‘Pakistan is a low-prevalence country, but we cannot be complacent about that. The official number of Aids cases in the country is 235,’ says Federal Health Minister Nasir Khan
FEDERAL Health Minister, Mohammad Nasir Khan will launch the Enhanced National HIV-AIDS Control Programme to be implemented all over the country with the assistance of the World Bank, signifying the government’s commitment towards keeping the country free from the epidemic. This further reiterates the commitment for achieving the targets set during the UN General Assembly Special on HIV/Aids and the Millennium Summit.
The major thrust of the project is to check the spread of disease to the general adult population by educating the masses and raising awareness, advocacy with opinion leaders, increasing the access of services by vulnerable groups, provision of quality STI services, ensuring blood safety and infection control and provision of treatment and care to people living with HIV/Aids. This will be achieved by providing specialized services through existing five major hospitals of the country, one each at federal/provincial level. These centres will be strengthened through training of doctors in prevention and care of HIV/Aids, free medicines for opportunistic infections and provision of Anti Retroviral Therapy (ARV).
But it is important to remember that to date there is no cure for HIV/Aids. The only way to check the spread is through health education and implementation of measures that control its spread. Medicines can only prolong and improve quality of life, and mitigate pain. Being informed and informing others is the essence of prevention of this disease, says our Heath Minister.
Federal Health Minister Mohammad Nasir Khan talked to Dawn on major areas of focus the new expanded response to combat HIV/Aids in the country:
Q: Reports say HIV cases in Pakistan are as high as 80,000 and that most Aids cases remain unreported. In a neighbouring country about 3000 people have died of Aids. What is the situation in Pakistan?
A: Luckily we in Pakistan still have a window of opportunity as we are a low prevalence country i.e. less than one per cent. However, we cannot be complacent about that, because if unchecked the disease can spread to general population very quickly and reach epidemic proportions. The numbers of cases of Aids reported to the Ministry are 235 to date.
There is no question that the actual situation may be otherwise, a number of Aids and HIV cases are not reported due to religious, social stigma and other taboos. We have a population of about 143 million people, and many of us get exposed to temptations of modern age and many risk factors are prevalent that can cause a sudden increase in the number of people infected e.g. increasing injecting drug use. There has been also tremendous enhancement in socio-economic status of certain class of people. Today it takes 14 hours to reach New York, and much less to get to Bangkok. Many people go there, including the young generation, and even many senior persons. A number of persons who travel abroad remain in the danger of getting exposed to HIV-Aids disease mainly due to lack of information.
We have to take immediate preventive steps and adopt advocacy about the real threat of Aids, and insist on preventive measures for the sake of silent victims of Aids, primarily our womenfolk. A number of men who get infected can spread the infection to their wives. Later, their children are also at risk to becoming infected with HIV and developing Aids.
This menace needs to be attacked at multi-ministerial level efforts to bring awareness of this disease to the younger generation, especially women folk, as well as at the level of universities and colleges. I am not suggesting a pornographic attitude. But one has to inform our children also about the Aids menace.
To date no cure for Aids has been found. Medicines can only prolong the period of life span. So, it is very important to focus on the preventive side.
Q: People say that Aids, hepatitis, malaria and TB are interrelated? Has the Government devised plans to arrest the spread of these diseases with particular reference to measures taken about arresting the spread of Aids in Pakistan?
A: This is a wrong assumption. Hepatitis, Malaria, TB and HIV-Aids are not directly connected, the only connection being that all are diseases of poverty. However, hepatitis B and C and Aids share same modes of transmission and prevention i.e. through sexual contact, blood, re-use of syringes and from an infected mother to her baby. There is an Ordinance in force in Pakistan making it obligatory that all blood has to be screened for HIV, hepatitis B and C.
We also know of a direct link existing between Aids and TB, as having TB lowers a person’s immunity making them more vulnerable to acquiring the HIV infection. This linkage has also be proven through scientific research.
I attended the SAARC Ministerial Health Conference at Katmandu and there we learnt that especially in the developing countries almost 40-50 per cent of AIDS patients also had TB. The focus, therefore, has to be on preventive measures.
Q: At one point, you were speaking of introducing awareness campaigns, and seeking services of different sections of society and inducting prayer leaders in this campaign. How much progress has been made?
A: We have been touch with political leaders and different political parties of all provinces. They have all joined together in making Pakistan polio free. Maulana Fazlur Rahman, and Qazi Hussain Ahmad are in the campaign for a polio free Pakistan. Other religious scholars, including Imams in the mosques are getting the message. In my last meeting in the NWFP with Health Minister, Mr Inayatullah, we had a very successful meeting with religious leaders, and most of them are now on board for polio, Aids, hepatitis and other communicable diseases.
Q: How is Pakistan coordinating with international agencies such as Who and UN in controlling Aids?
