If a woman or her partner is infected with HIV or Aids, there is a 30 per cent chance that their baby will be born with the virus, says Dr Rafiq Khanani, an expert on the disease. The virus is transmitted during pregnancy and can be fatal if it is not treated.
Pakistan may have established programmes for the treatment and prevention of HIV and Aids, but its incidence among children indicates that the epidemic is far from under control. In the past nine years, 49 children in Sindh have been infected with HIV and two with Aids, according to the Sindh Aids Control Programme (SACP). Of the HIV positive children, 28 are boys and 21 are girls.
“However, this is only a fraction of the real numbers,” said Dr Khanani. “The actual cases may be about five times this amount,” he said. This is because only five per cent of the deliveries take place in hospitals and even infected adults are not diagnosed.
Dr Khanani was the first doctor to diagnose an infected patient in Pakistan in 1987. He traces the local pattern of HIV in children to drug addicts and cross-dressing male sex workers. About 30 per cent of these people are married and transmit the virus to their partners and children, he added.
A child cannot be diagnosed for the disease during pregnancy, but doctors say that children born to infected women or those with HIV positive partners are highly susceptible. A child can only contract the virus just before or immediately after the pregnancy, as this is the stage in which bodily fluids and blood are exchanged. However, treatment during pregnancy can reduce the risk of transmission to less than three per cent. Lactating mothers can also transmit the virus, but the risk is very low – about less than five per cent, said Dr Khanani. “In Africa, the World Health Organisation says that even if the mother is infected, she should not stop feeding the child as there are more risks to the baby’s life if he or she is not breastfed.
The treatment for infected mothers that was first available in 1996 reached Pakistan ten years later. In the past, UNICEF has organised programmes and now The Global Fund to Fight AIDS, Tuberculosis and Malaria is supporting designated centres all over the country. In Karachi, the paedriatric ward at Civil Hospital as well as Aga Khan University Hospital are the only privately run centres providing treatment to children, said Dr Munawar Khan, the behaviour change communication coordinator at SACP. Infected mothers and their children can be treated with antiretroviral therapy. This comprises oral medicines that may vary with the intensity of the virus. The centres of the public sector work by registering the patients who get routine check-ups and treatment. The Prevent Parent to Child Transmission programme has three designated centres in Sindh, two of which are in Karachi at Civil Hospital and Qatar Hospital. The programme is funded by the Sindh government and aims to promote awareness, treatment and prevention through NGOs. It targets various vulnerable groups such as transgenders and sex workers.
“There are many instances in which HIV positive children have survived for over 12 years,” he said. However if they are not given treatment, the disesase may advance to Aids and the children will die.”
Despite all these efforts, Dr Khanani points out that it is difficult to stem the incidence of HIV in children as there is no awareness about the disease and the programmes often do not reach the vulnerable groups. The logic of focusing on children is that Pakistan has one of the largest number of young people in the world. They need to be protected and given correct information about HIV in order to protect them.
Published In The Express Tribune, June 24th, 2012.
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