Daily Times

As we observe World AIDS Day 2018, we need to be cognizant of certain facts. Currently 37 million people are living with Human Immunodeficiency Virus (HIV) globally, 22 million of them are accessing antiretroviral therapy and roughly half of those are responding to treatment with virus suppression, yet close to a million people die every year from Acquired Immune Deficiency Syndrome (AIDS). Women are considerably more susceptible and at risk for contracting the virus due to biological, social, cultural and economic reasons. Then there is the overwhelming fact that one in every four HIV positive persons are undiagnosed and therefore unaware of their HIV status globally, particularly in countries with low health awareness. Hence the theme for the day this year is “Know your Status”.

HIV/AIDS control has always remained a ‘hot’ subject for the global public health community. It has gained a lot attention owing to the massive proportions of the epidemic threatening not only health but human security as a whole. It is the only disease that has a dedicated UN agency for its prevention and control, and perhaps one of the few diseases for which universities will exclusively offer a master’s degree.

Currently, the worst affected part of the world vis-à-vis HIV/AIDS is the southern tip of Africa notably encompassing South Africa, Botswana, Zimbabwe, Namibia, Mozambique, Zambia and Angola in addition to several other high prevalence countries. South Africa alone has an estimated HIV population of 7 million or over 19 percent of the country’s population with ominous consequences for its life expectancy and several other health, demographic and economic indicators.

Pakistan detected its first HIV/AIDS case in 1987, a Tanzanian sailor identified as HIV positive in a medical unit of Civil Hospital Karachi. Being in the hospital management, I personally couriered his blood sample to NIH, which cross checked and confirmed his HIV positive status in a few days. Subsequently, the Governor of Sindh the late Hon’ble Ashraf W Tabani ordered his deportation to his home country, however, the national airline did not allow him to board the aircraft. Already very sick, he passed away a few days later in the Isolation Ward of Civil Hospital Karachi and was personally buried by the late Maulana Abdul Sattar Edhi.

Of course, HIV/AIDS facilities have become much more user-friendly in the intervening three decades, as compared to those initial days marked by fear, apprehension, ignorance and a general alarm surrounding the disease. There is yet the need to treat HIV/AIDS patients with utmost care and compassion by dispelling all the myths in order to ensure its robust prevention and control.

We must also not be complacent vis-à-vis HIV/AIDS control while considering our religious beliefs, as the HIV prevalence is growing in several Islamic countries due to risky and explicitly forbidden behaviors relating to immoral sexual behaviours and habitually consuming harmful substances

Nevertheless, the federal and provincial programs for HIV/AIDS control started way back in 1994 will standalone as a health intervention initiated in Pakistan’s Health Sector against a perceived threat in the future; normally the action comes in the face of a growing challenge. This single fact is responsible for containing the threat to the present low level of around 0.05-0.07 percent prevalence in the country. Yet we also have to be mindful of the potential hazard associated with the slightest degree of neglect, that could lead to a major epidemic in less than no time and reverse all the gains achieved over the past quarter century. Actually, the country has already been experiencing concentrated epidemics in two high risk groups of injection drug users (IDUs) and male sex workers (MSWs) including transgenders.

Pakistan has one of the lowest literacy rates in the region and despite maintaining a low prevalence, a greater focus on health literacy is required to effectively prevent HIV spread, particularly in view of risky behaviours such as high intravenous drug use. The media, particularly television and newspapers, is a major source of awareness concerning HIV/AIDS, however, despite its efforts alongside several national and international organizations, most people still may not know the difference between HIV and AIDS, its signs and symptoms and/or clinical features, although knowledge concerning the mode of transmission and prevention is somewhat better understood. Furthermore, communities often demonstrate a negative attitude towards patients of HIV/AIDS and even where the attitude is positive, serious myths and misconceptions exist concerning the disease that need to be addressed. This societal stigma, in turn, leads to under-reporting of cases.

While it is estimated that there are 75,000-150,000 HIV positive cases in Pakistan depending on our source of information, the National AIDS Control Program has currently registered 25,220 cases of which the eligible 15,390 cases have been put on anti-retroviral treatment. The program has been working with high-risk groups (including male and female commercial sex workers, injectable drug users, men having sex with men and transgenders), duly educating and counselling them while carrying out voluntary testing with utmost confidentiality and has completed its sixth round of disease surveillance. A significant problem it is facing stems from the sub-optimal health-seeking behaviour of the affected patients, an improvement in which is crucial to accessing prompt treatment that can potentially improve the quality of life. The good news is that several new ways of expanding access to HIV testing, such as self-testing, community-based testing and multi-disease testing can be helpful for people in knowing their HIV status.

According to a 2013 survey on drug use conducted by the United Nation’s Office for Drugs and Crime (UNODC), 4.25 million people in Pakistan are considered dependent on substances requiring structured treatment for their drug use disorder. Survey findings showed that cannabis alone had around 4 million users nationwide, while 860,000 people used heroin regularly, approximately 19,000 people used methamphetamine and nearly 1.6 million people misused prescription opioids or painkillers for non-medical use. These are indeed very high numbers from all perspectives.

We must also not be complacent vis-à-vis HIV/AIDS control while considering our religious beliefs, as the HIV prevalence is growing in several Islamic countries due to risky and explicitly forbidden behaviors relating to immoral sexual behaviours and habitually consuming harmful substances. Furthermore, a traditionally weak system of blood transfusion has been compounding problems in Pakistan.

Tuberculosis (TB) remains the leading cause of death among people living with HIV, accounting for around one in three AIDS-related deaths, therefore, people living with HIV with no TB symptoms need TB preventative therapy. It is also estimated that half of people living with HIV and tuberculosis are unaware of their coinfection and are therefore not receiving care.

The facts underlined above constitute the main ingredients to delineate Pakistan’s strategic priorities guiding the HIV response. Finally, it is hoped that notwithstanding the generous grants from GFATM, Pakistan will allocate substantially more indigenous funding to greatly upscale efforts and demonstrate its pledge and commitment to the international community in thwarting one of the greatest menaces ever faced by mankind.

The writer is a senior public health specialist of Pakistan and can be reached at gnkaziumkc@gmail.com

Published in Daily Times, December 3^rd 2018.