The acquired immune deficiency syndrome counts among the deadliest diseases of our time. The human immunodeficiency virus interferes with the immune system, making one vulnerable to other infections, which are otherwise less likely to affect one. In the absence of a vigorous treatment, an HIV infection leads to AIDS. A treatment to kill the HIV is as yet unavailable. However, with proper care it can be controlled. Antiretroviral therapy can help HIV patients live a long, healthy life with minimal risk of infecting others.
There are behavioural correlates overwhelmingly determined by broader socio cultural values and practices as well as structural factors making certain areas and social groups more susceptible to infections than others. Inequalities of class, gender and ethnicity leading to poverty, powerlessness and stigma produce a conductive environment for HIV infection and its widespread transmission.
A rapid increase in HIV cases in Pakistan and the recent cases in the Sindh province are alarming. Studies have revealed that currently there are as many as 150,000 carriers of the virus in the country. Some of the studies have also identified areas and social groups where this virus is predominantly prevalent. In 2018, a village in Sargodha was in the limelight for the reason. This year it is Ratodero, where the youngest patient reported is 16 months old.
Social groups susceptible to rapid HIV spread include drug injectors, transgender sex workers, male sex workers, those involved in polygynous sex practices, female sex workers and blood donors. The disease is found to have spreads mainly through sharing of injection syringes and unprotected sexual practices, sharing of razors, and from mother to child during pregnancy, delivery or lactation.
Poverty is one of the major factors that increase the risk. The poor are often forced to adopt risky lifestyles. Reports show that approximately 30 per cent of Pakistan’s population lives under the poverty line. Poverty is also linked to illiteracy and gender inequality.
AIDS is a relatively new disease. Many people in the country are not aware of its risks. People lack related information and awareness pertaining to its causes and consequences. What is required is a mass awareness campaign at various levels for educating people not only about the vectors responsible but also about preventive and curative measures. Awareness campaigns should include the highly sensitive topic of safe sex. This would be no easy task as the experience of family planning programmes has shown.
Pakistan is making efforts to meet the United Nations Sustainable Development Goals to control HIV spread by 2030
The social stigma attached to the disease is worrisome. Being a carrier of HIV is a taboo subject because at times unbearable consequences follow. I recall the case of a person who had looked healthy but was unexpectedly screened as HIV-positive. The diagnosis hit him like a bombshell. He believed that a disclosure of the diagnosis would ruin his life in multiple ways, including being ostracised. He, therefore, requested his doctor to conceal it.
Pakistan is making efforts to meet the United Nations Sustainable Development Goals to combat HIV/AIDS by 2030. It started its National AIDS Control Programme in late1990s. 28 treatment centres and more than 20community home-based testing centres have been established under the programme. The demand, nonetheless, is for more.
Like many other issues, the challenge to tackle this deadly disease is enormous and complex. A strategy to deal with it must not be limited to some of the factors – socio cultural or structural – because most of the factors are interwoven. A holistic strategy is needed to focus on poverty alleviation, population control, mass awareness concerning the causes, prevention and cure of the disease, removal of social stigma attached to HIV/AIDS, increase in centres, capacity-built staff, ample resources, political will and qualitative research studies, all at the same time.
Focusing on the HIV spread among drug-injection-sharing groups in Larkana, a qualitative study was conducted by an anthropologist at the Quaid-i-Azam University, Islamabad in 2005-06. The study focused on the reasons that force people to join such groups, ways of sharing syringes and helping one another.
The need is for simultaneously investing in substantial efforts on the prevention side to halt further spread as well as extensive attention on the therapeutic side for giving courage and confidence to patients to live their lives well. Counselling, psychotherapy and social sessions would be some of the significant channels to bring hope to the patients.
The writer is a PhD scholar at University of Vienna, Austria