hiv is an increasing health concern in pakistan with the number of cases growing .

moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the aids epidemic to take hold in pakistan , mainly among injection drug users , male/female sex workers and repatriated migrant workers .

aids may yet become a major health issue .

the national aids programme ’s latest figures show that over 4,000 hiv cases have so far been reported since 1986 , but un and government estimates put the number of hiv/aids cases around 97,000 ranging from a lowest estimate of 46,000 to a highest estimate of 210,000 .

more realistic estimates that are based on actual surveillance figures , however , suggest that this number may be closer to 40,000 – 45,000 .

the overall prevalence of hiv infection in adults aged 15 to 49 is 0.1 % .

( 0.05 % if one accepts the lower estimates ) .

officials say that the majority of cases go unreported due to social taboos about sex and victims ’ fears of discrimination .

on the other hand , more detailed and recent data suggest that this may be an overestimate .

hiv / aids in pakistan

. islamabad , pakistan , national aids control programme of pakistan , national aids control programme of pakistan , 2006 .
. islamabad , pakistan , national aids control programme of pakistan , national aids control programme of pakistan , 2008 .
developing a surveillance system for hiv / aids in pakistan . - pubmed - ncbi
hiv / aids , surveillance project , aids block , islamabad . drfaran @ urltoken
arshad altaf ( pakistan hiv / aids surveillance project ( hasp ) , karachi , pakistan . )
abrar n . aids / hiv knowledge , attitude and beliefs of adolescents of pakistan .
national aids control programme . hiv second - generation surveillance in pakistan , national report round 2 , 2006–7 ; islamabad : nacp ; 2007 . ministry of health and canada–pakistan hiv / aids surveillance project .
in pakistan , hiv is still a taboo that leads to discrimination - pakistan - dawn . com
according to pakistan global aids response progress report , pakistan’s hiv epidemic started in the 1980s when cases surfaced mostly amongst migrant workers employed abroad .
hyder aa , khan oa . hiv / aids in pakistan : the context and magnitude of an emerging threat .
shreedhar j : aids in india . harv aids rev . 1995 , fall : 2 - 9 .
zafar iqbal akh , sultana bakhsh , haroona jatoi . need and significance of hiv / aids preventive education in pakistan .
after being diagnosed with hiv , his experiences were not very different from other hiv carriers in pakistan .
epidemiological situation of hiv / aids in pakistan . hiv positive ( 1765 ) + aids ( 233 ) = total 1998 cases at islamabad , karachi , lahore , rawalpindi and fana ( pakistan demographic health survey , 2007 - 08 ) .
pakistan ' s first hiv / aids case was detected in 1987 [ 1 , 2 ] . the number has been increased according to the annual report of pakistan national aids control program ( nacp ) [ 3 ] .
the health workforce for hiv / aids is not only deficient in number but also lacks the required set of skills needed for dealing with hiv / aids cases ( 14 ) .
unaids . global aids response progress report 2014 ; islamabad , pakistan : unaids ; 2014 .
pakistan ' s national aids control program ( ncp ) is one of the pioneer institutions providing free treatment to any person found to be suffering from aids through its 20 aids treatment centers all over the country .
in 2009 , unaids pakistan and the national aids control programme estimated that there were around 98 000 ( 79 000–120 000 ) hiv cases in pakistan , with an overall general population prevalence of less then 0 . 05 % .
non‐governmental organizations ( ngos ) : at least 54 ngos are involved in hiv / aids public awareness and in the care and support of persons living with hiv / aids . these ngos also work on education and prevention interventions targeting sex workers , truck drivers , and other high‐risk groups . ngos serve as members of the provincial hiv / aids consortium , which has been set up in all four of pakistan’s provinces to coordinate hiv / aids prevention and control activities . although ngos are active in hiv / aids prevention activities , it is believed that they are reaching less than fifteen percent of the vulnerable population .
pakistan global aids response progress report further states that female sex workers reported an average of three clients a day .
correa m , gisselquist d . routes of hiv transmission in india : assessing the reliability of information from aids case surveillance .
the bulk of the credit in this regard goes to the private sector . over 50 non - governmental organizations ( ngo ) are working to improve the hiv / aids status quo in pakistan [
1 . cia the world factbook 2005 , pakistan ; urltoken ; july 2005 . 2 . the world health report 2005 , pakistan urltoken en / ; july 2005 . 3 . unaids country profile , urltoken + area / by + country / pakistan ; july 2005 . 4 . unaids / who epidemiological fact sheet urltoken ; july 2005 . 5 . hiv and aids in pakistan , hiv in pakistan , aids in pakistan , indicators , estimates , figures , hiv situation urltoken ; july 2005 . 6 . usaid hiv / aids country profile urltoken 7 . hiv / aids profile pakistan , urltoken ; july 2005 . 8 . the united nation ' s office for the co - ordination of humanitarian affairs , integrated regional information networks ( un ocha irin ) . urltoken ; july 2005 9 . world bank country development gateway urltoken urltoken ? selectedregions = 87249 ; july 2005 10 . u . s . census bureau hiv / aids country profile urltoken ; july 2005 11 . marie stopes international - pakistan urltoken pakistan ; july 2005 12 . unicef country tables urltoken ; july 2005
“over the years , through efforts at various fronts , i managed to introduce registered medicines for hiv in pakistan in 2003 . ”
national aids control programme . the hiv / aids surveillance project ( hasp ) : summary report – integrated biological and behavioral surveillance study ; islamabad : ministry of health ; 2007 .
khan oa , hyder aa : hiv / aids among men who have sex with men in pakistan . sex health exch . 1998 , 5 ( 2 ) : 12 - 3 .
a draft national aids policy and hiv and aids law ( both recommending the formation of a national aids council ) have been prepared by the national aids control program and will be presented to the national cabinet and parliament . approval of the policy and law would be an important step towards the multi‐sectoral dimension of the national response .
“there were no medications or guidelines available for hiv carriers in pakistan and my life was doomed in every sense , ” nazir recalls .
] . after the larkana episode , hiv has been documented among idu all over pakistan . currently , idu do not comprise the bulk of drug users in pakistan [
hanif m : no safer sex for pakistan ' s gays . world aids . 1993 , london : panos institute , 11 :
] . idu all over the country have started recording alarmingly high rates of hiv . according to the latest figures released by the national aids control program of pakistan , hiv / aids prevalence among idus has jumped from 0 . 4 % in december 2003 to 7 . 6 % in 2004 . however , in larkana , where pakistan ' s first hiv outbreak among idu was reported , the number approached an astounding , twenty - seven percent [
brody s et al . evidence of iatrogenic hiv transmission in children in south africa .
talking to news lens pakistan , faisal majeed , project director , provincial aids control program , punjab , said the government of pakistan is working hard to prevent hiv transmission with measures such as safe blood transfusions , establishment of surveillance and dealing with hiv - related stigma .
agha s : potential for hiv transmission among truck drivers in pakistan . aids . 14 ( 15 ) : 2404 - 6 . 10 . 1097 / 00002030 - 200010200 - 00024 . 2000 oct 20
in 2016 , the joint united nations team on aids ( joint team ) provided support to the government of pakistan to implement an effective hiv response at provincial level and to improve the quality and the continuum of hiv testing , treatment and care in the country .
in an effort to fully analyse and understand the hiv situation and its epidemiology in pakistan , a bilateral collaboration between the national aids control program and the canadian international development agency resulted in the establishment of an effective second - generation surveillance ( sgs ) system for hiv / aids between 2004 and 2012 in accordance with the published guidelines . this paper presents findings from the 4th round of sgs .
nih : national institute of health ; nacp : national aids control program ; arv : antiretroviral ; fana : federally administered northern areas ; hiv : human immunodeficiency virus ; aids : acquired immunodeficiency syndrome .
fighting hiv / aids in pakistan : unicef strategy and major lines of action explains a strategy and six lines of action for the hiv / aids intervention of the unicef pakistan country programme . the need for this strategy arose from unicef decision to develop hiv / aids as a cross - sectoral theme , several international and unicef global commitments , the funding of the government of pakistan’s enhanced hiv / aids control programme , and a growing understanding of the potential impact of hiv / aids on young people in pakistan . while there is limited data on risk behaviours and hiv prevalence in pakistan , there is evidence to show high levels of risk behaviours among vulnerable groups . this includes low condom use among female sex workers and syringe sharing among injecting drug users – both predictors of a growing epidemic . who / unaids forecast modeling estimated , in 2002 , that there were approximately 70 , 000 - 80 , 000 people infected . what this might mean for young people is uncertain , as no sero - or behavioural surveillance of young people have been conducted .
the hiv epidemic is well established in pakistan . it is defined as a concentrated epidemic meaning that the prevalence in traditional risk groups exceeds 5 % .
to improve hiv testing among children in pakistan , unicef additionally supported a situation analysis of early infant diagnosis ( eid ) of hiv in the country , using dried blood spots ( dbs ) .
pakistan is preparing to submit a concept note under new funding model to the gfatm in april 2015 . in this context , national authorities and un partner agencies will compile and review available information on the epidemiology of hiv in pakistan and develop an up - to - date epidemiological profile , of the country . the who country office will provide support to the national aids control programme in the epidemiological analysis of the hiv epidemic and aids response in pakistan . the consultant will also work closely with the technical working group constituted for providing oversight to the concept note development , under the new funding model for pakistan .