A: We have strong cooperation with all international agencies especially for infectious diseases e.g. with GAVI (General Alliance for Vaccination and Immunization) hepatitis B vaccination have been launched. Also we are one of the few countries in the world to have received global fund grant for HIV-Aids, TB dots and Malaria programmes.
Q: What is the money outlay for the coordination? Are you getting any foreign assistance? If so, what is Pakistan’s contribution?
A: Under the global fund initiative, we will get $20.6 million over the next four years, subject to good performance and meeting our targets every year.
Q: Are hospitals fully equipped in combating the disease? What arrangements have been made in rural areas and small towns?
A: All tertiary hospitals are equipped with diagnostic facilities. However, a lot still remains to be done to combat this disease. One must understand there is no cure for HIV/Aids disease. It is pointless to talk of cure. Medicines can only serve to prolong life and/or mitigate pain. There is no vaccine in the world either as prophylactics (for treatment of Aids disease).
In Africa 25 million people have died as a consequence of Aids, and 42 million people are now suffering (from this disease). Antiretroviral drugs are available but are costly and unaffordable. Even a rich country like the United States cannot afford to provide this medicine for free because it would be beyond the capacity of US budget to pay. Prevention through awareness raising aimed at behaviour change are must for preventing this disease and keep it from spreading.
Q: There were also reports that the government spends nothing on providing medicines for patients suffering from Aids. Is it true?
A: I admit it was not being done in the past, but under the new project the issue is being addressed. This was launched on 20th October, 2003 by Finance Minister, Mr Shaukat Aziz and will be implemented with the support of other Ministries e.g. Education, Labour and Manpower etc.. The project has been designed with a focus to providing quality services including relief to Aids patients. They will be provided services including free ARV drugs through five centres to be established at major tertiary-care hospitals under fully trained doctors and nurses supervision.
The medical perspective
THE basis of stigma and discrimination against people living with HIV/Aids is fear, which emancipates from misinformation about how one can get infected with HIV. Unclear and distorted information leads to prejudice and presumed lack of morality about those who are infected, as HIV is connected to the taboo subject of sex. HIV positive people and their families are ostracized socially, treated with disrespect, turned away from jobs, schools and hospitals. Fear of rejection isolates those vulnerable to HIV/Aids and makes it difficult to access help, information and early treatment. In this way the negative impact of epidemic is compounded.
A news item that appeared in Dawn Islamabad, on Sept 21 confirms the lack of information of doctors and para-medial staff, let alone the public in general. The three column headline of the news report read: HIV positive woman gives birth — Hospital room closed for fumigation.
The correspondent from Peshawar reports that, “the authorities at the Khyber Teaching Hospital have closed the isolation room adjacent to the labour ward for fumigation after a 17-year-old HIV positive mother, from Miranshah, North Waziristan gave birth to a baby...” The room the report adds, “has been closed for fumigation to protect other patients from being infected with the Aids virus.”
According to the doctor, “towels, gloves and bedsheets used by the woman were burnt where as instruments had been discarded soon after the delivery.”
Do we need to put HIV positive patients in isolated units? “Isolation is not required if hospital has standard infection prevention procedures practised and there is safe disposal of all waste especially blood and body fluids,” says Dr Nabila Zaka, Project Officer Women’s Health, Unicef.
Considering the inadequate infection prevention protocols at hospitals, Dr Nabila says, doctors usually keep hepatitis and HIV patients in special units so that the staff is careful and special treatment is given to linen and body fluids. “Burning linen and gloves is not necessary, dipping in 0.5 per cent chlorine solution for 10 minutes is enough for decontamination. HIV/Aids is not air or vector borne, so fumigation has no affect and is completely unnecessary,” she clarifies.
Why are doctors reluctant to treat HIV positive patients? “This happens in all countries as medical staff itself does not have adequate knowledge and confidence in handling these patients,” she adds. Once they are taught about standard protocols for self-prevention as well as proper infection prevention procedures, they will be more confident. She says adequate decontamination of reusable equipment, linen and gloves should be practised, while incineration is recommended for used sharps and syringe.
WHAT IS HIV/AIDS: Aids stands for acquired immunodeficiency syndrome, which is caused by a virus called HIV (Human Immunodeficiency Virus). This virus attacks the body’s immune system and slowly destroys it. This makes the body defenceless against infections by other germs and the human body becomes susceptible to ‘opportunistic infection’ such as TB, pneumonia and also cancer. With the passage of time, varying from person to person, the virus becomes active and ultimately leads progressively thus Aids occurs. Aids stricken people do not die because of this disease but the cause of death are the repeated effects of ‘opportunistic infections’.
Mosquito bites also do not transmit HIV infection.
However, if the HIV test is positive, Dr Nabila feels, extra vigilance is required to keep healthy. Many people who test positive stay healthy for several years. There are some treatments that can slow down the progression from HIV to Aids, known as the antiretroviral therapy.
“This therapy could reduce the suffering, but are very expensive and not the cure. Therefore prevention remains the only means of avoiding the disease,” she insists. Huma Khawar
