It has been more than 30 years since the HIV epidemic began impacting families and communities in Pakistan, but starting from this year’s World AIDS Day, observed yesterday on December 1, we can begin to draw the curtain on one of modern history’s worst epidemics. In September, Pakistan was one of 193 UN member states to adopt the Sustainable Development Goals and commit to ending the AIDS epidemic as a public health threat by 2030.
This goal is certainly ambitious, but achievable. Even without a vaccine or a cure, we know how to stop HIV with combination prevention efforts. But Pakistan has a fragile window of opportunity — only five years — to accelerate efforts. There are 94,000 people living with HIV in the country, and with 20,000 new HIV infections last year, Pakistan has one of the fastest growing epidemics in Asia. We must act now before the virus spreads further and becomes entrenched in more communities.
While the pace of the response needs to quicken across the globe, intensified efforts are a must in 35 fast-track countries. With an expanding HIV epidemic, Pakistan is one of these priority countries. UNAIDS is calling on countries to adopt the fast-track approach by front-loading investments and initiating efficient and innovative approaches over the next five years in order to reach critical HIV prevention and treatment targets. But that is not all. From the beginning, HIV has had consequences far beyond public health that have impacted many other social and development sectors. In every community touched by the disease, there is not only a glaring need to rethink health systems, but to also transform social norms. We must eliminate HIV-related discrimination in order to ensure dignified lives for key populations and people living with HIV.
Pakistan’s epidemic is primarily concentrated in key populations, which include people who inject drugs, sex workers, homosexuals, transgender people, prisoners and migrants, as well as their intimate partners. People who inject drugs have a national HIV prevalence of 27.2 per cent, while transgender people have a prevalence of 7.2 per cent. Despite these high numbers, HIV programmes for key populations remain far too few. UNAIDS’s fast-track targets call for 90 per cent of the people, who are aware they have HIV, to be on treatment and 90 per cent of those being treated to have suppressed viral loads by 2020. Currently only nine per cent of the people who inject drugs are aware of their HIV status.
Science has shown that antiretroviral medicine has the double benefit of keeping people living with HIV healthy, as well as preventing the onward transmission of HIV. The latest World Health Organisation guidelines recommend treating all who test positive for HIV. In 2014, a little over 5,000 people in Pakistan were being treated — that is about six per cent of all those estimated to be living with HIV. This abysmally low treatment coverage prevails because of reasons that are not difficult to identify. The problem lies in governance, accountability and limited domestic resource allocations. Political ownership and leadership are required for an effective HIV response. Sindh has an HIV Act but it lacks effective implementation. HIV legislation for other provinces is needed as well to protect human rights and reduce gender discrimination.
While expanding HIV combination prevention and treatment programmes is important, the AIDS epidemic will not be controlled in Pakistan if stigma and discrimination towards people with HIV continues. Aware of the critical importance of developing tolerance and acceptance, UNAIDS, the National AIDS Control Programme and partners published The Positive Diaries on World AIDS Day. We encourage you to read this book. With stories of people living with HIV, along with their photographs, you can put faces to the figures. Each of the 94,000 people living with HIV has a story to tell. The stories told are backed up by data. The country’s People Living with HIV Stigma Index, conducted in 2010, revealed high levels of stigma, and exclusion from families and religious activities as well as discrimination in employment. One-third of respondents reported being denied access to health care in the previous 12 months.
Stigma and discrimination are what emboldens HIV, giving the virus fertile ground in which to flourish. Fear of rejection, ridicule and even violence stop people from accessing HIV testing, prevention, treatment and other life-saving health services. Instead, many often choose to avoid medical advice. This means not only are individuals failing to access HIV treatment until it is too late, but also they may continue risky behaviours without the benefit of access to the tools that can prevent HIV transmission. Such a culture of silence leads to a general lack of awareness, putting the health of everyone at risk and leading to unnecessary discrimination for those already affected.
We would like to salute the courageous men and women living with HIV who have decided to speak out about their status in The Positive Diaries. The publication of The Positive Diaries and formation of young men and women associations through the platform of the APLHIV is a sign of immense hope, courage, bravery and progress in Pakistan. Just a few years ago, it would have been impossible to think of so many people living with HIV coming forward. While they speak of pain and suffering, they also acknowledge the love, compassion and support they have received from their families, communities and sometimes complete strangers. The government, UNAIDS, civil society and all esteemed organisations should form a movement that reaches out to our brothers and sisters in need. If discrimination against people with HIV ends, treatment is provided, along with increased domestic resources and legal and social barriers are removed through legislation, we can end the AIDS epidemic. With the fast-track approach through community-based HIV testing, we can shrink new infections to 2,000 a year in 2020. If we continue with business as usual, then we expect HIV infections to grow to 65,000 a year. The choice is clear. We have no time to lose.
Published in The Express Tribune, December 2nd, 2015.
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