UNAIDS: The First 10 Years

Chapter 4The United Nations Office on Drugs and Crime (UNODC) and UNAIDS were also carrying outimportant work within countries. Kristan Schoultz arrived in Pakistan as Country ProgrammeAdviser (CPA) in 1998, became UN Resident Coordinator in Botswana, and is now Director,Global Coalition on Women and AIDS. In 1998, Pakistan was a country with very low prevalence– less than 1% – but it was thought that a potentially important driver of infection wasinjecting drug use. The problem was that there were no data to support this theory.83UNODC (which became the seventh UNAIDS Cosponsor in 1999) largely focused on crimeand drug supply issues in Pakistan, but it also had a smaller mandate to look at demandreduction; within their demand reduction portfolio, it decided to look at issues related toHIV prevention. A survey carried out with their government partners had indicated that therewere approximately 500 000 heroin users in the country, and UNODC was concerned aboutthe possibilities of transmission of HIV in that population. So they approached UNAIDS todiscuss a way forward.UNAIDS agreed to collaborate and to assist in resource mobilization for this effort. Schoultzexplained: “The collaboration began with a joint study of behaviours and prevalence amonginjecting drug users. The study was undertaken by a local nongovernmental organizationcalled Nai Zindagi (‘New Life’ in Urdu) which was and still is one of the premier drugtreatment and rehabilitation organizations in the country. Nai Zindagi conducted the surveyof street drug users in one city of Pakistan, Lahore, and tested for both HIV and hepatitis Cprevalence, in addition to exploring risk behaviours and attitudes. Though no cases of HIVwere found, there was an indication of extremely high hepatitis C”. Schoultz recalled that “…almost 90% were hepatitis-C positive and this was a call for action. … It was quite scary whenwe found this evidence”.Schoultz then focused on process: “On the basis of that study … we, as the UN system, immediatelywent into action with advocacy efforts. We … engaged the anti-narcotics force in theExpanded Theme Group on AIDS in addition to the Ministry of Health and the Ministry of LocalGovernment, who managed the police, [and] started doing … TV shows, making presentationsto the newspapers, holding press conferences”. [‘We’ referred to the Chair of the UNTheme Group on HIV/AIDS and the UNODC representative.] Following the advocacy work, itwas agreed to set up a pilot project on harm reduction. This pilot project received only aboutUS$ 70 000, for one year, which was used to develop what Schoultz believed to be “a fairlycomprehensive harm-reduction project, which included needle exchange and a full range ofharm-reduction interventions such as basic primary health care, counselling, condom provision,and referral for drug treatment – all made possible through extensive street outreach”.The project was considered successful by all partners, including the Government of Pakistan,which actually included the words ‘harm reduction’ in its national Master Plan for drug control.Schoultz explained: “Largely as a result of what was learned in the Lahore pilot project, therewere a couple [of] follow-on projects that were financed by UNODC in other cities of thecountry. Then, through the continuing advocacy of the UN, civil society partners, and the