] . pakistan , as compared to its neighbors , has remained relatively safe from any indigenously acquired cases of hiv for about two decades . the situation however changed in 2004 when pakistan experienced its first full - fledged hiv outbreak [
the future of the hiv epidemic in pakistan will depend on the scope and effectiveness of hiv prevention programmes for pwids , their sexual partners , sex workers and their clients .
decades of corruption and poor planning of resources have translated into a fight for pakistan ' s very own continued existence . keeping this in mind and the horde of other problems currently encountering pakistan , any efforts directed towards prevention and control of hiv / aids are quite laudable .
more than 1 , 700 collaborators in 124 countries including pakistan contributed to the study .
] . the government has to come forward and face the truth about hiv in pakistan . embarking not only upon national - level mass awareness programs , practical steps including wide - spread screening for the high - risk populations has also to be instituted . stigma and discrimination about hiv / aids in society could only be removed when prominent figures including politicians and sport stars start discussing about hiv / aids in public . as soon as this stigmatization barrier is overcome , a major chunk of the battle against hiv in pakistan would be conquered . what has to be reiterated again is that the time to act is now . timely steps taken at the present can go a long way in preventing a wide - spread hiv epidemic in pakistan .
1 . in a country with low literacy rate one should expect low level of awareness about hiv / aids . awareness needs to be created at all levels especially in rural areas .
“better late than never . with the help of a christian charity organisation in lahore , i was able to gather enough courage to fight hiv . i did that by initiating a platform called ‘new life aids control society’ to raise awareness regarding medication and treatment for hiv carriers in pakistan since 1999 .
funding : the hiv / aids surveillance project was funded by the canadian international development agency ( cida ) grant number pk - 30849 .
according to the study conducted by pakistan demographic health survey , 2007 - 08 , from all the four provinces of pakistan along with fata and ajk . in the light of the above said study , total 1998 patients were identified as hiv infected out of which , 1765 were hiv positive only while 233 developed aids . the study above said study showed that hiv is most prevalent in the sindh province while least prevalent in ajk ( figure
khan aj et al . unsafe injections and the transmission of hepatitis b and c in a periurban community in pakistan .
ahmed j , shaikh bt . an all - time low budget for healthcare in pakistan .
pakistan is following an hiv epidemic trend having moved from low prevalence , high risk , to a more concentrated epidemic in the early 2000s .
] . the number of idu is bound to increase in the near future , and as this happens , the relative cases of hiv / aids will also rise . the first hurdle in the spread of hiv seems to be already traversed .
] suggest that the hiv prevalence among hijras in karachi , a city of 13 million people in southern pakistan , approximates around 4 % . the situation is bound to be even worse in the rural parts , particularly in the pathan - dominated northern pakistan , where homosexuality is socially tolerated [
unaids : report on the global aids epidemic 2006 . accesed : 2 feb 2007 , [
prescribing practices of 354 physicians practicing in city of karachi in pakistan were audited in 2001 . antimicrobials , vitamins / minerals and injections were over prescribed .
the deaths from hiv / aids in pakistan increased from 350 in 2005 to 1 , 480 in 2015 , showing an average increase of 14 . 42 percent a year , says the findings of the meta - analysis coordinated by the institute for health metrics and evaluation ( ihme ) at the university of washington in seattle .
emmanuel f , fatima m . coverage to curb the emerging hiv epidemic among injecting drug users in pakistan : delivering prevention services where most needed .
1 . review descriptive epidemiological data of published / unpublished resources and reports to describe the epidemiology of hiv and aids in pakistan , including an assessment of the quality and availability of data and the investments needed to improve measurement of disease burden .
the findings were released on the heels of an international aids conference in durban , south africa , that started on tuesday .
the number of new hiv infections in pakistan grew at an average of 17 . 6 percent per year between 2005 and 2015 , making it the highest increase in the world .
shah sa , altaf a , mujeeb sa , memon a . an outbreak of hiv infection among injection drug users in a small town in pakistan : potential for national implications .
similar to its south - east asian neighbors , the greatest risk for the spread of hiv in pakistan stems from idu . currently estimated at over 180 , 000 in number [
the overuse of injection practices in pakistan has become a therapeutic norm in the practice of general practitioner ( gp ) . majority of these injections is administered under unsafe conditions exposing the patient to infectious diseases , including abscesses , hiv / aids and viral hepatitis b & c .
the overall goal of this exercise is to review and amalgamate hiv data of pakistan to determine strategic priorities for the hiv response and suggest efficient resource allocation for the programmes .
shaikh ia , shaikh ma : teachers attitudes about hiv / aids prevention education in secondary schools . j coll physicians surg pak . 2005 , 15 ( 9 ) : 582 -
reaction ( referring to allergic reactions ) and abscesses were reported as the most common side effects of injections . aids was the predominant risk mentioned by communities because of poor injection practices . they also believe that aids is widespread in
khanani rm , hafeez a , rab sm , rasheed s : human immunodeficiency virus - associated disorders in pakistan . aids res hum retroviruses . 1988 , 4 ( 2 ) : 149 - 54 .
lahore : nazir masih , 58 , an hiv / aids patient , became an outcast when he socially disclosed he was suffering from the deadly disease .
] . 97 , 400 cases of hiv / aids were estimated in 2009 and more than 6 , 000 cases are registered till now ( 2010 ) . till march 2010 , 3325 patients were registered at national aids control center nih islamabad . 1425 patients are on arvs ( figure
mayhew s , collumbien m , qureshi a , platt l , rafiq n , faisel a , et al . protecting the unprotected : mixed - method research on drug use , sex work and rights in pakistan ' s fight against hiv / aids .
raglow gj , luby sp , nabi n . therapeutic injections in pakistan : from the patients’ perspective .
shah sa , altaf a , mujeeb sa , memon a : an outbreak of hiv infection among injection drug users in a small town in pakistan : potential for national implications . int j std aids . 2004 , 15 ( 3 ) : 209 - 10 . 1258 / 095646204322916713 .
in pakistan , the hiv / aids programme has always depended on the donors and extra mural funding . the bilateral and multilateral donors and other development partners have invested to address the hiv threat in pakistan . the global fund ' s total pledge to hiv / aids in pakistan is us $ 37 , 523 , 500 . however , the grant performance has been rated as inadequate and did not meet the expectations ( 16 ) . in all times , capacity of the national programme to coordinate with provinces has been a challenge , and this has been even grimmer after the 2011 devolution . accountability has to be instituted strictly at all levels and in all components of the programme . the private sector must be involved in the sharing of responsibility and risk pooling .
rai ma , khan mn , khan s , khanani r , ali sh : pakistan / india open borders . . . to hiv ? . aids . 20 ( 4 ) : 634 - 5 . 2006 feb 28 ;
hiv ( human immunodeficiency virus ) transmission has been reduced by protected sex and screening of blood products and other body fluids in the developed countries . it has been reported that pakistan is at high risk of hiv / aids infection but presently the prevalence rate is considerably low . the number of reported cases of hiv / aids in pakistan has been continuously increasing since 1987 . by 2010 the total number of registered cases has reached to 6000 and this figure is on the rise with the passage of time . some serious strategies must be implemented to control this deadly disease .
shaikh fd , khan sa , ross mw , grimes rm . knowledge and attitudes of pakistani medical students towards hiv - positive and / or aids patients .
but he did not give up . masih launched an organisation to help aids patients and spread awareness about the disease in the country .
the situation concerning pakistan and hiv is indeed very precarious . the country lies at a very crucial junction . hiv has as yet not exploded . most of the populace remains safe , as for now . however , concentrated epidemics have emerged , which means that very little time is left before a steep rise in infections occurs . the battle against hiv / aids in pakistan has to be fought on a number of fronts : not just the afflicted population , but also on changing peoples ' perspectives and ushering in the proper government policies and response measures . neighboring china serves as a good example to follow as regards formulation of a national policy about hiv / aids [
“i took the medical test as a formality and was diagnosed as hiv positive , thus leading to my deportation to pakistan . ”
the government had registered 14 , 705 hiv carriers across pakistan till december 2015 but fighting cultural ignominy is still a serious challenge .
according to pakistan global aids response progress report , the epidemic trend is moving from low prevalence to high risk due to the steady increase in the number of persons injecting drugs regularly for non - therapeutic purposes .
another hiv carrier from rahim yar khan , who wishes to remain anonymous , told news lens that he was diagnosed with hiv at a medical camp in lahore in 2010 .
national aids control programme . available from : urltoken of treatment centres . pdf [ cited 21 august 2014 ]
gender - and age - disaggregated data was collected as part of ibbs in 23 cities , and is currently being analysed . this data will enable the joint team and partners to address gender specific issues of the aids epidemic in pakistan . in order to assess gender related issues regarding tb / hiv coinfection , the joint team , along with the national aids control programme and the national tb control programme , also undertook a gender assessment of hiv / tb health sector , in order to evaluate gender barriers related to access , treatment and services .
