BY DR.ABDUL RAZAK SHAIKH,
HIV is recognized as a 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 HIV epidemic to take hold in Pakistan, mainly among injection drug users (IDU), male, female and transvestite sex workers (MSW, FSW, and TSW) as well as the repatriated migrant workers. HIV infection can lead to AIDS that may become a major health issue.
In Pakistan National, AIDS Control Programme was established in 1986-87 with a focus on diagnosis of cases that came to hospitals but progressively began to shift towards a community focus. Since that The Government of Pakistan (GoP) has maintained a sustained response to the HIV epidemic through a close collaboration between the National AIDS Control Programme (NACP), Provincial and AJK AIDS Control Programmes, UN agencies, bilateral and multilateral donors, and a consortium of NGOs and civil society Organizations (CSOs), including People living with HIV/AIDS (PLHIV) representative organizations, operating at national and provincial level.
Presently 24,147 cases are reported, 14088 are getting Antiretroviral (ARV) therapy and 4,130 People who inject the drug (PWID) and getting ARV treatment. The UN and government estimated the number of HIV/AIDS cases around 97,000 ranging from the lowest estimate of 46,000 to the highest estimate of 210,000.
The latest survey shows that 130,000 in Pakistan HIV cases and near about 56,000 patient are in Sindh, only 14,518 are registered HIV cases in Province of the Sindh and 239 are of AIDS.
The overall prevalence of HIV infection in adults aged 15 to 49 is 0.1%. 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 epidemic evolves in three phases. The first phase is low prevalence when the prevalence of the disease is less than 5% in any high-risk group in the country. The second phase is a concentrated epidemic when the proportion of infected people in any high-risk group rises more than 5%. Third and the last phase of an epidemic is the generalized epidemic when the prevalence of HIV infection rises over 1% among blood donor or pregnant women. Like other Asian countries, Pakistan is following a comparable HIV epidemic trend having moved from ‘low prevalence, high risk’ to ‘concentrated’ epidemic in the early to mid-2000s.
Pakistan’s epidemic is primarily concentrated among two of the key population groups driving the epidemic in the country. These are people who inject drugs, with a national prevalence of 27.2% (weighted prevalence of 37.8%); followed by Hijra (transgender) sex workers, standing at 5.2% and then 1.6% among male sex Workers. The prevalence in female sex workers still remains low at 0.6%. The geographic trend of key populations is from major urban cities and provincial capitals, expanding over time to smaller cities and peripheries.
During the last three decades, the HIV pandemic has entered our consciousness as an incomprehensible calamity. HIV and AIDS have already taken a terrible human toll, laying claim to millions of lives, inflicting pain and grief, causing fear and uncertainty and threatening economic devastation.
Pakistan is the second largest country in South Asia that stands only a few steps behind India and Nepal in terms of HIV epidemic. Despite many efforts, the HIV infection rate has increased significantly over the past few years and in fact, the country has moved from a low prevalence to the concentrated epidemic with HIV prevalence of more than 5% among injecting drug users (IDUs) in at least eight major cities. Other high-risk groups, such as men who have sex with men (MSM), hijra sex workers (HSWs) and female sex workers (FSWs), also look set to reach this threshold level. Many bridging populations, totaling almost five million persons, are in direct sexual contact with these groups and are exposed to HIV infection through unprotected sexual activity. The heterogeneity and interlinking of high risk injecting and sexual behavior, combined with low levels of HIV knowledge and prevention, and high levels of other sexually transmitted infections (STIs), indicates that HIV could spread rapidly to marriage partners or sex clients and result in a generalized epidemic.
In Sindh there were 11 centers working for HIV/AIDS, two at Karachi and Larkana, having a capability to treat the patients, Agha Khan Hospital and Indus Hospital are working in private Sector free of caste. Other centers are at Lyari General Hospital Karachi, JPMC Karachi, Abbassi Shaheed Hospital Karachi, LMC Hospital Hyderabad, PMC Hospital Benazirabad, Civil hospital Sukkur, Civil Hospital Mirpur Khas has started to work. All medicine of ARV is free of caste. There are different blood transfusion laboratories and not doing HIV test properly that is also the reason for spreading. The common signs of AIDS are fever, cough, loss of appetite, weight loss, pneumonia and red spots all over the body.
We envision a Pakistan where every person living with HIV has access to quality care and is treated with dignity. Effective prevention, care, and support for HIV/AIDS are possible in an environment where human rights are respected and where those infected or affected by HIV/AIDS live a life without stigma and discrimination.