KARACHI, Nov 9: The provincial Aids control programme has registered nine children who tested HIV positive, including three with full-blown AIDS, raising fears that continued lack of awareness and carelessness on the part of parents may result in a situation where the virus is transmitted from mother to child and becomes prevalent in the second generation in Sindh.
In the backdrop of claims from various quarters that efforts for HIV (human immunodeficiency virus) prevention and control are far too scattered, the Sindh Aids Control Programme (SACP) has so far discovered across the province nine children under the age of 12 who tested positive to the virus. Three of these have full-blown Aids (acquired immunodeficiency syndrome).
According to official statistics updated in July, there were 1,767 HIV positive and 127 Aids cases in Sindh, which constituted nearly 50 per cent of the total reported HIV/Aids cases in the country. The majority of the people suffering from this deadly virus are men, while the predominant mode of transmission is heterosexual practices.
Dr Arshad Mehmood, the provincial programme manager of the SACP, said that in developed countries preventive measures have helped reduce the transmission of HIV from mother to child. If transmission occurs, the treatment options available mean that the child will often survive into adulthood.
Pointing out that Aids was a disturbing reality in Pakistan and Sindh, he said that children are often infected in the womb. Therefore, it is imperative to save children from being infected with HIV at birth.
About 20 per cent of HIV-positive children develop a serious disease within their first year, most of whom die by the age of four. In the remaining 80 per cent, the disease progresses more slowly.
With the involvement of a private hospital, the SACP has started providing antiretroviral therapy to two of the three children born to HIV-infected mothers and in need of treatment. The third child will start getting treatment in a couple of weeks, said an official.
The first child, an eight-year-old boy from Karachi, was born to parents who tested positive for HIV. The father has since died while the mother survives.
Similarly, the second case is that of a nine-year-old from the interior of Sindh, whose father and mother were both HIV-positive. The father has died while the mother and child are under treatment by SACP.
The third infected child is a girl of about 15 months. Both her parents, who are based in Hyderabad, carry the virus. The case was reported to the SACP by an NGO.
SACP officials say that most of the nine HIV/AIDS-positive minors were born to families where the fathers had the opportunity to travel abroad and stay there for long periods in connection with their jobs. Such separation from their homes for extended periods of time leads expatriates into social and sexual practices that put them at the risk of exposure to HIV/AIDS.
There is no law in Pakistan to screen the blood of returning expatriates for the HIV virus. Reportedly, 80 per cent of the reported HIV/Aids cases concern Pakistanis deported from Gulf countries. Upon their return, these men maintained families in which the women generally lacked the skills necessary to negotiate for safer sexual practices.
Referring to this, an SACP officer related the case of a baby taken to physicians for pneumonia treatment. She was later found to be HIV-positive when she was one and a half years old and failed to survive. She had been born to a mother similarly infected, the virus originally transmitted by the baby’s father who also passed it on to the baby’s step-mother. The father and the step-mother died during the past year.
The cases reported so far to the SACP were detected by chance or brought on record through the efforts of volunteers and counsellors engaged by NGOs working in high risk groups, said the official. He noted that discovering an HIV/Aids case was a daunting task in Pakistani society, where one can not discuss the subject openly or freely.
UNAIDS estimates about 85,000 adults and children are infected with HIV in Pakistan, while about 3,700 cases have been reported to the National Aids Control Programme. The underreporting is normally attributed to the social stigma attached to the virus, limited surveillance, voluntary counselling and testing systems, as well as the lack of knowledge among the general population and health practitioners.
Dr Qamar Abbas, deputy programme manager of the SACP, said that healthcare providers should recommend HIV testing and counselling as part of the care to infants born to HIV-positive women as a routine component of follow-up care for such children.
The risk of HIV being transmitted from a mother to her child can be reduced by using a combination of antiviral drugs, choosing an elective caesarean delivery and when possible, avoiding breast feeding, he said.
Replying to a question about the gap between the numbers of HIV/Aids patients registered in the province and those being treated, Dr Abbas said that this was due to treatment protocol.
“Before initiating treatment we need to know the level of a type of white blood cell called a CD4 lymphocyte in the patient for an objective determination or assessment of when to initiate antiretroviral treatment (ART),” he said. “Under the revised guidelines of ART initiation, there is no need to initiate treatment in patients with a CD4 count of more than 350 but such patients must be kept under observation.”
Dr Abbas observed that Aids could be stopped from turning into a second generation problem only when people were motivated enough to disclose their HIV-positive status to their families, communities and health-care providers.
An HIV/Aids physician with the SACP, Dr Sikandar Iqbal, said that mother-to-child-transmission of HIV may lead to a vast majority of infected children. “If a woman already has HIV then her baby may become infected during pregnancy or delivery,” he commented, saying that ARV therapy given to women could minimise the risk of the transmission of the virus from pregnant women to newborns.
Dr Iqbal explained that once a child was infected with HIV, he or she faced high chances of illness and death if not provided with the required treatment. “Antiretroviral treatment slows the progress of the HIV infection and allows infected children to live much longer, healthier lives,” he added, mentioning that social taboos, inadequate knowledge amongst parents, poverty, late diagnosis and testing, and the absence of specialised training for hospital staff were among the problems faced by local Aids managers.
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