the hiv / aids epidemic in pakistan is following along the same atypical lines as it has done so far in the rest of asia . starting from isolated high - risk population subgroups , the virus jumps the barrier to cross into the mainstream general populace . once this barrier is crossed , little if at all anything can be done to prevent a complete hiv onslaught .
khanani rm , hafeez a , rab sm , rasheed s . human immunodeficiency virus - associated disorders in pakistan .
the world bank was the largest financer of hiv / aids programs in pakistan . it assisted the government’s hiv / aids efforts through funding the second social action program ( 1998‐2003 ) . in addition , the world bank worked with the government and other development partners ( cida , dfid , usaid , and un agencies ) to support the government’s program through the hiv / aids prevention project . the bank provided us $ 37 . 1 million , 75 percent of which was a no‐interest credit and 25 percent of which was grant money . the project which closed in december 2009 supported hiv prevention services to most at risk groups , mass media campaigns aimed at raising awareness and reducing stigma , promoting safe blood transfusion and building management and institutional capacity .
the number of hiv infections in pakistan grew at an average of 17 . 6 percent a year from 8 , 360 to 45 , 990 during the period under review .
though statistics show that hiv is a grave problem , the ban placed on condom advertisements in 2014 depicts how reluctant the government of pakistan is to address this serious issue .
between 2004 and 2012 , a bilateral collaboration between the national aids control program and the canadian international development agency resulted in the establishment of an effective national sgs system for hiv / aids through the canada–pakistan hiv / aids surveillance project . this was implemented by a consortium of agriteam canada consulting , university of manitoba , canada and proaction : partners for community health inc , with technical assistance from the public health agency of canada . this sgs was designed to monitor the hiv epidemic among key populations at high risk , that is , pwids , and hijra , male and female sex workers ( hsws , msws and fsws , respectively ) . since the first pilot sgs was conducted in 2004 , pakistan has conducted four sgs rounds with pwids , hsws , msws and fsws in 8 major cities in 2005–2006 , 12 cities in 2006–2007 , 9 cities in 2007–2008 and 20 cities in 2011 . 8–12 findings from these surveys revealed changes in the hiv magnitude and trends over time , which helped in developing a comprehensive response to the epidemic . 13–15 the approach proved to be extremely relevant in a concentrated epidemic such as pakistan ' s , whereby behavioural information is vital in predicting epidemic transition .
although the countries of south asia have low hiv prevalence rate in the general population , and the number of new hiv infections has remained relatively stable in asia and the pacific , there has been high and increasing hiv percentage among key populations .
planning and development division . islamabad : ministry of finance , government of pakistan ; 2013 . health & nutrition expenditures ( 2001–2012 ) . economic survey of pakistan .
it may sound ludicrous but the fact remains that to properly combat any problem , the affected have to first accept it and then conquer over it . the society in pakistan has as yet not accepted hiv / aids as having anything to do with them . trends may be changing , but the age - old stigmas and taboos related to hiv still persist . hiv is considered extremely shameful , particularly in the rural setting . even discussions on this topic are frowned upon . awareness about hiv / aids in general is extremely limited . the severity of the situation could be deduced from a survey conducted among school teachers in the capital city , islamabad . an outstanding sixty percent of the teachers responded by saying that ' they thought hiv was irrelevant in our cultural setting . ' [
gray rh et al . , rakai project team . probability of hiv - 1 transmission per coital act in monogamous , heterosexual , hiv - 1 - discordant couples in rakai , uganda .
the institute estimates there were about 39 million people globally living with hiv in 2015 , as compared to 28 million in 2000 .
janjua nz , akhtar s , hutin y . injection use in two districts of pakistan : implications for disease prevention .
janjua nz , akhtar s , hutin yj . injection use in two districts of pakistan : implications for disease prevention .
since it was first detected in 1986 , the hiv / aids epidemic in pakistan has progressed from a low - level epidemic to a concentrated epidemic , with measurable prevalence rates among all prominent risk behaviour groups . pakistan ' s hiv epidemic , once concentrated primarily among pwids , is now increasingly characterised by significant sexual transmission ( ie , msws , hsws and fsws , ) . 19 while many countries in the mena region are still trying to identify and describe their key populations , pakistan has already established a knowledge base to characterise , operationalise and estimate the sizes of their key populations . 16
panda s et al . transmission of hiv from injecting drug users to their wives in india .
shah sa , khan oa , kristensen s , vermund sh : hiv - infected workers deported from the gulf states : impact on southern pakistan . int j std aids . 1999 , 10 ( 12 ) : 812 - 4 . 10 . 1258 / 0956462991913600 .
although the estimated hiv burden is still low—around 0 . 1 percent of the adult population – pakistan is facing a concentrated epidemic among injecting drug users ( idus ) with hiv prevalence of 21 percent among idus in major urban centers across the country . given linkages between idus and other vulnerable populations including male and female sex workers , pakistan needs to scale up targeted intervention urgently to prevent rapid increase in hiv among vulnerable groups .
pakistan millenium development goals report . 2005 , accessed : may 11 , 2006 , [
in 2015 , 41 percent of the people living with hiv were using art , as compared to less than 2 percent in 2000 .
like many developing countries , pakistan faces elavated risk of hiv transmission as a result of poverty , low literacy , gender - related discrimination , ignorance about modes of transmission and the stigma that prohibits people with risk behaviours from seeking hiv testing or disclosing their hiv positive status .
the joint team’s resources are limited , in a context where funding the national hiv response despite considerable improvements in the last decade , levels of stigma and discrimination against people living with hiv and key populations remains high in pakistan , leading to increased vulnerabilities and barriers to access hiv care . there are numerous other issues hindering access to hiv treatment , care and support services by key populations , including existence of discriminatory laws and policies , economic hardships among people living with hiv and lack of awareness on existing services .
on the other side , the current government policy falls under the auspices of the national hiv / aids strategic framework . the program has four foci : improved hiv prevention , expanding interventions among vulnerable groups , preventing transfusion related infections and improving infrastructure [
globally , unicef will work to stop the spread of hiv / aids and ensure that children and young people already affected by the disease are cared for . this means… • preventing parent - to - child transmission of the disease ; • preventing transmission among young people ; • expanding care facilities for children and parents living with hiv and aids . expected results by 2005… • a gender and age disaggregated situation assessment and analysis of hiv / aids and its impact on children and young people ; • national policies and strategies approved and action plans under implementation to reduce the risk and vulnerability of young people and to ensure protection and care for children orphaned or made vulnerable by hiv / aids ; • national policies , strategies and action plans under implementation to prevent parent - to child transmission of hiv / aivs
the joint team also supported the development of by - laws and operational manuals of the association of people living with hiv ( aplhiv ) . this process supported institutional strengthening of aplhiv to be a more progressive organization in engaging communities in the national aids response .
the joint team supported the national and provincial aids control programmes of balochistan , punjab and sindh in the development of their capacities to ensure quality assured diagnosis and treatment services in alignment with the new who guidelines disseminated in 2016 . selected staff members from the provincial and national chapters were thus , trained in global and regional courses conducted by who . forty one healthcare providers ( physicians and gynaecologists ) received capacity building training on the new hiv treatment guidelines . hiv treatment , care and support facilities are available to people living with hiv in pakistan through 21 antiretroviral therapy ( art ) centres , which include six paediatric hiv treatment centres , 16 hiv testing services , 11 prevention of parent - to - child transmission ( pptct ) sites and 21 community home - based care ( chbc ) sites . tb - hiv co - infection sites were also scaled up from 17 in 2015 to 31 in 2016 . a total of 9570 tb patients were screened for hiv and 49 tb patients were found positive for hiv . the number of people enrolled in care have significantly increased from 12 929 in 2015 to 17 224 in 2016 , as well as the number of people living with hiv on treatment from 6292 in 2015 to 8888 in 2016 .
schwartländer b , stover j , hallett t , atun r , avila c , gouws e , et al . towards an improved investment approach for an effective response to hiv / aids .
abbasi w . thousands of aids patients face doom as billions misappropriated . available from : urltoken [ cited 28 july 2014 ]
in 2016 , the unaids secretariat was critical in providing support to the government to generate reliable strategic information , to engage stakeholders into the national aids response and to mobilise resources to improve its sustainability .
pakistan ' s hiv epidemic that once was characterised primarily by transmission among people who inject drugs ( pwids ) is now increasingly characterised by significant sexual transmission .
government : pakistan’s federal ministry of health initiated a national aids prevention and control program ( nacp ) in 1987 . in its early stages , the program was focused mainly on blood screening and some health promotion and hiv education activities for the general population . it suffered from a weak strategy that did not address high risk populations and inadequate surveillance and research whereby there was little credible data to inform decision making . the national strategic framework for hiv aids was developed in 2001 through a broad consultative process that set out priorities for effective control of the epidemic . based on the framework the government launched the “enhanced hiv‐aids control program” for the period from 2003‐2008 . the program marked a shift to a decentralized approach with the nacp and five provincial programs that would oversee implementation of most activities .
