October 12, 2006

In 2005, HIV/Aids related illnesses caused the deaths of 3.1 million people worldwide. In 2005, five million new HIV infections occurred globally; approximately 14,000 every day. The first case of Aids in a Pakistani citizen was reported in 1987 in Lahore. During the late `80s and `90s, it became evident that an increasing number of Pakistanis, mostly men, were becoming infected with HIV while living or travelling abroad. Upon their return to Pakistan, some of these men subsequently infected their wives who, in some cases, passed the infection to their children, reports Rabail Qadeer Baig

The deadly HIV/Aids pandemic is one of the most searing problems faced by the human race today. Globally, more than 25 million people have died of Aids since 1981. In Africa 40 million children have become orphans due to this virus.

India has the world’s highest HIV/Aids caseload with 5.7 million infected people. Over the years, the country has reported many instances of families disowning their loved ones, children being thrown out of school, landlords refusing to rent houses to people living with HIV/Aids, infected women having to abort their foetus themselves as doctors would not touch them and widows or divorcees infected by their husbands and shunned by families.

The disease is present in Pakistan and poverty and illiteracy have added to its spreading here. The general public is vulnerable due to other risk factors as well. According to the latest United Nations report, in Pakistan 3,000 died of Aids in the year 2005; while around 85,000 are estimated to have contracted the virus. Ironically, only 3200 know that they are HIV positive. The remaining 80,000 plus are not aware of their illness.

The Human Immunodeficiency Virus (HIV) is a retrovirus that infects cells of the human immune system. It is a virus that steadily weakens the body’s defence (immune) system until it can no longer fight off infections such as pneumonia, diarrhoea, tumours and other illnesses, all of which can be part of the Acquired Immunodeficiency Syndrome (Aids). Unable to fight back, most people die within three years of the diagnosis.

This disease is only spread through direct contact with contaminated blood via dirty needles and open wounds, contaminated blood products and transplanted organs. It transfers from an infected mother to her child during pregnancy, birth process and breast feeding but mostly sexual contact with an infected individual.

Aids is basically the advanced stage of the HIV infection. This generally occurs and is characterised by the appearance of frequent opportunistic infections i.e. viruses that take advantage of a weakened immune system and lead to crippling diseases and eventually death. HIV is the subject of intense scientific research and basic information about HIV and Aids is constantly changing. It has been on the rise for more than a decade and has reached alarming levels in recent years and is thus the most devastating epidemic across the globe.

Scientists identified the Aids virus as early as 1959 and while some reports and studies have documented HIV prior to 1970, available data suggest that the current pandemic started in the mid `70s. By 1980, HIV had spread to at least five continents –– North America, South America, Europe, Africa and Australia.

In the 1980s, the Centres for Disease Control (CDC) in the US, published a report about the occurrence of a rare lung infection, without identifiable causes, in five men. This report is sometimes referred to as the ‘beginning’ of Aids. The acronym Aids ––– Acquired Immune Deficiency Syndrome was defined by the CDC. In 1982, the United States Health and Human Services Secretary Margaret Heckler announced that Dr Robert Gallo of the National Cancer Institute had isolated the virus, HTLV-III, which caused Aids.

In May 1986, the International Committee on the Taxonomy of Viruses ruled that both names should be dropped and the dispute was solved by a new name, HIV i.e. the Human Immunodeficiency Virus. By the end of the year 1986, 85 countries had reported 38,401 cases of Aids to the World Health Organisation.

The South African Ministry of Health announced in 1995 that some 850,000 people, 2.1 per cent of the 40 million population were believed to be HIV positive, but in some groups such as pregnant women the figure had reached eight per cent and was rising. By 1998, Africa was home to 70 per cent of people who became infected with it.

According to the annual World Health Report, Aids became the fourth biggest killer globally only 20 years after its inception. South Africa’s latest survey in 2005 showed that the total number of people living with the virus had risen to an estimated 6.29 million –– far more than any other country. WHO has estimated that there were more HIV infections and Aids deaths in 2005 than in any previous year

Particular groups of people, known as vulnerable groups, are more at risk of being infected. These include Female Sex Workers (FSWs), Male Sex Workers (MSWs), Injecting Drug Users (IDUs), youths, prison inmates, coal miners, etc. Denial about risks and vulnerability and social stigma attached to HIV/Aids further aggravates the problem.

