29 September 2004	Wednesday	13 Shaban 1425

ISLAMABAD, Sept 28: Pakistan is a "high-risk" country for the spread of HIV/Aids due to several socio-economic, demographic and behavioural factors, claims a UN report.

The report, which was recently launched by United Nations Population Fund (UNFPA) and Government of Pakistan, says at present, about 0.1 per cent of the adult population is infected with HIV/Aids, which is considerably lower.

However, the country is considered to be at high risk for a number of reasons including the widespread cultural denial of behaviours that spread HIV and sexually transmitted infections (STIs) in general; low literacy rate and a poor educational environment; pervasive poverty; gender issues; and a young population (63 per cent being under 25 years), says the report titled Pakistan Population Assessment, 2003.

It says there are large concentrations of individuals in major cities with behaviour that makes them extremely vulnerable to rapid spread of HIV and sexually transmitted infections (STIs) such as chlamydia, syphilis and gonorrhoea.

Such individuals include male and female commercial sex workers, men who have (unprotected) sex with men or transvestites, injecting drug users and highly mobile occupational groups such as truckers.

"It is likely that in Pakistan, the epidemic will start in one or more of these groups and then spread to the general population through individuals who have contact with both high- risk groups and the general population," says the report.

In epidemiological parlance, the report states, individuals who spread the infection from concentrated high-risk groups and the general heterosexual population are termed the bridging group or population. Typically, these are married or unmarried men who are clients of sex workers or bisexuals, or share needles with injecting drug users.

The reports says little is known about the sexual conduct of men in Pakistan, but the available evidence suggests that both pre-marital and extra-marital sexual contacts, either homosexual or heterosexual, are "common" to create and sustain a generalized HIV epidemic.

The report also stresses immediate and effective action to avert the threat of HIV epidemic in the country. It says while some classical STIs are reproductive tract infections (RTIs), other are not, or not primarily transmitted by sexual intercourse.

They can be acquired iatrogenically during the insertion of intra-uterine devices or abortion. They can also arise endogenously due to proliferation of organisms normally present in the body.

Among the RTIs, bacterial vaginosis has become increasingly recognized as a major public health concern in Pakistan. The report has also welcomed the anti-HIV/Aids programmes of the Ministry of Health, like the National Aids Prevention and Control Programme, and the Pakistan Reproductive Health Services Package.

It says, at present, over 70 NGOs in the country are involved in the prevention of "this silent and largely invisible epidemic". These NGOs are working in all provinces, in both urban and rural areas, but very few are currently supported by external donors. Instead, they rely upon self-financing mechanism or community contributions.