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August 22, 2004
EXCERPTS: Larkana lessons
Dr Syed Abdul Mujeeb draws the readers’ attention to the Aids crisis looming in the interior of Sindh
Sindh’s famous historical, cultural and political city, Larkana, once seemed to be safe from HIV/Aids, as all other major cities of the country were. Like people in other cities, the citizens of Larkana believed that HIV/Aids was not their problem. It was something which happens to “other people”. The first case of HIV/Aids was detected in Larkana in 1992, and till May 2003 a total of 46 cases were reported there. However nobody ever thought that a storm of HIV/Aids pandemic was gathering force and would soon be unleashed to hit the whole province and then the country.
It was May 17, 2003. It was an ordinary day in Larkana. The only unusual event was a request from the jail authorities for an HIV test for one of the ailing jail inmates. This jail inmate was a local villager, who had not visited any other major city of Pakistan, let alone any foreign country. He had only one occupation — drug addiction. This kept him away from all other work. He regularly sold his blood to feed his addiction. The use of injecting drugs was the panacea for all his ailments, so the search for this drug was the only mission left in his life.
The Sindh Aids Control Programme maintains a local screening centre in Larkana and it was asked to perform this test. The staff at the centre also expected this to be a routine test, that would once again produce a negative result as had happened many times before. Previously only those persons had tested positive for HIV/Aids who had travelled abroad and had had contact with someone suffering from the infection. Since this addict had not travelled outside Pakistan, the technician regarded him an unlikely case for HIV. He was proved wrong. He was most surprised when he found a positive result. Not believing what he saw, he consulted his colleague, who also felt that a mistake had been made. Both the technicians decided to repeat the test before reporting the results to their superior. The test was repeated, but the result remained unchanged.
The shocked technicians consulted their pathologist, Dr Ghulam Shabbir Sheikh, who rejected the earlier results and asked for yet another test before him on a fresh blood sample and with a new diagnostic kit. The test was repeated. The dreadful had happened, confirming everybody’s worst fear that HIV/Aids had penetrated the local population. Dr Ghulam Shabbir Sheikh immediately informed the Sindh Aids Control Programme, Karachi, about the positive result and dispatched the blood sample of the patient to Dr Ashraf Memon for further verification and notification of the disease.
While investigation of the first locally reported case of HIV infection was yet to be completed, there was an upsurge of new cases in Larkana. In a span of a single week, a total of 17 new cases of HIV infection among injecting drug users were confirmed in the city. In addition to the Larkana screening centre, the screening centres of Hyderabad, Sukkur and Karachi also started reporting HIV infection among the injecting drug users.
Though the threat of the spread of HIV/Aids in Pakistan was thought to be imminent by most of the public health experts, they were unprepared for the disease when it actually struck. The local civil administration, which was nervous about the emerging situation, became panicky and started throwing all drug users into prison and forcing anti HIV tests on them. Media personnel too were unaware of the sensitivities involved in reporting HIV/Aids pandemic and started sensationalizing the news. To spice up their stories, they would follow HIV infected persons and their families as if they were hard criminals. They started reporting their names, families, and photographs in the newspapers and TV channels. It was as if being sick with HIV infection was an unpardonable crime.
Larkana was considered the paradise for drug addicts because of the easy availability of the drug. The fear of the police, forced testing and media harassment led the injecting drug users and HIV infected persons to flee the city and spread all over the province and the country. All opportunities to educate and counsel them to prevent further spread of the disease in the province and country were lost. It was interesting to note that the local civil administration, which showed its proverbial iron hand against the users of the drug was very kind hearted towards the drug suppliers. No supplier was ever questioned or arrested.
The Provincial Programme Manager, Sindh Aids Control Programme, Dr Sharaf Ali Shah, was shocked by this outbreak of HIV/Aids in a small city of his province and the inability of the existing system to provide care to the patients in a humane and professional way. He reassessed the situation and took a critical look at the programme. Many weaknesses were identified and new strategies for intervention were formulated. With the consultation of other senior health officials, local civil administration, national and international Aids programme managers, new guidelines for actions and interactions were developed.
In tackling the outbreak of HIV/Aids in Larkana, the Nazim Larkana, Mr Khursheed Junejo, had a key role to play. After initial confusion and nervousness, he reassessed the situation and the sensitivites involved in tackling the HIV/Aids crisis. He made all-out efforts to prevent the injecting drug users and HIV infected persons from being thrown into jail. He took special steps to have them admitted, taken care of and counselled humanely at the appropriate health care centres. No such facility was available in Larkana. “Nai Zindagi”, a national level NGO, offered support to the local administration. A local journalist, Mola Bux Kulhoro, also played an effective role in highlighting the gravity of the situation and also reminded the media of their responsibility in upholding the basic human rights of people living with HIV/Aids.
The Larkana outbreak is indicative of the fact that the HIV/Aids pandemic time bomb is also ticking in Pakistan like elsewhere in the world, and a single iota of complacency can bring about a catastrophe here. We need to be vigilant all the time if we really want to avoid the repetition of the Larkana outbreak. This should also make us realize that injecting drug users are also selling their blood and this business is going on without any checks, despite the ban on commercial blood donation since 1997. The potential source is there and a lit match is smouldering near the powder keg. n
Translated by the author.
Excerpted with permission from
Pakistan Mein Aids ki Waba
By Dr Syed Abdul Mujeeb
Scheherzade, B-155, Block 5, Gulshan-i-Iqbal, Karachi
Email: scheherzade@ahmedgraf.com
ISBN 969-8636-42-0
194pp. Rs160
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