sex workers in pakistan represent the second most serious threat for hiv transmission . the government refuses to accept illicit sex underway in the country , although there are established prostitution centers in all the major cities of pakistan . the so - called ' red - light ' areas , in addition to female prostitutes , also house hijras – male transvestites . these hijras provide valuable insight into hiv demographics , as data pertaining to female commercial sex workers is very limited . reports [
efforts directed towards emtct in pakistan recognized the role of men in infecting their wives and thus , the importance of their involvement in prevention of infection of wives and their children . this is why the pptct programme in pakistan includes counselling for partner disclosure and couples counselling to make informed decisions about planning and spacing pregnancies . in 2016 , as a result of counselling , 21 hiv positive married women decided to use contraception to avoid unwanted pregnancies .
a man holds a red ribbon to mark world aids day , at the entrance of emilio ribas hospital , in sao paulo december 1 , 2014 . photo : reuters
according to usaid estimates , there are 94 , 000 individuals in pakistan living with hiv , out of which 26 , 000 are females aged 15 and above , while 2 , 100 are children .
coates tj , the voluntary hiv - 1 counseling and testing efficacy study group . efficacy of voluntary hiv - 1 counselling and testing in individuals and couples in kenya , tanzania , and trinidad : a randomised trial . the voluntary hiv - 1 counseling and testing efficacy study group .
meeting with national aids control programme officials dr . baseer khan achakzai , dr . quaid saeed and other partners , nacp , islamabad
rafay , who has contributed to the study said one of the main reasons of increase in the infections in pakistan is the use of infected syringes among injecting drug users .
health systems factors present the fourth category of bottlenecks that need to be addressed to achieve the 90–90–90 targets in paediatric and adolescent hiv in this region . children and adolescents under 15 years of age who are living with hiv are considerably less likely to receive treatment than adults , with less than one in four children between the ages of 0 and 14 [ 24 % ( 22–26 % ) ] accessing art in 2013 . for instance in india , paediatric hiv treatment continues to be initiated at specialized centres of excellence paediatric centres of excellence , mostly situated in urban settings ; whereas in pakistan and nepal treatment initiation is either at provincial or district health facilities , which are also fairly limited in numbers . this inadequate decentralization of care limits the access to hiv treatment for children in rural localities . interrupted procurement and supply of antiretroviral drugs and commodities for early infant diagnosis has also been reported . inadequate data on paediatric hiv are also evident in most countries limiting the capacity of countries to generate necessary evidence for decision making . in 2015 , only five countries in the region reported hiv data in the unaids - led global aids response progress reporting .
the human immunodeficiency virus ( hiv ) epidemic in pakistan has become well established among injection drug users ( idus ) [ 1–3 ] . in 2008 , the national aids control programme estimated that there were about 100 000 street - based idus in pakistan , of whom nearly 21 % had hiv infection [ 2 , 3 ] . more recently male and transgender sex workers have shown early evidence of epidemic transmission , particularly in cities where they have the most sexual contacts with idus [ 2 , 3 ] . at present , there is little evidence of hiv transmission to the general population , and it is unclear which subgroups will provide the bridge for transmission from idus to the population .
i am sufferer and i know how difficult to live with that in pakistan but you are to be very strong to stay alive .
bossert tj , mitchell ad . health sector decentralization and local decision - making : decision space , institutional capacities and accountability in pakistan .
in order to better understand unicef’s challenges in developing and implementing hiv / aids programming for young people , including adolescents , a swot analysis ( strengths , weaknesses , opportunities , threats ) was conducted . the proposed lines of action for unicef reflect its comparative advantages and existing opportunities .
pakistan , the world ' s second most populous muslim nation , has started to finally experience and confront the hiv / aids epidemic . largely portrayed as having free of this menace till now , this south - asian republic seems to be following in suit with its hiv - havocked neighbor , india . with isolated outbreaks being reported all over the country , time already seems to be running out for the sixth most populous country in the world .
about 95 % of idus in pakistan are sexually active and 38 % have a regular sexual partner [ 3 ] . a recent modelling study demonstrated that idus were more likely to transmit hiv to their spouses and regular sex partners than to sex workers in any city in pakistan [ 4 ] . this is consistent with regional experience . a 2000 study showed that 45 % of wives of hiv - positive idus from manipur , india were also hiv infected [ 5 ] . however , it is unclear if’ the spouses and regular partners of idus are merely at risk of hiv infection or if they play a bridging role in the onward transmission of the infection to others . to date , few studies provide information about this vulnerable population , and none have examined the vulnerabilities or hiv transmission potential of the spouses of idus in pakistan .
] . their work ranges from providing needle - exchange programs for idu to spreading awareness about hiv / aids to the masses . worth mentioning is the organization , ' amal , ' which means ' action ' in pakistan ' s national language , urdu . it has outreach hiv training programs focusing not only on idu but also for the out - of - the - limelight population , female sex workers .
finally , surveillance remained a major focus of the national response to hiv in pakistan during 2016 . to this end , mapping and integrated biological and behavioural surveillance ( ibbs ) of key populations were conducted as part of the 5th round of second generation surveillance in 23 cities of the country , focusing on comprehensive assessment of the size , sociodemographic characteristics , behaviours and hiv prevalence in groups who are at higher risk of hiv and form an important part of the transmission paths through which hiv epidemics can emerge .
he promised to return to pakistan before leaving the country to visit his ailing wife in london , and now , after his . . .
this paper shares the key results of the 4th round of sgs conducted in 20 cities in pakistan . we also present key experiences and lessons learnt in the development of an effective sgs system , which can be utilised within the asian , eastern european and latin american countries , but more importantly be contextually relevant for the middle east and north africa ( mena ) region , for the development of a response against hiv / aids .
see
individual level injection history : a lack of association with hiv incidence in rural zimbabwe
, e37 .
nazir came to learn about the disease in 1990 when he visited pakistan’s embassy in abu dhabi for passport renewal and a visa extension which required a mandatory medical test for visa applicants .
the public sector health management information system ( hmis ) system lacks completeness , authenticity and therefore needs complete revamping . moreover , the information from the vertical programmes like hiv / aids needs a meaningful integration in hmis for timely decision making ( 15 ) .
establishment of 16 hiv treatment centers all over the country with functioning 07 pmtct centers where more than 2000 hiv positives are getting anti retroviral treatment .
securing technical support for the national and provincial aids response to strengthen access to combination prevention services tailored to people and populations at higher risk of hiv , including behaviour change communication , condoms , harm reduction , hiv testing services and pre - and post - exposure prophylaxis and disease surveillance .
] . the number of infected persons might be running in millions if proper screening is carried out . the behaviors conducive to the spread of hiv infection to young people are curiosity about sex and drugs , negative peer pressure , and economic frustration in pakistan [
the joint team under the leadership of unicef continued to work towards the elimination of vertical transmission in pakistan . in 2016 , 125 hiv positive pregnant women received prevention of parent to child transmission ( pptct ) of hiv services and 65 children were born , all of whom received art prophylaxis during the first six weeks after their birth .
] , and a mushrooming population ( growth rate of pakistan lies at 2 . 5 % ) [
pasha o et al . household members of hepatitis c virus - infected people in hafizabad , pakistan : infection by injections from health care providers .
kassi m , afghan ak , khanani mr , khan ia , ali sh . safe blood transfusion practices in blood banks of karachi , pakistan .
serial prevalence data obtained from the sgs rounds in pakistan provide an understanding of the progression of hiv in this country . 8–11 the sero - prevalence among pwids has shown a consistent increase across all rounds , which increased from 10 . 8 % in 2005 to 37 . 8 % in 2011 . although the analysis conducted in 2011 produced a weighted hiv prevalence , and the numbers cannot be strictly compared with the previous rounds ( as previous analyses were not weighted ) , it does show an upward and a rapid progression of hiv prevalence in this group . likewise among hsws , the gradual and consistent increase in hiv prevalence from 0 . 8 % in 2005 to 7 . 2 % in 2011 indicates that the epidemic is now well established in this group . a similar trend is noted in msws , which now stands at an overall hiv sero - prevalence of 3 . 1 % . while only one fsw tested positive for hiv from a sample of 12 cities in 2007 , 25 fsws tested positive for hiv from the same number of cities in this round . 10 even with lower prevalence rates , the sheer size of this population and its close links with the general population warrants careful monitoring of this population to ensure successful prevention of hiv transmission .
strong community health systems is another opportunity and is supported by various community health workers ( chws ) cadres , such as accredited social health activists in india , lady health workers in pakistan , and female community health volunteers in nepal .
with modern treatment hiv is no more a life threatening disease . in medical terms it is now called medically manageable disease . one survey conducted by uk says that people living with hiv and are on art have a higher life expectancy compared to other hiv negative people .
