14 May 2004	Friday	23 Rabi-ul-Awwal 1425

KARACHI, May 13: A shift is taking place in the mode of transmission of Human Immunodeficiency Virus, which may soon cause an explosion in the total number of HIV cases in the country.

Until the middle of last year slightly more than 2,000 cases of HIV/Aids had been reported in Pakistan, of which only a few involved abusers of injectable drugs. However, since then 45 new cases have been reported from Larkana and 65 from Karachi which involve addicts who inject drugs.

The new cases have set off alarm bells among the physicians charged with monitoring the situation because, first, the number involved is a sizable one and, secondly, because the stage is now set for transmission of the virus from vulnerable groups to the general population.

"Up until now Pakistan has been facing a textbook situation in that the vulnerable groups, having considerable number of HIV cases, remained somewhat cut off from the general population," chief of the Sindh Aids Control Programme told Dawn on Thursday.

"However, the scenario has changed tremendously in the last 12 months," he remarked. Dr Sharaf Ali Shah expressed the apprehension that drug addicts, whose number runs into millions, could act as a 'bridge population', that is a group of people that carries the problem from the vulnerable groups to the public.

According to Dr Shah, the addicts who use injectable drugs regularly share needles. "They pool in their money to get hold of one syringe filled with the narcotic. And, they use this syringe one after the other." He was of the opinion that first there would be an explosion in the number of HIV cases among drug addicts and then this would be replicated in the general population.

Asked why in recent months the number of addicts who tested positive for HIV had shot up, Dr Shah said: "The reason is obvious. The number of people who abuse drugs traditionally used to inhale them. But now, the addicts are mostly injecting narcotics.

"This shift in the manner in which drugs are used is fuelling the number of new HIV cases and also causing a shift in the mode of its transmission from one person to the other."

When asked what steps had been taken by the government to stem the rot, Dr Shah claimed that three non-governmental organizations (NGOs) were busy in undertaking "harm reduction activities", as per international standards. "But I must admit that not much good is coming out of them.

"First of all, the problem is a massive one. It's simply not possible for a couple of NGOs to make a difference. Secondly, until and unless the drug addicts are provided counselling and psychiatric help before detoxification and rehabilitation and employment after it, success in this area will remain elusive."

The chief of the Sindh Aids Control Programme called for a multi-sectoral approach towards the problem. "This issue requires the involvement of several government departments. Until and unless that is done, no positive news is likely to appear soon," he said.