Ahmad Waqass Goraya
Pakistan is surrounded by countries with huge populations suffering from HIV/AID. India has the highest numbers of HIV patients in the world. China tops the chart by the highest number of HIV among Injecting Drug Users(IDUs). Pakistan also shares the culture with India and may eventually emerge as a country with a huge population suffering from HIV/AIDS. HIV/AIDs is not on our priority list. Pakistan is one of the few countries who don’t have any HIV/AIDS Policy. The focus is on Malaria , Tuberculosis, Dengue and recently on hepatitis Band hepatitisC. A literature review and study of the situation tells us that Pakistan is actually sitting on a ticking bomb and there is nothing being done to defuse the bomb.
There are numerous risk factors in Pakistan and entry gates of disease are open. The number one risk factor is the unsafe medical practices both by the quacks as well as the qualified professionals in the medical field. The second factor is the unhealthy sexual practices. Condoms are used by less than 20% of the population. Safe Sex is not practiced even among sex workers. As per World health organisation (WHO), 94% of the syringes in Pakistan are re-used. It is not uncommon to find blood in new syringes. Same is true for the other surgical equipment. Per capita Injection ratio is around 13.5% . The patients as well as the doctors prefer to administer medicine via the drip or an injection. A huge proportion of workers consider getting a glucose drip with some multivitamins a safety from the disease and a source of energy. Most Quacks practice this all over Pakistan. Hepatitis B and hepatitisC affects around 10-15% of the total populatoin,one of the highest in the world.
Along with many other factors, the number one factor of this spread is unsafe medical practices and the needles being the number one source of it. The statistics of prevalence in Pakistan aren’t very accurate and encouraging. As per the goverment’s figures, Pakistan has 0.1% (97,500) HIV cases. This is based on statistics from the World Bank, World Health Organisation and other international organizations from 2005. And only 4000 patients are getting treatment in Pakistan. The organisations estimated it to be between 90,000-250,000. These reports are based on accidental discoveries during blood transfusion or medical procedures etc in 2005. However the reports from the ground data by various NGOs show different results .Overall we can see that there is no general epidemic but a very high and alarming figures of concentrated epidemic. i.e. disease in some risk groups.
The avialable date from the last few years suggests that IDUs have 20-31% HIV in Sindh , 10-15% in Sargodha, Lahore, Peshawer and Quetta. Along with IDUs , we have another unique highrisk group, that is the boys accompanying long route truckers as well as the street children. The ratio of HIV among them is alarmingly high. Some random testing camps in various areas showed alarming rates of disease in certain areas. In 2008, a testing camp by New Light AIDS Control Society found that almost 30% population of the two neighborhoods in JalalPur Jattan(Gujrat) is HIV positive. Test were carried out on 312 people and out of that number 101 were found to be HIV postive. One of the major entry points in the society and another group carrying diseases is the deported immigrants from UAE, Saudi Arabia other gulf countries. These countries deport the immigrants immediately if Hepatitis, HIV or any other such diseases are found during bi-annual tests they conduct. The workers who undergo these tests aren’t usually informed about test results. And many don’t disclose the results on their return to pakistan, even if they know . So these people serve as entry points of disease in the society.
We have many other pockets with high rates in HIV some of which are Peshawar, DG Khan, Larkana along with others. During a study conducted in 2009, many people were found to be HIV positive in Sindh, Southern Punjab and Khyber Pakhtunkhawa due to unsafe medical practices. Disease load was found to be below 1% among sex workers of both sexes and transgenders. What we see from various figures is that HIV is present 10-31% among various closed groups and these carriers are present all over Pakistan. IDUs, deported individuals and other high risk groups can caues HIV out burst and in a matter of years this concentrated epidemic can turn into a general epidemic.
Just like we had Hepatitis out burst and got 15% population infected. Pakistan needs a national HIV/AIDS policy. This should be our priority in the health sector. The second step after having a policy is the legislation to provide safety to HIV patients in a hostile society.Furthermore, there is a dire need to take action against the medical mal-practices as well. Further considerations can include community level awareness programmes, sex education in university and colleges and awareness through the media.
The author is a biochemist and a medical anthropologist based in Pakistan. He is also a member of the Editorial Board of the Rationalist Society of Pakistan. He tweets at @goraaya