September 30, 2008	Tuesday	Ramazan 29, 2008

KARACHI, Sept 29: Sindh which has the highest number of HIV/Aids patients in the country is finding it difficult to continue with its anti-HIV activities owing to the limited delivery of service packages and intervention sites.

Sources in the Sindh Aids Control Programme said that besides a certain curtailment in the activities carried out by NGOs through the funding of international donor agencies and shortage of relevant equipment, the SACP was also facing an acute shortage of kits used for screening to ascertain HIV status in individuals in the high-risk groups.

It is estimated that there are 90,000 cases of HIV/Aids in the country, out of which Sindh has about 50 per cent, prevailing among the injectable-drug users, female and male sex workers and transvestites living mainly in Karachi, Hyderabad, Larkana and Sukkur.

According to a surveillance report based on surveys of high-risk groups at four major cities of Sindh — Karachi, Hyderabad, Sukkur and Larkana — there are around 48,000 high-risk persons at 6,235 hotspots.

A senior official at SACP said they had very lately been told by the surveyors that certain changes had been seen in the trends of suspected persons.

In contrast to past data, now a maximum of 30.4 per cent prevalence of HIV has been found in the injectable-drug users in Hyderabad, which was around 29.8 per cent in 2006-07. Similarly the largest prevalence percentage of HIV in the case of male sex workers and hijras has been found in Larkana.

The data called for immediate interventions against the transmission of the immunodeficiency virus, the official said, adding that some new intervention sites had been included in a new PC-1, under which the SACP would function and implement various projects through the NGOs for the next five years (2008-2013).

According to a source, the approval of the PC-1 by the central government as well as the World Bank had been delayed for one reason or another, while a majority of the projects approved and implemented in the past few years had technically ceased to function.

NGOs working as partners in various Aids initiatives, including detoxification for injection drug users, rehabilitation of IDUs, peer counselling for IDUs, handling of patients living with HIV, delivery of services to hijras and sex workers and jail inmates in regard to HIV infection and treatment and management of sexually transmitted infections had proved their significance in the past.

In view of an outbreak of the HIV epidemic among injecting drug users and sex workers in Larkana and Hyderabad, Sindh as well as Pakistan, has already crossed the “low prevalence” stage and entered the “concentrated epidemic” and any further delay on the part of policy- and decision-makers and the funding agencies could prove lethal for the entire population, the source said.

In the given situation, SACP is required to try to control or reverse the spread of HIV among groups facing the highest risk and to keep epidemic from establishing among the bridging groups and general population; to create an environment in the province where the people living with HIV can access medical and social services and enjoy life without facing the stigma or discrimination.

In the meantime, SACP is about to exhaust the HIV-testing kits which are used at its voluntary counselling and testing centres across the province.

The organisation has repeatedly informed the World Bank, the National Aids Control Programme, Unicef and the federal health ministry that it is faced with a shortage of kits for the last many months, but the issue still remained unresolved.

The SACP had also requested the NACP to procure the kits and lend them to SACP, but to no avail as the federal programme, according to SACP officials, maintained that it did not have any surplus HIV kits in stock.

There are 26 surveillance centres and referral laboratory functioning in Sindh and as such their functioning is highly affected by the shortage of kits. In view of the crisis, now the SACP is also seeking permission from the authorities for local purchase of HIV kits through the market on a priority basis for a period till December.

It is largely viewed that in a situation when one in four injecting drug users, one in 25 male sex workers and one in 100 female sex workers have been detected HIV positive in the province, the limited management and technical capacity at all levels and delay in procurement of services might translate further into an increase in the number of HIV infections.

At present CD-4 count of HIV patients in Sindh is done at the Sindh Institute of Urology Transplantation under a memorandum of understanding signed between the NACP and the SIUT, while the SACP has one centre of excellence for some assignments, including the provision of anti-retro viral drugs for the treatment of HIV/Aids positive patients at Karachi.

However, the centre did not have any CD-4 count and viral load count facilities, said the source, adding that there was a need to develop more HIV/Aids centres in the province and equipping them with the CD-4 count and viral load assessment facilities on a priority basis so that new cases of HIV or Aids could be attended to locally for further confirmation and other relevant measures.

The SACP also needs to upgrade its referral laboratories and surveillance centres across the province and to train the technical staff and ensure capacity enhancement of the Aids control programme in the province, said an insider in the programme.

According to official data, there are 4,259 HIV-positive cases, including 3,530 males and 430 females, and 458 full-blown Aids cases, including 390 males and 65 females, in the country. Sindh had 2,114 HIV-positive and 164 Aids cases till June 2008.