By Faryal Sajjad


Pakistan is advancing towards a public health crisis with an estimated 133,529 people having contracted HIV/AIDS. Problematically, ‘the primary mode of HIV [and Hepatitis B and C] transmission in Pakistan continues to be the use of contaminated injection equipment among people who inject drugs’ (PWID) with prison inmates being one of the most vulnerable populations. Needle-based harm reduction programmes are non-existent in Pakistan’s prisons, in contrast to neighbouring Iran, which following a surge in prison-based HIV infections, introduced harm reduction programmes in 2003. Iran’s approach holds important lessons for Pakistan, not only because the two countries have been religiously and ideologically close, but also because the success of Iran’s harm reduction programme has been achieved through attitudinal changes by policymakers.


During the 1970s, Pakistan was a major producer of illicit opium. In 1979, the country produced an estimated 800 metric tonnes, becoming the ‘largest producer of illicit opium in the world that year.’ To fulfil treaty obligations under the 1961 Single Convention on Narcotic Drugs, authorities launched cultivation reduction efforts resulting in a sustained decrease in opium production in Pakistan after 1979; production of illicit opium in the country decreased to near zero by 1999-2001. Despite domestic supply reduction success, Pakistan has become a lucrative transit zone for drug trafficking due to its location in the so-called ‘golden crescent’, sharing a border with Afghanistan, the world’s largest producer of opium and the source of 85% of global heroin supply. The increase in Afghan opium cultivation in recent years has reduced prices and increased both demand and consumption within Pakistan, with an estimated 20 tonnes of pure Afghan opium consumed annually in Pakistan. The situation has resulted in a HIV epidemic among PWID. In 2012, HIV prevalence among this group in major urban centres in the country was close to 21%;11 by 2015, it had risen to 40% in several cities including provincial capitals.