transvestites, are now among the most oppressed and loathed groupsin Pakistan. Hijras are often the receptive partner in intercourse, making them particularly at risk for HIV infection. Similarly, zenanas are married males who secretly identify as women. Giryas are the male "husbands" of hijras and zenanas, who often do not know of their partners' promiscuity, further increasing their chances of infection. While homosexuality is by most indications not rampant in Pakistan, transvestites are a particularly visible group in public spaces. Other MSM populations include maalishias -- boys who are masseurs but may also sell sex. Already marginalized in Pakistani society, the 1979 Hudood Ordinance, enacted under military ruler Muhammad Zia-ul-Haq, declared homosexuality a criminal offense, driving MSMs further underground. That these groups live largely outside the umbrella of the state as well as the goodwill of the people presents a significant barrier to those trying to deliver health care to these men.

According to the Asian Epidemic Model, HIV/AIDS concentrates first among high-risk groups, but then makes its way to the general population through bridging groups who are in sexual contact with high-risk individuals. While the bridging population is difficult to characterize, the wives of IDUs, clients of sex workers, and truck drivers all frequently engage in unprotected sex with high-risk groups. The bridging population, however, is not the only route for HIV to reach the general population; 6.8 percent of IDUs donate blood, yet less than half of blood transfusions are screened for diseases in Pakistan. In the nightmare scenario that the HIV virus reaches the general population, it will be very difficult, if not impossible, to contain.

Thankfully, HIV/AIDS has been recognized as a health-policy priority in the country. The Pakistani government has collaborated with NGOs to provide condom delivery, needle exchange programs, drug rehabilitation programs, and treatment for those at risk of HIV. HIV/AIDS interventions between 2008 and 2009 reportedly reached more than 30,000 IDUs, 25,000 male and hijra sex workers, 12,000 female sex workers, and 50,000 truckers. Furthermore, a recentSupreme Court ruling gave hijras complete citizenship rights as a "third sex," allowing them access to social welfare and financial support programs. This is a major step forward for a group historically ostracized and considered undesirable. And from 2008 to 2009, the percent of IDUs reached through the prevention programs spiked from 15.5 percent to 53 percent. Similarly, the percent of IDUs reporting use of sterile injecting equipment has increased from 30 percent to 80 percent in the past three years alone.

Despite these successes, health-care workers still have much work ahead in order to achieve their goal of halting and reversing the spread of HIV in Pakistan. Current efforts are not reaching a significant proportion of the targeted population, and despite the large increase in those reached through prevention programs, it is still not enough to prevent a genuine outbreak. However, the greatest obstacle in the way of those wanting to expand the epidemic response remains a lack of funding. This has been further strained since the floods in 2010, which diverted most available funds that may have otherwise gone to checking the spread of the disease.

Like most other public health challenges, responses to the HIV/AIDS outbreak are deeply intertwined with the prevailing social and geopolitical landscape in Pakistan. Dealing with HIV/AIDS in particular brings to the surface taboos such as sex, gender identity, drug abuse, and homosexuality, issues that people in Pakistan are wary to address. However, such cultural change is ultimately necessary if Pakistan is to deal with HIV/AIDS holistically, before this simmering crisis boils over.

Published in Foreign Policy, August 25, 2011.