with services in 4 cities. Programs for sex workers lag somewhat but are bolstered by the fact that the metropolises have higher levels of knowledge and safer behaviors. However, the overall levels of coverage of services remain low at around 16% for IDUs and <10% for sex workers nationwide. The communication project has performed probably the least with only 44% of Pakistani women reporting ever hearing of the word "AIDS" in 2007. Finally HIV treatment was started in 2005. Currently over 900 individuals receive free HIV medicines and tests from 9 public and 3 private sector facilities. Future of HIV in Pakistan and response Going forward the Government of Pakistan has approved a 5-year plan that will be worth almost PKR 8 billion. However, a number of challenges will have to be met during this phase. The most immediate perhaps will be developing the methodology of measuring the impact of program interventions. A National M&E Framework has been developed but implementation on it has yet to start. To respond to this threat NACP in collaboration with Provincial programs and other partners developed its first national strategy framework in 2001 that culminated in establishment of first response called Enhanced HIV and AIDS Control Project that ended in 2008. This was followed by 2nd National strategic Framework that was more focussed to interventions in Key Populations. The country then developed the 3rd Strategic Framework 2015-20 that focussed on quality HIV treatment and care services. Lack of the ability to measure the outcomes or impact of interventions in real time (so that this knowledge can inform program direction) was likely the most important factor in the low performance of the first Enhanced Program. Other challenges that must be overcome include establishment of a transparent financial management and a smooth logistical and procurement system. Much of the Enhanced Program services are contracted out and delays in procurement of these services meant that many of the cities went without services for months to years. More complex (and longer term) challenges will include determining how to integrate many of HIV activities within other health activities, improve planning to anticipate future direction of the epidemic and its response and to enhance efficiency and effectiveness of the interventions. For these research must become part of the interventions to guide their implementation using local context and to involve epidemiological tools such as routine analysis of available data and even