“i urged them to come forth and register themselves as hiv carriers for medication , hence making a breakthrough against the social stigma surrounding hiv carriers . ”
shao y : aids epidemic at age 25 and control efforts in china . retrovirology . 3 : 87 - 10 . 1186 / 1742 - 4690 - 3 - 87 . 2006 dec 1
to build our main set of arguments , we have chosen the who ' s health systems building blocks to elaborate the present situation with regards to the response to the hiv epidemic in pakistan . each building block is discussed separately in this article based on the information available in the existing literature . to explain the situation according to each building block , a literature search was conducted over the internet , using nomenclature of the building blocks , that is , service delivery , health workforce , information system , drugs - supplies - technologies , financing , and leadership , and governance in hiv / aids sector . the online library of pakistan ' s national aids control programme and websites of the global fund to combat aids , tuberculosis and malaria and the world health organization were used for our literature search . we consulted google scholar , for the same medical subject headings ( mesh ) terms , and the full texts of articles of our choice were retrieved from medline / pubmed , where available .
in contrast to the overall slow decline in new infections , the number of people living with hiv has significantly increased globally , largely due to the expansion of art .
abdul s mujeeb , hashmi mr . a study of hiv - antibody in sera of blood donors and people at risk .
khan aj , luby sp , fikree f , karim a , obaid s , dellawala s et al . unsafe injections and the transmission of hepatitis b and c in a periurban community in pakistan .
the combination of the high number of new infections and low antiretroviral therapy ( art ) coverage has proven deadly in pakistan , reveals the research study findings .
shaikh bt , ejaz i , achakzai dk , shafiq y . political and economic unfairness in health system of pakistan : a hope with the recent reforms .
like any other developing country , in pakistan , first level care is mostly sought in the private sector , because of distrust in the quality of care in the government system , limited working hours , shortage of trained human resources , and dearth of supplies ( 9 ) . a meagre portion of gross domestic product ( gdp ) and a minimal developmental expenditure on health have been incurred persistently over the last two decades in the public sector health system of pakistan ( 10 ) . most of the proportion in the allocation has chiefly gone to the recurring costs of a few big hospitals , and therefore the vertical programmes such as national hiv / aids control programme are primarily supported by the bilateral donors like global fund ( 11 ) . by and large , the health system has been weak in all areas from service delivery , human resources , information system , to matters pertaining to governance and leadership . we used who ' s framework of building blocks for health system strengthening and analysed the health system of pakistan for taking stock of the responsiveness towards the threat of hiv / aids in the country . below is an account of each building block with its issues and proposed solutions .
there has been skepticism unaids / who working group statistics , for fact sheets can be only as good as information made available . as these figures estimated by the working group ( an annual increase of 1571 % ) were not associated with evidence - based strategies , but rather on reports by various institutions and agencies whose reliability was questionable , the doubt still persists . following identical trends , and annual percent increases calculated above , there should have been an explosive hiv / aids epidemic in the country in 2005 , this is not in evidence . nonetheless there is no denying the fact that there has been an increase in the number of hiv / aids cases in the country . my personal concern is that the inflated rates shown in 2003 by the unaids / who working group on global hiv / aids and sti surveillance , and estimates based on these figures may mask the true epidemic as and when it makes an appearance . this would be a national tragedy and may not be very far !
sex workers reported to engage in a combination of hiv risk practices such as having a high number of sex partners and engaging in unprotected sex with paying and non - paying partners . consistent condom use which is the key to preventing sexual transmission of hiv infection showed significantly low levels , most notably in msws and hsws . given the potential for the spread of hiv infection through unprotected anal sex , the progression of hiv in these populations and their possible role in bridging sexual networks to pwids is a cause for serious concern . service utilisation data from pakistan continues to show low levels of awareness about , and participation in , prevention programmes . this indicates the need to scale up interventions and bring substantial improvement in coverage to reach a larger proportion of these key populations .
pakistan : country profile . united nations office on drugs and crime . accessed on : 8 may 2006 , [
4 . use the evidence to suggest focused , targeted and cost effective and evidence - based response to hiv in the country .


karen millen is a british women 's clothing retailer , specialising in tailoring , coats and eveningwear .

the company has stores throughout the united kingdom , united states , indonesia , austria , denmark , norway , russia , the republic of ireland and many other european countries .

karen millen

the karen millen coat is one of the best selling items in the karen millen repertoire . made of the finest coat supra low tops the karen millen coat is stylish and comfortable at the same time making the woman who wears it feel very special . karen millen coat can also be custom tailored for you . karen millen usa has a fantastic sale of karen millen coats 2011 season . recently the karen millen sale drew a lot of celebrity women to shop for karen millen coats 2011 autumn collection .
millen , who reinvested considerable sums in baugur which she lost when it collapsed , is suing karen millen fashions and mosaic fashions us which opened a karen millen store in new york in 2014 .
the karen millen retail business remains safe , as millen had sold her share in it for £35 million in 2004 .
world - famous fashion designer , karen millen obe , has been declared bankrupt .
karen millen has appointed tesco chief customer officer robin terrell as non - executive director .
ed with customer service . my husband bought me a karen millen handbag for christmas .
bonmarché chief executive beth butterwick is stepping down to join karen millen in the same role .
' i ' m deeply devastated ' : fashion icon karen millen tells of . . .
read more : karen millen poaches tracey stainer from l . k bennett to lead design teams
pentland brands has signed a deal to be the new global footwear licence partner for karen millen .
ms millen is embroiled in a row with the bank’s administrators , who now own her former business and all rights in the name ‘karen millen’ .
butterwick will lead a strategy to reshape karen millen globally by increasing its focus on digital . change change
the icelandic banks had helped fund the investment group baugur , which owned major stakes in karen millen .
millen says the demise of baugur and the restructuring of karen millen holdings mean the agreement not to use her own name in business can now be challenged .
fashion brand karen millen has appointed agency nys corporate to manage its conferences , events and travel across europe .
throughout the eighties , the business expanded with more and more karen millen stores opening across britain’s high streets .
she said kaupthing‘s administrators , which now own the karen millen brand , had prevented her from starting again .
however , her personal bankruptcy does not affect the karen millen business , which she has no involvement with .
she wanted to use the trade marks ' karen millen ' , and ' karen ' for a new homewares and lifestyle business , focused on the us and china .
in 2004 , millen sold her share in the karen millen retail business to aurora fashions , which was then taken over by aurora ' s parent company kaupthing .
a karen millen shop in london . the chain has thrived despite ownership upheaval . photograph : david sillitoe / guardian
karen millen let us into its knightsbridge pop - up atelier to follow a trench coat from sketch to store .
a london branch of karen millen in 2000 , at the brand’s zenith . photograph : david sillitoe for the observer
the karen millen label made good progress in the 1990s when they opened stores and boutiques in america and europe . karen millen usa is still growing at a fast pace much to the chagrin of the competitors . although karen millen or kevin stanford , no longer own the company , the innovative outlook and an eye for detail is still meticulously maintained .
by the time of the icelandic crash , ms millen and mr stanford had sold the majority of their shares in karen millen , with baugur becoming one of the main investors .
karen millen has been without a ceo since mike shearwood left in september after the firm scrapped plans for a management buyout .
ms millen said she was a victim of fraud by collapsed icelandic bank kaupthing , who own karen millen . the bank prevented the designer from using her name to launch a new brand
what millen does next remains to be seen . her bankruptcy will limit her business activities for two years . nevertheless , it seems unlikely that the karen millen story will stop here .
karen millen was founded in 1981 by kevin stanford and karen millen . with a loan of just £100 they began manufacturing and selling white shirts to their friends . a party plan network followed , and in 1983 they opened their first store in kent .
millen said kaupthing’s administrators , which now own the karen millen brand , had also prevented her from starting again , after she wanted to launch a range of products under her own name .
aurora fashions ireland , which also manages karen millen locally , has 27 free - standing stores and 34 concessions across the republic .
karen millen , founder of the eponymous womenswear chain , has been declared bankrupt by the high court over an unpaid tax bill .
the karen millen jacket is very special for its exquisite design , contemporary supra mens shoes and embellishments and excellent workmanship . in fact you can even have a karen millen jacket that is custom tailored to perfection . although in keeping with the current trends and fashion , the karen millen jacket never gets outdated or looks old - fashioned . the fresh modern look is somehow maintained even after years .
the international expansion of karen millen is set to step up a gear today , with the launch of a new york flagship store .
mr shearwood was chief executive of aurora until karen millen was spun off in 2012 , but he was still serving as a director .
with the high street teeming with great stores offering quality , on - trend items , karen millen’s new approach is a welcome one .
however , at the time she was also fighting a legal battle with icelandic bank kaupthing over the use of the karen millen name .
the karen miller label has woman as the central theme around which all products revolve . the karen millen coat and jacket is worn by celebrities and high society women in uk , usa and many european countries . karen millen eveningwear is a fabulous union of contemporary styling , fastidious tailoring , fine embellishments such as laces , trimmings , embroidery etc .
he battle for the karen millen name is hotting up . millen the woman says she is embarrassed by the brand . but the chain she relinquished control of in 2004 has threatened legal action if she returns to business , as planned , under the brand name karen or km .
karen millen , the fashion designer who for 20 years helped to define what women wore to work , has been declared bankrupt over unpaid tax .
fashion designer karen millen is heading for a high court battle with the company she founded to try to recover the right to use her name .
fashion designer karen millen has said she is ' deeply devastated ' as she faces losing her luxury mansion after she was declared bankrupt over unpaid tax .
the karen millen brand , seen on celebrities including nicole scherzinger and spice girl emma bunton , still has kent outlets in canterbury , bluewater and bromley .
karen millen , founder of the eponymous fashion chain , has lost a high court battle for the right to use her name for homewares and lifestyle ventures .