“Access to quality sexual and reproductive health services including HIV prevention, treatment and care, is one of the fundamental rights of all human beings,” says Raja Khalid Mehmood, President, Pakistan National Aids Consortium (PNAC). “Getting these services is believed to be closely associated with overwhelming poverty and other developmental challenges.” PNAC, through its different initiatives –– projects, trainings, and publications –– has been striving for the right of the people to quality sexual and reproductive health services.

According to a UNAID Aids epidemic update, one new HIV infection occurs every six seconds, every minute of every day. In 2005, there were 4.9 million people newly infected with HIV; of these infections, 700,000 occurred in children under the age of 15. In the United States, over 40,000 people are infected with HIV every year. It is the number one cause of death for African American women aged 25-34.

In 2005, HIV/Aids related illnesses caused the deaths of 3.1 million people worldwide. In 2005, five million new HIV infections occurred globally; approximately 14,000 every day. Kaiser Family Foundation’s fact sheet: Women and HIV/Aids says that women represent half of all the people living with it. African American women accounted for 67 per cent of estimated Aids cases in 2004. Since the mid `80s, the proportion of Aids cases among women has more than tripled, from seven per cent in 1985 to 27 per cent in 2004.

About two-thirds of all the people estimated to be living with HIV reside in Africa. Western Europe and North America remain the only regions in the world where most people in need of antiretroviral treatment are able to get it. About 80 per cent of new HIV infections in women occur in marriages or long-term relationships with primary partners.

The first case of Aids in a Pakistani citizen was reported in 1987 in Lahore. During the late `80s and `90s, it became evident that an increasing number of Pakistanis, mostly men, were becoming infected with HIV while living or travelling abroad. Upon their return to Pakistan, some of these men subsequently infected their wives who, in some cases, passed the infection to their children. In 1993, the first recognised transmission of HIV infection through breastfeeding in Pakistan was reported in the city of Rawalpindi.

In 1988, shortly after the diagnosis of the first HIV/Aids case in the country, the Ministry of Health established the National Aids Control Programme (NACP), based in Pakistan’s National Institute of Health. Despite budgetary limitations, the NACP has played an important role in the creation of awareness about HIV/Aids in Pakistan through an extensive general public awareness campaign.

Local and international NGOs have made important contributions to the nation’s response to HIV/Aids, and have been instrumental in reaching populations that are difficult to access. As very few of these NGOs receive significant donor funding, they generally rely upon self-financing mechanisms or contributions from the communities they serve; thus, their activities are relatively limited in scope.

In recent years, donor funds for HIV/Aids in Pakistan have been extremely limited. Nevertheless, several UN system agencies and some bilateral donors have responded to the need for greater donor involvement in the fight against HIV/Aids, either through the provision of direct support to the government agencies or NGOs for HIV/Aids initiatives or through the Social Action Programme.

In Pakistan there is still limited epidemiological data on HIV/Aids and almost no resources or facilities to measure HIV prevalence among vulnerable groups overtime, apart from a few pilot studies of some high-risk groups.

Recent reports from the Sindh Aids Control Programme (SACP) show a rapid increase in HIV prevalence among people injecting drugs in Karachi. The national STIs (sexually transmitted infections) and RTIs (reproductive tract infections) survey of high-risk groups in March-August 2004 indicates an even higher level of HIV seropositivity (the presence of antibody to HIV as detected by appropriate laboratory tests), estimated at 23 per cent from a sample of 400 people injecting drugs in Karachi.

Similar trends are emerging among the MSWs and transvestites in Karachi, although this is still considered to be a localised spread, but a signal for action to be taken. This high-risk behaviour is further authenticated by data from a survey in 2005 showing a high incidence of needle sharing among IDUs, with 82 per cent reporting to have used a shared needle at some time in the previous week in Lahore, and 35 per cent reporting to have shared a needle for all injections in the previous week.

