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A looming scourge

July 28, 2013

Back in 1986, two young doctors at the Jinnah Postgraduate Medical Centre, Karachi were intrigued: two of their patients failed to respond to all treatment. Nothing worked. The only visible symptom was increasing debility; arousing concern that other infections might set in.

After much frustrating investigation, their suspicions increased — what if it was HIV (Human immune deficiency virus)? This virus had already caused infection in Africa, America and other countries. They sent blood samples abroad for analysis. Yes, it was HIV. Those two patients were given all possible treatment, informed about the necessary precautionary measures, including regular check-ups, and given guidance about how to safeguard their own and their wives’ health. The two patients were followed up for a long time, but eventually they disappeared. One man’s wife gave birth to a child infected with HIV, who eventually died. Random HIV cases started emerging from various parts of Pakistan.

By 1987, doctors were gaining new awareness about the spread of HIV. The World Health Organisation (WHO) instituted medical surveillance to measure the extent of its prevalence in Pakistan. The public linked the infection to homosexuality and illicit sex; stigmatisation of patients followed. From those early days, the number of HIV/Aids patients has grown to an estimated 130,000 adults aged 15 and above; including 28,000 women. Already, 48,000 people have lost their lives to HIV/AIDS and 21,000 children have been orphaned.

Few other diseases impact society the way HIV/AIDS does — it affects the entire family, gives rise to enormous stigmatisation, disagreements and even separation of husbands and wives; it also causes severe illness from opportunistic infections and death; it changes a society’s whole approach to morality and sexuality. HIV engenders a huge range of emotions; trying to maintain physical and emotional health in such circumstances is indescribably difficult.

The virus takes a long time to make its presence felt in the body — in some cases as much as 12 years: that is when AIDS (acute immune deficiency syndrome) becomes visible, with its main symptom of progressive debility. Currently, Pakistan is fortunate that HIV infection is not yet an epidemic; however, it risks becoming one.

The virus has an easy mode of spread, through sexual contact, where sensitive mucous membranes are at immediate risk, or via infected blood, as may happen during blood transfusions, via injuries, through the use of unsterile instruments such as dentist’s tools or hypodermic syringes. Unfortunately, there is extremely limited information available in the media regarding preventive steps for its control. While doctors, surgeons and dentists take care to curtail the mode of spread, it’s not the same for ordinary folks.

Due to rigid and strait-laced behavioural patterns, condoms, which would prevent the spread of HIV, can’t even be advertised; many blood banks do not carry screened blood, which has been tested and has no risk of infecting others. This happens even though most people now readily and voluntarily give blood donations, nevertheless, professional blood donors, largely drug addicts, who sell their blood are also used.

Another source of infection is via sex workers: female sex workers and hijras (transvestites and homosexuals) adds another 4pc to the population. Truckers frequently utilise the services of such sex workers, spreading infection from urban to rural locales, where outreach of healthcare is already minimal.

There is a constant risk of spread of infection from drug users to their wives and children: they become the tragic unwitting victims who face life-long stigma, lonely poverty and increasingly poor health.

Pakistan’s National AIDS Control Programme (NACP) conducts surveillance, research and control for HIV/AIDS. Its mandate includes provision of information to the public about the infection and its prevention; however, the easy proliferation of illicit drugs counteracts these measures. Many addicts, who use injectable drugs themselves become infected, and spread the infection. They tend to collect at central points, where “concentrated epidemics” arise. Safe injection practices are uncommon. Already, infection rates among drug users have jumped from 10.8pc in 2005 to 37.8pc in 2011. Both overall prevalence and the number of sites have increased, pointing to relatively advanced proliferation.

So far, Pakistan has been luckier than other countries, in that HIV infection is somewhat limited, due to universal circumcision, taboos on sex that have led to a higher proportion of extramarital sex with female or male sex workers and the fact that about 45pc of all sex acts sold are by male or transgender sex workers (HIV Surveillance Project, 2007; UNAIDS).

Reportedly, the NACP is in the doldrums. The Global Fund donors have threatened to withdraw funding if bureaucratic hurdles and mismanagement are not rectified. At the moment, says the report, there is no full-time head of NACP. The devolution process has added further complexity, in that the future of the programme is uncertain, as to whether it is to be a provincial or federal subject. Combined with the alleged corruption, continuation of the NACP is at risk.

If donor funding is withdrawn, the health of Pakistanis will be jeopardised; as it is, the high incidence of immunisable diseases like polio has already given the country a bad image.

Yet, although HIV infection is not curable, its worst impact can be allayed for many years with antiretroviral (ARV) drugs. But if there are no funds for these drugs, the future will be dim.

The ARV therapy can ensure a better quality of life for the patient; it’s been available for several years, but being expensive, its provision has been in limited quantity. Other countries, such as South Africa and India, who regard this as state responsibility, have worked to provide cheaper ARV drugs; in fact, one of India’s labs is manufacturing them for wider distribution. Pakistan, too, needs to evolve similar strategies to fight HIV.

In the larger perspective, ours is a society that is being destroyed by its own taboos, its rigid cultural norms, especially for women and girls, and the overwhelming stigmatisation of HIV-infected persons.

The NACP needs, in its onward programme, to counteract these incomprehensible attitudes too — provided the programme works efficiently without mismanagement and corruption.