KARACHI, Jan 5: Facts and figures given in an official document of the National Aids Control Programme show alarming increase in proportion of HIV infection among Injecting Drug Users in Karachi.
Officials believe that the country faces a shift in HIV epidemic in the country from low level to ‘concentrated’ among the Injecting Drug Users in Karachi.
According to an NACP report developed with collaboration of UNAIDS – Pakistan, the fact showing the rise of proportion of HIV infection among the IDUs was also validated by several studies reporting an increase in prevalence from 0.4 per cent in January to 7.6 per cent in August 2004 and to 23 per cent and 26 per cent in January and August 2005 respectively.
“This increase in levels of HIV indicates a shift in HIV epidemic in the country from low level to ‘concentrated’ among the IDUs in Karachi,” it says.
According to the report, Pakistan with a population of approximately 157 million occupies an important and strategic position especially in reference to two of its neighbors China and India where HIV and AIDS has graduated to epidemic proportions.
Currently, Pakistan is categorized as ‘Low-Prevalence High Risk’ country for HIV infection. The National AIDS Control Programme/ Ministry of Health using WHO/UNAIDS model estimates the number of HIV infections in country between 65,000 and 70,000; with a prevalence of less than 0.1 per cent among general population.
First case of AIDS was diagnosed in Pakistan in 1986. Since then sporadic and isolated cases have been reported from the provinces. The report says in addition to the regular passive surveillance mechanism, a number of studies on size estimations, behaviour and biological aspects have also been conducted among the various high-risk groups in recent years. These are a good pointer of the trends; however generalization could be an issue.
In July 2003, an outbreak of HIV infection was identified among the jailed Injection Drug Users in Larkana. Over a 10-month period (August 2003 to June 2004) the number of reported HIV cases increased from 19 to 69 among the IDUs. During the same period similar trends were observed in Karachi where seven per cent (57) of IDUs were reported as HIV positive against the total 800 screened by the Sindh AIDS Control Programme. This indicated a rise in proportion of HIV infection among IDUs in Karachi.
The HIV prevalence among IDUs in number of cities in Punjab and Sindh also reported increasing trends; 26 per cent Karachi, 2.5 per cent in Lahore; 12 per cent in Sargodha; 0.5 per cent in Rawalpindi; one per cent in Sialkot; and 9.5 per cent in Faisalabad.
In view of the changing HIV situation among the high-risk groups, the NACP with the support of development partners undertook two major activities to study the trends and set baselines: A comprehensive national study of reproductive tract and sexually transmitted infections in Lahore and Karachi in the first phase and covering the NWFP, Balochistan and bridging populations in the second phase. Besides, a pilot study under the HIV and AIDS Surveillance Project; the first round of active surveillance has already been conducted in eight cities; preliminary reports and data are under analysis.
The findings from both the survey and pilot study for active surveillance corroborated findings for each other. In line with experience from other countries, after IDUs, similar HIV trends are noticeable among men having sex with men and Hijras (transvestite) in selective geographical areas.
On the modes of transmission, the data illustrates sexual transmission to be the commonest mode (37 per cent) followed by sharing of the infected needles (21 per cent); however definite mode of transmission could not be ascertained in 34 per cent (due to either misreporting or stigma). Thus both trends as well as characteristics of the epidemic are following a “typical Asian model of HIV”.
“It is now required to undertake nationwide estimates of the high-risk groups, their behavorial patterns to ascertain the magnitude of the problems and also do modeling for future projections. This would help the government in further strengthening national response to address the emerging threat in comprehensive manner,” said the report.