Moreover, 30 per cent of IDUs have reportedly bought sex from women in the previous month, 90 per cent of whom did not use a condom. At the time of the survey in 2005, 42.5 per cent of IDUs in Lahore and 26.2 per cent in Karachi were legally married. Additionally, one-third of the respondents had bought sex within the previous month and one-third had had sex with a regular partner.

This is a cause for concern because of the potential for HIV to spread to the general population. The same study by FHI, conducted for the NACP and funded by DFID, on STIs in Karachi and Lahore revealed close social networking among the high-risk groups, which could easily transmit HIV infection through the bridging groups into the general population.

Hence in Pakistan heterosexual transmission of HIV/Aids accounts for majority (37 per cent) of the reported cases, next frequent mode of transmission (18 per cent) being related to contaminated blood or blood products, followed by injecting drug use (four per cent), homosexual or bisexual sex (six per cent) and mother to child transmission (1.3 per cent).

Transmission modes for 35 per cent of the reported HIV cases are unknown. The fact is devastating that only two per cent of HIV-infected people in Pakistan are receiving antiretroviral drugs. “Drug use is the core of the problem in Pakistan”, said UNAID. “The country will need to improve its prevention efforts if it is to avoid serious HIV outbreaks.”

Many places provide testing for HIV infection. Common testing locations include local health departments, offices of private doctors, hospitals, and sites specifically set up to provide HIV testing. It is important to seek testing at a place that also provides counselling about HIV and Aids.

A quick test for detecting antibody to HIV is a screening test that produces very quick results, usually in five to 30 minutes. In comparison, results from the commonly used HIV antibody screening test, the Enzyme Immunoassay (EIA), are not available for one to two weeks. The availability of rapid HIV tests may differ from one place to another. The rapid HIV test is considered to be just as accurate as the EIA.

The most common methods of prevention suggested by experts from the pandemic are medication through a device, or by blocking the process of reproduction. Types of contraception include: the cervical cap, condoms (male and female), contraceptive diaphragms, implants, injection, Intrauterine Systems (IUS), Intrauterine Devices (IUD), natural family planning methods, oral contraceptives, spermicides (chemicals used to immobilise and kill sperms) and sterilisation.

At present, scientists all over the world are developing and testing topical ‘microbicides’ that women could apply to protect themselves against HIV and other sexually transmitted organisms. Microbicides are compounds that can be applied inside the vagina or rectum to protect against STIs including HIV. They can be formulated as gels, creams, films, or suppositories. Microbicides may or may not have spermicidal activity (contraceptive effect).

At present, an effective microbicide is not available. It has also been discovered that the risk of HIV transmission from mother to newborn is less than two per cent if women receive a combination of antiretroviral therapies during pregnancy. Antiretroviral drugs are medications for the treatment of infection by the retrovirus HIV. Different antiretroviral drugs act at various stages of the HIV life cycle.

Recently, the government of Pakistan with the technical assistance from donors has carried out a mid-term review of the national response of HIV/Aids in Pakistan. The mid-term review draft has recommended enhancing the pace of implementation and greater role for NGOs in fighting the epidemic. This mid-term review will be followed by divisions in the national strategic framework. This will also facilitate preparation for the next five-year plan for funding from the international community.

However, new and greatly increased efforts are needed to prevent HIV. To meet the challenge of keeping the next generation HIV free it is necessary to invest more resources to protect young people of both sexes. Women have higher vulnerability; therefore gender sensitive approaches are very vital when designing prevention programmes. There is a dire need for further action, more collaboration, leadership, community involvement, UN assistance and the government support to improve the quality of life for people living with HIV/Aids.

“We can’t possibly keep living in a fool’s paradise. Our main objective should be targeting these vulnerable groups, strategically,” says Abid Atiq, Technical Advisor, Interact Worldwide and an expert on HIV/Aids. He points out, “Either people are too open about the whole situation or very conservative. Family planning collapsed because we blurted it out.”

The fact remains that Aids destroys families, decimates communities particularly in the poorest regions of the world. Moreover, it threatens to destabilise the social, cultural, and economic fabric of the entire nation.

One thing is clear, we cannot fight Aids by sidestepping the issue. Talk openly, to friends, family, peers and children about the virus, high-risk behaviours, preventions and precautions and fight the fight against HIV/Aids.
 

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