she wanted to use the trade marks ' karen millen ' , and ' karen ' for a new homewares and lifestyle business , focused on the us and china . the designer made £35million when she sold her share of her business in 2004
designed with uncompromising attention to detail , karen millen glasses feature bold use of colour , alongside distinctive design details , creating styles to flatter many different face shapes .
it came after the administrators to kaupthing , which now own karen millen the brand , had prevented the designer from using her name to launch a new brand .
following the collapse of baugur during the financial crisis of 2009 and the subsequent restructuring of karen millen holdings , which had been controlled by administrators to the failed icelandic kaupthing bank , millen decided to challenge the agreement , according to the times .
clients include many of the high street brands such as coast , karen millen , topshop and river island . an exciting opportunity has arisen for a production . . .
within hours of being declared bankrupt at the high court this week , the british fashion designer karen millen was talking of her devastation — and blaming everyone but herself .
karen put her heart and soul into her collections , without ever having a catwalk show .
millen also lost money in the 2008 financial crisis after other icelandic investments failed .
ms millen opened her first store in maidstone in 1983 under the name cue .
millen claimed that she had lost significant sums as a result of the baugur collapse and said she wanted to use the karen millen name in a different sector from the chain’s heartland of fashion , but judges ruled it would cause confusion between the two brands .
we ' re currently recruiting candidates to work across our karen millen , ellesse and kickers brands . building a family of brands , for the world to love , . . .
but last week karen millen , the woman , became famous all over again for the wrong reasons , after suffering the humiliation of being declared bankrupt over an unpaid tax bill .
karen millen set up her business with her partner kevin stanford in 1981 , taking out a £100 loan which they used to manufacture cotton shirts and sell them to their friends .
their first shop opened in maidstone in 1983 , selling catwalk - type clothes designed by karen .
karen millen has already been split off from the group and mr shearwood’s exit from aurora could allow him to launch a management buy - out of the women’s clothing brand , pictured .
in the karen millen store in dubai marina mall . i had chosen a dress for my 16 yr old daughter but once she got it home she decided it wasn’t what she wa
at its height , karen millen was one of the most recognised names on the high street and a byword for style and quality . it was the product of a powerful partnership .
by the time the pair came to sell their business to icelandic investors in 2004 , there were 130 karen millen stores in cities as far - flung as beirut and los angeles .
before the icelandic bank collapse , ms millen and her business partner - former husband kevin stanford - were flying high in the fashion industry , with interests in oasis , whistles , all saints , house of fraser , ghost and principles , as well as karen millen .
and miss millen also lost money in the financial crisis after other icelandic investments failed .
in march 2011 it was announced that karen millen would be established as an independent company , with derek lovelock as executive chairman , working with joint managing directors gemma metheringham and steve price .
gradually and carefully , they expanded during the eighties . soon , karen millen stores were opening all over the high street . there was no great secret to the popularity of the clothes .
karen millen is used to seeing her name in lights . with 400 outlets spread across 65 countries , there is even a store that bears the kent - born designer’s name in mongolia .
karen millen opened her first self - titled store in maidstone’s royal star arcade in 1983 and watched the business flourish into a multi - million - pound brand with branches across the world .
judge david cooke said in the court documents : ‘the terms of the agreement included a number of restrictive covenants and other obligations on the part of ms millen and mr stanford intended to protect the business karen millen holdings and its subsidiaries and the intellectual property rights that they owned .
karen says they had no great ambitions at the outset , but the business evolved and kept growing .
mike shearwood , the karen millen boss , has stepped down from the board of aurora fashions , pushing the high street clothing group closer to a break - up and sale of its brands .
style icon : at its height karen millen was one of the most recognised names on the uk high street . but the fashion retail entrepreneur has told how selling her business left her feeling low
karen millen’s london and new york stores are just the beginning . with 40 new ones planned worldwide , including its first shops in canada and india , the company has a busy year ahead .
, managing director of karen millen , said : “as a fast growing international brand with a strong british heritage , these are two really important appointments for us . we look forward to becky and
speaking to this paper five years ago , millen said the decision to part was hers .
but while stanford remarried and had more children , millen’s love life has been less straightforward .
karen millen would like to keep you updated about our new arrivals , exclusive previews and promotions . if you are happy for us to do this , please enter your email address and sign up .
without the involvement of the founders the karen millen stores have kept on going , although the chain is having something of a midlife crisis as millennials opt for a casual look even on nights out .
karen millen would like to keep you updated about our new arrivals , exclusive previews and promotions . if you are happy for us to do this , please enter your email address and click sign up .
mosaic continued trading throughout , though it changed its name to aurora fashions after the pre - pack . somewhat remarkably , considering the upheaval , the company did well , with karen millen a star performer .
millen and stanford have pursued several legal claims against the estate of kaupthing in an attempt to recover the tens of millions they – and many other investors – lost in iceland’s financial meltdown . the designer says the last nine years have been “one long legal battle” that has left her exhausted and ready to “finally put the past behind me” . it seems millen is finally letting go of karen millen .
hmrc successfully challenged the firm in 2010 , and issued millen with the tax bill in september .
i am a loyal customer of karen millen i have bought many beautiful dresses that have worn so well . i have recently purchased 2 jumpsuits to be delivered to the trafford centre store 2 weeks ago and th
a beacon for style - conscious women since its launch in 1981 , karen millen has seen many a style overhaul . one thing remains is the label’s dedication to sensuality and sophistication . discover the collection here .
one industry expert told the mail this week that ms millen had been ‘foolish’ for entering the scheme .
as a result , they issued millen with a notice to pay about £6million in september last year .
millen , who was awarded an obe in 2008 , claims to have been a victim of fraud .
karen millen was declared bankrupt at the high court this week . her blend of smart tailoring and wearable evening wear at high - street prices led to a rapid expansion of her business , with 130 outlets around the world
life was tough when karen was growing up because her father’s illness made work difficult and there was never enough money .
it has been suggested that millen may come back with another proposal to use the “karen” name only , as the court felt less strongly that that would cause issues . it is not known if she will take this option .
karen millen glasses are just £125 , including standard single - vision lenses , and you can get a second pair free in our great 2 for 1 designer glasses offer . you can even make designer sunglasses your second pair .
ms millen also claims to have lost significant sums in the 2008 financial crisis after other icelandic investments failed .
hmrc disputed the scheme in 2010 and issued millen with a notice to pay £6m in september last year .
as for fashion , she does wear some of her own label clothes but admits to dressing quite differently from the typical karen millen style , which is quite structured - and she is a huge fan of the british high street .
“the consumer has moved on , ” says lorna hall , retail analyst at trend forecaster wgsn . “fashion trends have become more casual and that has sidelined brands like karen millen that had a vernacular focused on getting dressed up . ”
greed that bankrupted the fashion queen of the high street : she built a £35m empire on a £100 loan - but now karen millen ' s gone bust after a £6m tax dodge . so what did happen to her millions ?
karen millen , who grew up on a council estate in kent before founding the hugely successful business that bore her name , said she was “deeply devastated” after she was unable to pay a £6 million demand for unpaid tax from hmrc .
but millen says she has been unable to pay the tax bill because of battles with collapsed icelandic bank kaupthing .
the retail business will not be affected by the bankruptcy as millen no longer has any involvement in the store .
karen millen is entirely design led , and designs all of the ranges in - house . the design team inspires , guides and informs the business on upcoming trends . they are responsible for developing new shapes and key pieces for the season .
the fashion brand has named becky bateman as retail director for the uk & ireland and she will be responsible for leading the “karen millen proposition in the home markets” , through customer service and by delivering “ultimate brand experience” in its uk stores .
karen millen with her partner kevin stanford founded the justin bieber supra shoes in england which is now 20 years old . with only ? 100 , that was borrowed , the two partners began manufacturing and selling white shirts to their friends from the white cotton material they bought with the borrowed money . their network of friends created a strong client base so that they could progress fast and the first karen millen store opened in kent in the year 1983 followed quickly by stores all over england .
karen millen had been part of the aurora fashions group , which also owns warehouse and oasis , but was spun out on its own in 2012 as it was anticipated it would end up being bought in an mbo by former ceo mike shearwood .
karen millen is just a brand of clothing and does not reflect me as a person in any way… sometimes i find it a little difficult as i have no control over what they design and at times it can be a little embarrassing .
ms millen at her £3million home in kent in 2001 . the 55 - year - old now faces losing the property
gemma metheringham , the current managing director of karen millen , says she is
genuinely puzzled
by millen ' s comments .
even before she sold the business , i honestly think she was falling out of love with it . of course the collection has grown and evolved significantly , so it is quite likely that it doesn ' t reflect her taste now .
to steer it down a more fashion - conscious route , karen millen hired photographer david bailey to shoot its latest campaign . katy england , famed for her work with the late alexander mcqueen and partnership with kate moss on her topshop collection , was on styling duty .
ironically , however , her biggest heartbreak appears to have been the sale of her company . describing the day she signed away karen millen in july 2004 , she told the mail in 2011 she became ‘an emotional wreck’ and felt as if she had ‘betrayed’ her staff .
her mother , sheila , a retired secretary , is 73 and , says karen with a knowing smile , is living with a much younger man .
this is one of the key areas metheringham is keen to highlight . a large production run for a karen millen piece might be 4 , 000 , which , when spread around its 400 international stores , leads to the type of exclusivity you can’t get elsewhere on the high street .
according the times miss millen said that in 2001 her accountants told her to enter a tax avoidance scheme known as round the world .
