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An ounce of prevention

July 28, 2013

Twenty-six years after the first HIV-positive case was identified in Pakistan, an ordinance related to this global epidemic has taken shape, but, sadly, restricted only to Sindh due to the devolution of health matters from the federal to provincial governments.

The formation of Sindh HIV/Aids Control, Treatment and Protection Ordinance, 2013, announced in May this year, is the first HIV/Aids legislation in the region aimed to help protect people living with HIV from discrimination in all spheres of life, including healthcare, employment and education.

The Sindh AIDS Commission, formed as a result of the ordinance, will advise the government on formulation of policy, issues of prevention, control, care, support and treatment.

This is indeed a positive step towards dealing with this infection, but not enough to achieve the Millennium Development Goal Six, which states that Pakistan will “halt and begin to reverse the spread of HIV/Aids by the year 2015”. In addition to many other factors, the fact that each province deals with this serious health issue in its own way means that the AIDS control programmes in each province has different approaches and results.

In Balochistan, the programme is nonexistent due to the resistance of the people and the policymakers to take any initiative to tackle this issue given the taboos attached to it. And the current conditions in the province are of no help in this regard either.

The Enhanced HIV/Aids Control Programme in the rest of the provinces are being designed and carried out keeping in mind the statistics, experiences, emerging needs and the availability of non-governmental support, such as from NGOs and international health and AIDS control agencies.

With high prevalence of this infection among injecting drug users (IDU) — HIV prevalence among IDUs in Karachi, Larkana, and Hyderabad is considered to have increased to 40pc — Sindh Enhanced HIV/Aids Control Programme has taken a targeted approach to focus on this high risk group.

According to Dr Muhammad Ahmad Kazi, provincial programme manager, Sindh Enhanced HIV/Aids Control Programme, they are collaborating with the Sindh Anti-Narcotics Force, that has the data of and access to drug users in the province, to establish a focused programme to test, support and treat HIV-positive IDUs.

Another project in Sindh, with the support of United Nations Office on Drugs and Crime, has led to the screening of high risk female injecting drug users and female inmates in jails, and provision of the required treatment and the voluntary counselling. Furthermore, as a result of a Supreme Court directive, screening of jail inmates, especially women and children in various jails of the province, has been conducted recently. The Enhanced HIV/Aids Control Programme is also focusing, with the support of the Unicef, on the prevention of parent-to-child transmission of HIV infection.

Yet another new initiative in Sindh, still in the early stages, is targeted toward street children, a young key affected population with the support of United Nations Population Fund and Unicef. However, funds for public projects, even as crucial as those related to health, are always short and are released after much delay. Even the most targeted policies and plans are futile exercises in the absence of funds to implement and carry them out.

And this is one of the main reasons that the Enhanced HIV/Aids Control Programme as an alternate strategy is working through partnerships not only at the international level with the Global Fund Geneva, among others, but also with local NGOs to deliver its service delivery packages for successfully containing HIV/Aids in the province.

Surprisingly, the Punjab Aids Control Programme (PACP) has no financial constraints and claims to have full support of the provincial government, both in cash and kind, for the implementation of its projects, as PACP provincial programme manager Dr Salman claims. And, even after the World Bank stopped its funding in 2010, the programme has had enough support by the government to carry out its awareness, treatment and control activities.

The training of lady health workers in Punjab to approach and identify expectant mother carrying the HIV virus has made some headway in detecting HIV cases. Timely intervention and treatment of the identified cases has helped in prevention of the spread of the infection from mother to child.

Khyber Pakhtunkhwa, with different dynamics from those of Sindh and Punjab, has not made as much headway as these two provinces, but at least it has a programme in place — the Provincial HIV/Aids Control Programme Khyber Pakhtunkhwa — which is providing treatment and counselling to identified patients. However, awareness and advocacy initiatives there still leave much to be desired.