HIV outbreaks in Pakistan indicate lapse in regulation of health system: Lancet

Published June 29, 2019
Lancet Infectious Diseases says discovery of new cases points out worrying but potentially addressable knowledge gap. — AFP/File
Lancet Infectious Diseases says discovery of new cases points out worrying but potentially addressable knowledge gap. — AFP/File

KARACHI: The recent HIV outbreaks in Pakistan indicate a worrying but potentially addressable knowledge gap in infection control processes and mechanisms of HIV transmission and a severe lapse in regulation of country’s health system, which allows people without appropriate training and certification to call themselves doctors.

This is stated in a recent editorial in the Lancet Infectious Diseases — a leading international medical journal.

It refers to the letters it has received from Pakistan about the recent HIV outbreaks in Sindh and Punjab that appear to have stemmed from unsanitary and unregulated medical practice usually in rural towns.

In March, 2019, an outbreak of HIV was reported in a single village in Sargodha district, Punjab, where the prevalence of HIV infection increased from 1 per cent to around 13pc in six months.

Interviews with many patients revealed that many of them had been treated by the same unlicensed practitioner before testing positive for the virus.

Lancet Infectious Diseases says discovery of new cases points out worrying but potentially addressable knowledge gap in infection control processes and mechanisms of HIV transmission

It also talks about the HIV outbreak in Larkana and says that so far around 700 cases have been identified, affecting more than 600 children, most of whom are younger than five years.

“The reports of HIV epidemics in Pakistan linked to health providers (legitimate or not) have highlighted a potentially unappreciated source of the burden of blood borne infections in the country, which has previously been attributed to transmission among the country’s considerable population of injecting drug users and sex workers.

“These reports are concerning for several reasons. First, they could indicate a worrying but potentially addressable knowledge gap in infection control processes and mechanisms of HIV transmission among health workers in Pakistan,” says the editorial.

Making a deeper analysis of the situation in the country, it suggests there could be a severe lapse in regulation of country’s health system, which allows people without appropriate training and certification to call themselves doctors.

“Thirdly, they could lead to fear and mistrust of the health system, further exacerbating the country’s health woes and putting health targets out of reach,” it says.

It also notes the consistent poor performance of Pakistan in the health sector and cites a 2018 Unicef report which ranked it as the riskiest place to be born in the world.

“Numerous health indicators particularly those related to maternal and child health are worse in Pakistan than elsewhere in the South Asian region.

“Preventable communicable diseases remain a primary cause of morbidity and mortality in the country, a situation that can be attributed to many complex societal, political and structural factors that lead to inadequate sanitation, unsafe drinking water, overcrowding, low socio economic status and poor vaccination coverage.”

Citing Pakistan’s 2017-18 Demographic and Health Survey, it says that as little as 32pc of women and 67pc of men in Pakistan have ever heard of HIV/AIDS with comprehensive knowledge of the disease limited to 4pc and 10pc, respectively.

These findings are despite the Pakistani government launching the NACP, an HIV/AIDS prevention and awareness programme in 1986-87.

On the response to the HIV outbreak in Larkana, the editorial says it ‘was fairly swift involving various international agencies and provincial and federal governments.

“A new antiretroviral treatment clinic for children has been established in Larkana, although how long these treatments will be unavailable in unclear, with access to ART generally limited in the country.

“The UN in Pakistan is supporting the federal government to develop short-term and long term plans for identifying and mitigating the continuum of care for HIV, promoting health education and reducing stigma. However, it should not have taken this tragedy to spur action. The health authorities in Pakistan must at least now use it as a catalyst for change,” it concludes.

Published in Dawn, June 29th, 2019

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