“obviously i am deeply devastated by this outcome , ” said millen . “all of my energy has been eaten up by such negativity .
they were high quality , beautifully cut and benefited from scrupulous attention to detail . karen and kevin controlled the whole process from design to manufacture to sale .
aurora was forced to seek the appointment of an examiner for the irish arms of coast , warehouse and karen millen in late 2014 . the last was spun out in a management buyout from aurora in march 2011 . it is owned by the icelandic bank kaupthing , which also ultimately owns aurora .
nys corporate will provide a single - source solution for karen millen’s events and travel for its retail and head office staff across the uk and europe . the agency will manage venue finding and event management support as well as all online and offline rail , air , hotel and ancillary travel bookings .
millen sold her business – and the right to use her own name – in 2004 for £95m . photograph : ian gavan / getty images
ms millen reportedly also had a holiday home in majorca and an apartment in london although it is unclear whether she still owes those properties .
however , hmrc successfully challenged the scheme in 2010 , and issued miss millen with a notice to pay about £6million in september last year .
miss millen , a former student at medway college of art , now uca university for the creative arts , began her career making shirts .
previously , karen millen’s collections seemed to exist in a vacuum far removed from exciting things elsewhere on the high street . with the success of brands such as zara , now one of the world’s largest retailers , and more recently cos and & other stories , the retailer had to rethink its offerings .
at the moment we are just bringing teenagers together and taking them out to things like concerts at the o2 , football and rugby ,
explains karen .
but that deal represented a low point for karen , by then separated from the father of her three children . she felt ‘lonely’ , ‘rudderless’ and quietly desperate .
briggs , who also preyed on lonely single women with money , wooed karen after she booked into a hotel he was running , and they were soon dating .
karen may protest that her ambitions for the new business are relatively modest , but women who love quality clothes will be hoping the lady doth protest too much .
ironically , just when it seemed that life couldn’t get any better , it began to fall apart and millen and stanford separated after 20 years .
the daughter of carpet - fitter anthony millen and his secretary wife sheila , millen was one of four children raised in a modest three - bedroom council house on an estate in maidstone , kent , not far from the georgian house which , until it is sold , is her present home .
there are still karen millen stores on the high street but she has mixed feelings about them . ‘they are very over - branded , ’ she says . ‘the clothes are strong and don’t need logos on every button or zipper . they are also sometimes over - styled , with too much trimming and detail . ’
millen sold her business to the icelandic group baugur for £95m in 2004 and with it signed away the rights to use her name on future businesses .
the truth is , of course , that her brilliant designs were key to its success . but sadly , while building their retail empire , karen and kevin drifted apart .
however much of a let - down karen’s recent romantic adventures might have been , the disappointment pales into insignificance alongside the emotional turmoil wrought by the sale of her business .
‘it was early on a friday morning in july 2004 when i met kevin in the foyer of a hotel in birmingham to meet with the lawyers , ’ karen says .
she adds :
i see every single sketch that goes through the studio . i think it ' s really important that somebody holds the brand together . i am a sort of unlikely stepmother for karen millen .
as is so often the case , mother and stepmother seem set to clash over who rules the roost .
“the past nine years have been one long legal battle against the banks to try to achieve justice and have now taken their toll , ” millen said .
karen’s own romantic journey has been less predictable . panic and desperation drove her into the arms of a notorious conman called graham briggs , whom she met travelling through france in 2003 .
as the global economy shifts , china is no longer just a manufacturing base for karen millen . the chain is opening stores in beijing and shanghai this year and has plans for 65 outlets there over the next five years . it is part of a major push that has seen it open shops in markets as unlikely as kazakhstan and azerbaijan .
karen is also giving a great deal of hope through hopehiv , based at the gateway school of fashion in south africa , which aims to give fashion skills to young people affected by hiv . what ' s wonderful for karen is that teachers from the university for the creative arts in rochester , where she studied , have been pivotal in getting it off the ground .
ironically , that home - made dress got karen back into sewing again and made her realise how much she ' d missed fashion . even more exciting is news that the retail queen who , in 2004 sold karen millen , the label she ' d set up with her ex , kevin stanford nearly 30 years ago , is working on a new label with some of her former colleagues .
i feel like now i ' ve gone back a full circle . i ' m very much hands on again ,
she laughs .
karen was 19 and fresh out of a city & guilds fashion course at kent’s _ medway college of design , while kevin , then 20 , was unhappily studying mechanical engineering at university .
miss millen , who opened her first shop almost 35 years ago , failed to pay £6million to hm revenue and customs over her involvement in a tax avoidance scheme .
but miss millen said her battles with kaupthing had left her unable to pay the bill - putting her home , any second properties , cars and valuables at risk .
millen , who created the high street brand 35 years ago , claimed she had been the victim of fraud by the collapsed icelandic bank kaupthing , the times reported .
a self - confessed home girl , karen was born in maidstone , where her very first shop opened in 1983 in pudding lane under the name cue , and now lives in nearby wateringbury .
set in five acres and with stunning views across hop fields , it was the dream home she had always wanted . but behind the facade , karen was miserable . the romance had died .
and there is a real emphasis on quality , something karen millen has always done well . one of the new collection’s cut - work dresses involved more than three hours of cutting by hand . then , there’s a limited - edition striped jacket that costs £499 – only 357 have been made . each one was hand - painted , individually printed and panel cut .
“i never wear the clothes , ” millen said in a 2012 interview as she started a legal campaign to win back the right to use her name on new designs .
millen said she was the victim of fraud by kaupthing , an icelandic bank that collapsed in 2008 , which financed the buyer of her business in 2004 for £95 million .
ms millen , who was appointed obe in 2008 , failed to pay a demand from revenue & customs of about £6 million arising from her involvement in a tax avoidance scheme .
aren millen , the high end fashion designer who was declared bankrupt on tuesday , has joined a very long list of celebrities who have run aground due to unaffordable tax liabilities .
karen met kevin stanford , the man who would become her romantic and business partner , when they were both on holiday in morocco in 1980 . it was , she says , ‘love at first sight’ .
many women might regard this as a typically male response to a break - up and roll their eyes . however , karen is still close to her ex - partner , whom she describes as ‘family’ .
millen considered an apprenticeship as a painter - decorator to help the family finances , but a school visit to a college fashion show ignited a passion for design when she was 16 .
he was later accused of conning wealthy british expats out of nearly £2 million . millen has always vigorously denied briggs’ boast that she had given him £1 million after he seduced her .
millen , 55 , who founded the high street chain more than 35 years ago , failed to pay £6million to hm revenue and customs following her involvement in a tax avoidance scheme .
now , however , karen , 50 , is ready for the next phase . she is plotting her return to the fashion industry . as they say in creative circles , she has got her mojo back .
the win comes after a competitive tender process that took place between june and september 2015 . when asked why they ultimately chose nys , karen millen’s retail operations manager for uk and europe said :
we chose nys corporate because it provided a global solution for our business . both store and head office staff can book travel easily from the portal and we have greater visibility of reporting and expenditure .
millen wanted to use her name on homeware products in china and the us . however , last august a high court judge ruled that this would breach the terms of the original agreement .
one such win was karen millen , for whom nys are now providing a single - source solution spanning retail and head office staff across the uk and europe . the solution includes managing all online and offline rail , air , hotel and ancillary travel bookings , as well as venue finding and event management support . the highly competitive tendering process for this sizable account took place between june and september 2015 .
ms millen , 55 , was declared bankrupt at the high court on tuesday . she faces losing her £3 million home in kent as well as any secondary properties , cars and other valuables .
karen is also involved in doing up a house she has bought in majorca - the family ' s favourite holiday destination - and renovating her apartment in london , despite confessing she has very little confidence in her abilities .
ms millen said she was ' deeply devastated ' , and insisted she had been a victim of fraud by collapsed icelandic bank kaupthing which financed the buyer who bought her business in 2004 for £95million .
three years later , they opened their first shop in maidstone , selling catwalk - style clothes designed and made by millen on her kitchen table . a second shop soon followed in nearby tunbridge wells .
but all this wasn ' t enough for karen , who wanted to give something back to society .
getting involved in charity was an obvious thing to do , i could meet new people and do good things as well ,
says karen , who has worked with her close friend , debbie pezzani , to set up teens unite fighting cancer , dedicated to improving the lives of young people aged between 13 and 24 with life - limiting illnesses .
they lived in a breathtakingly beautiful georgian mansion in the kent countryside . the house , in which karen still lives , has a swimming pool , seven - a - side football pitch , tennis court , helipad and mini lake .
ms millen said she was “deeply devastated” . she claimed she had been a victim of fraud by kaupthing , the collapsed icelandic bank , which financed the buyer of her business in 2004 for £95 million .
her much - loved former teacher and head of fashion , sheelagh wright , is now project director and together they took on 22 students for the first year . karen travels out three times a year and is delighted at the progress .
the shift in the fashion landscape has led to a concerted push by karen millen’s new management to shed its “footballers’ wives” image by highlighting , among other things , that its clothes are designed at head office in london’s trendy shoreditch district . however , the most recent accounts available at companies house show a loss of £10 . 5m on sales of £161m in the year to the end of february 2016 , reflecting the heavy investment involved in the revamp .
