KARACHI, Sept 26: With Pakistan entering the 'concentrated epidemic' category, the situation in the country vis-a-vis Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) is getting alarming , according to the chief of Sindh AIDS Control Programme. There might be more than 100,000 cases of HIV/AIDS in the country.
Dr Sharaf Ali Shah told Dawn on Sunday that the prevalence of HIV/AIDS in the injecting drug users (IDUs) was more than the cutoff point of 5 per cent. "The internationally-recognized definition says that if the prevalence of HIV/AIDS in any of the risk groups is more than 5 per cent then the country should be declared as one facing a concentrated epidemic," said Dr Shah.
He said Pakistan was initially described as a low-prevalence, high-risk country. "But this characterization is no longer valid. The country has already qualified for the concentrated epidemic category."
The prevalence of HIV/AIDS among the IDUs in Karachi was 7.6 per cent, he said. "In Karachi, 2,130 IDUs were tested for HIV/AIDS recently, of which 162 were found to be positive."
In Sindh, according to the chief of the provincial AIDS control programme, more than 4,200 IDUs were tested between June 2003 and August 2004. "And the number of people who had HIV or AIDS was 226, which means that the prevalence is 5.3 per cent."
In the NWFP and Punjab, said Dr Shah, the surveillance system for detection of HIV/AIDS cases was in poor shape. "These two provinces have been claiming that there are few HIV/AIDS cases there. But I think it's only due to the failure of the surveillance system, or the non-existence of it, that the numbers are low there."
Asked if the federal health minister was right in claiming recently that there were only 5,000-odd cases of HIV/AIDS in the country, Dr Shah said: "The number of recorded and confirmed HIV/AIDS cases is far less than that figure. It is actually about 2,200."
However, the number of projected cases is far greater, claimed Dr Shah. "He said a computer programme, having the prevalence among risk groups as inputs, had projected that Pakistan had more than 60,000 cases back in 2000.
"If this exercise is conducted today, I think the number of projected HIV/AIDS cases would be somewhere between 100,000 and 150,000 because the prevalence among the risk groups has risen sharply in the intervening period."
When asked to justify his pessimistic stance, Dr Shah said: "Look, in 2000 the risk groups had low prevalence, therefore, many of the inputs to the computer programme were zeros.
"This is no longer true, with many inputs being five times the earlier ones." His pessimism also stemmed from the reality that the number of IDUs was increasing at a tremendous rate, he added.
Dr Shah was of the opinion that IDUs were not cutoff from the other groups in society. "Many of these people have families and many sell sex. This means that these people can easily fuel the prevalence of HIV/AIDS. In addition, they often share needles."
Dr Shah said many Pakistanis who did not indulge in objectionable practices could easily get infected with HIV. "A person can get tainted blood through one of the many blood banks where the products are not screened properly for HIV. Similarly, he can be infected if he unknowingly shares a needle with someone who is HIV positive."
Many hospitals do not ensure that every needle used was a sterilized one, he said. "In the same manner, the barbers and dentists also regularly use implements which are not properly sterilized. So the chances of an 'innocent' man falling prey to the menace is quite high."
Ideally, he said, the blood banks should be dealing mostly in blood donated by volunteers. "But the reality is that only 20 per cent of the blood available there is donated by volunteers.
The rest is either donated by family donors or commercial ones." The blood banks could not become safe from the standpoint of HIV/AIDS until more than 95 per cent of the blood available was donated by volunteers, he said.