Cases of human immunodeficiency virus (HIV) are increasing in some of the most marginalised communities in Pakistan, according to the National Aids Control Programme (NACP).

An estimated 133,299 people have HIV in Pakistan, which is 10,000 people more than last year and an increase of almost 100pc from 2007 when an estimated 70,000 people had the disease.

The virus is most common in transgender and male sex workers as well as those who inject drugs. A lot of the cases are also of female sex workers, those who receive contaminated blood as well as patients who come here from abroad.

“Some of the main reasons for the increase in HIV cases in Pakistan are lack of political will, bureaucratic hurdles, inability to understand the issue, the absence of technical facilities and the lack of trust in the health care system,” said NACP manager Dr Baseer Achakzai.

Talking to Dawn, Dr Achakzai said the Global Fund has been contributing 80pc of the funds for the HIV programme since the year 2000, which leave only 20pc for the federal and provincial governments to give.

“Global Fund provides funding for medicine, testing kits, financial support for patients and some of the staff is also paid from their funds. The federal and provincial governments are responsible for paying salaries and utility bills etc,” he said. He explained that Global Fund provides assistance in both government and private sector.

“It has allocated a budget of $9.023 million for the government sector for the period between July 2015 and Dec 2017. Of these funds, $1.3 million was spent in Punjab, $0.84 million in Sindh, $0.43 million in KP and $0.36 million on Balochistan. The Association of People Living with HIV was also given $0.2 million,” he said.

Dr Achakzai said Global Fund has allocated $35.5 million for the next three years, i.e. 2018 to 2020 which will be spent in the public and private sector.

“The private sector only works with people who inject drugs, but NACP works with all segments. It will be unfortunate if Global Fund allocates half the fund for the private sector,” Dr Achakzai said.

Asked about frequent claims made by federal and provincial health departments that they do not get funding, the doctor said the programme has never faced problems regarding the availability of medicines, financial assistance, test kits etc, which he said were provided by Global Fund. However, the programme hardly gets funds from the government, he said.

“It is embarrassing but it is a fact that the salaries of NACP staff were delayed for 11 months during the last fiscal year and salaries have not yet been released for this financial year either. There is political will for eradicating polio, but not so much for eliminating HIV,” he said.

Though HIV is a bigger problem than polio, if Global Fund were to stop funding, the programme will run out of tablets for patients within a week, he added.

Another NACP representative Dr Quaid Saeed said there were only 19,000 registered patients in the country who receive proper treatment and others do not want to join the program due to the stigma attached to their disease. He said the virus keeps spreading via unregistered patients.

“HIV cases are increasing in Pakistan and we have the second most patients among South Asian Association for Regional Cooperation countries after India. We are not doing anything to stop and reduce the spread of the virus, we are only providing treatment,” he said.

OST for drug users

According to Dr Achakzai, most people who inject drugs contract HIV and that an effort was therefore launched for introducing Opioid Substitution Therapy (OST) for them. OST are oral tablets which are given to those who inject drugs so that risks of the disease spreading via injections are minimised.

“We held meetings will all stakeholders in which prominent professors took responsibility for maintaining a record for the tablets and giving them to people who inject drugs. A firm offered to provide a free of cost software which will be able to track the medicine from the manufacturer to the patient. But we were told this will increase the chances of the tablets being used as drugs and the proposal was refused,” he said.

Dr Achakzai explained that if the proposal had been accepted, the majority of people who inject drugs could have been saved from the virus and that a majority of HIV patients are intravenous drug users.

“For me, the rejection of the proposal was a crime,” he said.

Dr Rizwan Qazi from the Pakistan Institute of Medical Sciences said that during a meeting a few months ago, a detailed presentation was given in support for OST which the Narcotics Control Division refused to implement, maintaining that the tablets could be used as drugs.

Asked why HIV cases were increasing, Dr Qazi said it was not correct that the number of HIV cases was increasing in Pakistan.

“In the past, cases would be diagnosed 10 years after the disease was contracted, after complications would develop. Because of better facilities, patients are diagnosed earlier and doctors also prescribe tests for diagnosing the disease to drug addicts. HIV cases were there in the past as well, now they are detected sooner,” he said.

HIV/AIDS not important for govt

NGO Nai Zindagi’s senior programme manager, Salman Qureshi told Dawn HIV and AIDs is not a priority for the government

“The government should ensure coverage for HIV patients. The stigma attached to the disease is also a huge hurdle. We once had 40,000 registered patients most of whom chose to leave the programme,” he said.

The NGO’s chief executive, Tariq Zafar said the trust was started in 1989 and was initially a 12-bed treatment centre in Lahore. The government asked Nai Zindagi to support the program for treating intravenous drug users in 2011, he said, and that a centre will be established in Karachi soon.

“We then established a 180-bed facility in Islamabad where people from across the country are treated. The Economic Affairs Division monitors our work,” he said.

Mr Zafar explained that his trust receives approximately $5 million each year the details of which are on the NGO website. He said Global Fund has ranked the trust at A2 level, which means near to 100pc. He said some 2,700 patients had received treatment at the centre in Islamabad over the last three years of which 20 had died during treatment.

Published in Dawn, August 13th, 2017