a lot has happened in the last five years but , as karen says :
great things can come out of changes , and even when bad things happen , i ' ll always try and put a positive spin to it .
instead of having buyers , karen millen designs all of its clothes in the uk . unusually , it also has its own pattern cutters . these are the people that turn a design into an item of clothing . metheringham is fiercely proud of this side of the business and eagerly gives me a tour of the pattern room – a huge light - filled workshop , littered with dummies , all draped in material , some closer to resembling finished items than others .
metheringham was hired by millen and her then husband and co - founder of the brand , kevin stanford , as design director in 1999 . two years later , millen and stanford sold half the business to icelandic bank kaupthing , and in 2004 lost majority control when the business was merged with oasis ( backed by another icelandic group , baugur ) to create mosaic fashions . metheringham stayed on and was made joint managing director in 2009 .
then he cruelly bragged to friends that she gave him £1 million after he had seduced her . karen looks embarrassed when asked about this . ‘i went out with him at a time when i was feeling emotionally fragile , ’ she says stiffly .
karen millen , designer , entrepreneur , multi - millionairess and mum , makes such a quiet entrance into the lounge where i am sitting admiring her fabulous view that i nearly drop my coffee cup . it ' s typical of her - a petite 5ft 2in , with her long blonde hair , black jeans and t - shirt , she could be any yummy mummy waiting at the school gate , and is modest to a fault about her success and undeniable talents .
the primary function of the press office is media relations on behalf of karen millen ; they secure press coverage to include features , news pieces and product placement on the km brand in all media around the world . this include print and digital media as well as blogger engagement and social media . they also look after our seasonal press events and special brand projects . they also manage the seasonal brand campaigns which include the shoots , media advertising placement and public relations .
the tailored in london atelier gave our customers the chance to experience the craftsmanship and strong creative spirit that lies behind everything we do at karen millen . each piece was precision cut and crafted with traditional tailoring techniques , using luxurious fabrics to create a modern and highly personal garment for each customer , here in london . the direct personal connection between our designers and pattern cutters enables us to perfect our signature tailored fit and deliver incredible quality for our customers in store .
ms millen has certainly enjoyed an a - list lifestyle in recent years . aside from the upkeep of her lavish home and the porsche she used to drive around in , her three children have also been privately educated .
millen did not cut all ties with the company . she and her family trust retained a stake of almost 7 % , while stanford held a further 3 . 75 % , as well as owning 8 % of baugur . both baugur and mosaic were casualties of the icelandic crisis . now millen claims she was duped by her former co - investors , saying :
i will not rest until i have my company completely restored to me .
miss millen , who was awarded an obe in 2009 , has three children and lives in a late georgian house in tonbridge , kent , which boasts a swimming pool , tennis courts , a football pitch and a lake .
one leading city accountant who advised his client to invest in the scheme told the mail last night that ms millen should have known the scheme was ‘risky’ and kept the tax on one side in case she needed to pay it .
but despite receiving £35m for her share of the business – a blockbuster deal that involved millen signing away the rights to use her own name – the rags - to - riches story returned to rags in the high court after she failed to hand over an estimated £6m that hm revenue and customs said it was owed . millen told the times her accountants had advised her to use a tax planning scheme , the validity of which was successfully challenged by hmrc in 2010 .
although kaupthing had made her rich , millen and stanford , whose business interests remained linked despite their divorce in 2001 , suffered heavy losses after the bank failed during the 2008 banking crisis , taking many of their personal investments with it .
revenue and customs challenged the scheme and , in 2010 , the court of appeal ruled that the uk could tax the gains on the disposals . millen was reportedly ordered to pay about £6m back to the taxman in september last year .
naturally creative , karen made clothes and furniture for her dolls . she considered an apprenticeship as a painter - decorator so that she could earn money to help her family , but a school visit to a college fashion show ignited her passion for design at the age of 16 .
and now she is starting out again . ‘i want to have something small of my own . i am not looking to build another brand . i want something more personal to me that i can enjoy doing again . ’ the new line of clothing will be called karen .
millen set up her business in 1981 with her partner kevin stanford . the chain was acquired by icelandic investor baugur in 2004 . the deal – valued at £95million – included an agreement that stopped her using her own name in future business ventures .
millen also said that in 2001 her accountants advised her to enter a tax avoidance scheme called round the world , which promised members they could avoid millions in capital gains tax from the sale of shares by transferring the shares to trustees in mauritius .
according to the times , millen — whose clothes eponymous high street chain helped to define what women wore to work for the past two decades — could now lose her £3 million home in kent as well as any other properties , cars and valuables .
millen said she was advised by her accountants to invest in a tax avoidance scheme called round the world in 2001 . the scheme sought to avoid uk capital gains tax on planned disposals of shares by putting them into the hands of trustees in mauritius .
i think it ' s very difficult , isn ' t it ? to apply what we would consider to be our life standards to other people ' s standards in china .
karen millen has signed up to the ethical trading initiative , an alliance of companies and ngos that has developed a code of conduct , which is generally well - received among campaigners .
i think you almost need to take that very professional approach to it ,
she says .
i don ' t think you ever relax about it .
ms millen meanwhile claimed this week that she had been a victim of fraud by kaupthing , a collapsed icelandic bank , which financed the buyer of her business in 2004 for £95 million — though what that fraud was , exactly , she did not make clear .
in 2003 , she became embroiled in a relationship with convicted fraudster graham briggs who had recently been released from prison after a £50 , 000 fraud on the isle of wight and who was running the hotel that millen had checked in to in france’s dordogne region .
however , the hmrc won a legal dispute with round the world in 2010 – as the scheme was found to be “carefully orchestrated” from the uk and could therefore be taxed – and issued millen with a notice to pay about £6 million in september last year .
karen millen employs some 1 , 100 people in the uk , with 200 in head office and the rest in shops . the manufacturing is done abroad , about half in china and half in eastern europe . metheringham says this is not just for financial reasons .
i think it would be difficult to find the people who were prepared to take the trouble [ in the uk ] . some of the clothes we make have up to 80 pattern pieces . somebody ' s really got to be prepared to put that extra bit of skill into it .
keen on painting and decorating , school said it wasn ' t really a career for girls and suggested fashion instead - and the rest is history . aged 19 , fresh out of college , she went on holiday and met kevin , who was doing a degree in engineering but interested in starting up a business with karen .
in the 13 years since millen sold the company , she has appeared to be living in a bubble , dividing her time between her three children and charity fundraising . she celebrated her 50th birthday by throwing a 1930s - themed party on the orient express for close friends that included the models kelly brook and caprice and the entrepreneur jacqueline gold . in interviews millen , who was appointed an obe for services to fashion in 2008 , was often snapped posing by the swimming pool of her immaculate georgian mansion , which boasted a football pitch and lake . it is now expected to be sold .
the ‘round the world’ tax avoidance scheme in which ms millen invested offered members the chance of avoiding paying capital gains tax on the sale of shares by transferring them to trustees in a country where the tax rate for capital gains is zero — in her case , the idyllic island of mauritius .
when you ' re a bigger company , it ' s very much figure led and it ' s hard to keep the creativity then ,
says karen .
although it was a wrench selling the business , i was actually quite happy . it was emotional , but definitely the right decision and i ' ve never regretted it .
‘there was nothing wrong with the scheme technically , ’ he said . ‘unfortunately there was one test case involving a member whose accountants had left a paper trail to this country and on the back of that everyone else — including ms millen — will now have to pay the tax owed in the uk . ’
millen says she is “devastated” by bankruptcy but blames kaupthing , the collapsed icelandic bank that backed the 2004 deal , rather than her own financial decisions for her current woes . her story is a stark reminder of the noughties’ high street boom , fuelled by the expansion of icelandic banks , that would go spectacularly bust during the credit crunch .
but the action also proved an expensive mistake . insiders pointed out she had been paid “a lot of money” for her name and in 2016 millen lost – the judge agreed with the company that letting her use her signature elsewhere would create confusion for shoppers . the ruling left her to foot an estimated £2m - £3m bill for both sides’ legal costs .
but there was no real love in the house ,
admits karen .
we made it look beautiful , but it had no real heart , so now i ' ve really put my heart into it and made it mine . fashion and interiors go hand in hand really , both are about proportions and colours . and i love travelling so i like picking up things and adding them in .
i never wear the clothes ,
millen says .
i think the brand has somewhat stood still and the overall style is in danger of looking a little staid , which is reflected in their performance . although there are one or two pieces that are strong , they become overshadowed by the majority of the collection , which i feel is too heavily branded and overpowering .
when the couple worked together , millen had focused on the creative side while stanford ran the shops . “i was never the driving force behind it , ” she told one interviewer . “it was always kevin . he’s the ambitious one . i’ve just gone along with it . ” the same approach appears to have cost her dearly when it came to investing the fortune they made together .
millen has not designed clothes for the company that bears her name for well over a decade , yet she remains forever yoked to the business that she started with stanford in 1981 , when she was just 19 . “when i hand over my credit card , people will often say : ‘how funny , you have the same name as the shop , ’” she said in a recent interview .