Raju, a 25-year-old boy from Quetta, migrated to Karachi to look for sustainable livelihood and better income prospects. Just like several other ‘immigrants’, he picks garbage from various parts of Karachi. His life, however, took a devastating turn when he realised that the income prospects in Karachi are as bleak as in Quetta. Raju, who thought it wise to seek refuge in drugs, started injecting himself with heroin to drown his sorrows.
Raju’s unidentified partner in crime was in another zone whilst injecting himself with a good dose of heroin.
“We know it is wrong but we do not want to quit. We use clean syringes and do not exchange them because we know it can cause Aids,” said Raju, rather incoherently, during one of his lucid moments.
With a majority of its population living under the lower-income strata, Pakistan finds itself among the countries with an increasing number of HIV patients. Approximately 70 per cent of the total population resides in the rural areas, since agriculture remains the main source of income for many. Migratory practises and poverty have given rise to a number of diseases including Hepatitis and HIV/Aids.
Over the last few years, HIV Aids cases have drastically increased in Pakistan, primarily amongst the injecting drug users (IDUs). Sindh and Punjab are the most affected regions because of their respective over-populated structure.
Concentrated epidemic According to Dr Asma Nasim of the Sindh Institute of Urology and Transplant (SIUT) – an expert in the area of infectious diseases – Aids has become a ‘concentrated epidemic’ in Pakistan, with more than five per cent of the most-at-risk population (MARP) being infected. MARP includes all the commercial sex workers, including transvestites, IDUs and people who indulge in sexual activities with commercial sex workers. The spouses of MARPs are also under a massive threat of getting infected.
“Unofficial figures released by various authorities show that HIV/Aids has affected 27 per cent of the IDUS in Pakistan, as opposed to 16 per cent in the last year, which is alarmingly high. Considering the ratio of increase, it will be wise to say that the general population of Pakistan is also at risk of getting infected” Asma told Dawn.com.
Lack of awareness, remains one of the most critical issues which, has played a pivotal role in spreading HIV/Aids.
“Most of the drug addicts are not unaware that the syringe being exchanged and used by 10 junkies, can cause HIV/Aids. The rest are not exactly bothered about the repercussions,” she added.
Aids control campaigns Various not-for-profit and governmental organisations are trying to create awareness and curtail the spread of the disease. UNAids, Sindh Aids Control Programme and National Aids Control Programme are a few names that top the list.
The doctors at SIUT pick IDUs and bring them to the hospital where they are tested for HIV/Aids.
“A CB4 cell-count test is conducted on each one of them and if the cut-off is less than 350, the IDUs are provided with a combination of zidovudine, lamivudine and nevaripine, amongst other drugs,” Asma said, adding that “HIV/Aids patients are required to take these medicines for life”
Success of the campaign relies on the detoxification of the addict and his/her conviction to stay away from unsafe practises which might transmit the disease.
Rehabilitation and awareness are key to recovery, according to Dr Muhammad Zakria Kandhro - President of Al-Nijat Welfare society - an organisation dedicated to creating awareness about the disease. “It is very important to detoxify the IDUs and get them used to the concept of taking medicines. They are provided with mock drugs and rehabilitated for three to six months.”
Keeping the IDUs off the drugs can be very tricky, according to Kathleen Alexander, who is the Project Manager at the House of Hope. This, she said, is due to a low success rate, which can even come down to five per cent. Most of the IDUs relapse due to social alienation, poverty and domestic issues.
The stigma Female carriers have the capacity to spread the infection at a rapid rate as the ratio of female sex workers is higher than male and transvestite sex workers in Pakistan. Female patients have a low registration rate as they are more stigmatised, due to their gender and societal norms.
Female IDUs also live in the oblivion because the society is willing to accept a male addict but females are forbidden to reveal their fondness for ‘acquired tastes.’
“The ratio of registered male population is higher than the female population. We have launched various awareness campaigns, which have helped bring the figures down and our Hyderabad centre is housing 250 female patients. Karachi also has a database of 50-55 female patients,” Kandhro said.
Moreover, HIV-positive patients are also stigmatised for the ‘epidemic’ that they carry and are not admitted in the renowned state-owned hospitals.
An IDU perspective Ilahi Bux, a rehabilitated drug addict, is a 25-year-old boy who fell into the vicious trap of heroin. According to him poverty, domestic problems and many other economic factors enticed him to become an addict. However, he blatantly claims that back then we were not aware of the hazards of exchanging the same syringe.
Nadeem John, another rehabilitated addict, said, “I stopped taking heroin a year ago however was an addict for over 15 years. I have committed crimes and done every possible thing to satisfy my ‘cravings’. We did not really care about HIV/Aids back then but now we do because government and organisations are putting in a lot of effort to highlight the issue.”
Bleak future Global recessionary pressures and Pakistan’s stance on fight on terrorism, coupled with various other factors, have impacted the amount of donations that the international agencies previously granted Pakistan.
“Previously we were able to accommodate more IDUs, launch massive awareness drives and reach out to the general population because we had abundant funds. However, now we can only manage to induct 15 IDUs and HIV/Aids patients because the funding is almost nonexistent” said Alexander.
Alexander is very pessimistic about the future of rehabilitated IDUs in Pakistan as many of the projects are closing down in the country.