Denial and neglect

Facts, it is said, care little about feelings or emotions. Ground realities do not need permission from perceptions before they start to affect us all. Unfortunately, too often in our land, the reverse is also true. Our perceptions stay strong, even when facts and solid evidence support the contrary.

If we were to ask around, about the status of HIV and AIDS in Pakistan, most pundits would dismiss it as a non-issue. Many would be furious since the HIV problem, according to them, is counter to our norms, and hence must be absent from society altogether. That notion, unfortunately, has nothing to do with facts. Results from a survey conducted in partnership with UNAIDS and funded in part by the Global Fund, shows a fairly concerning picture for HIV in Pakistan. The survey shows that Pakistan has about 133,000 HIV patients. The number is certainly concerning, but there are two other features that are even more troubling.

First, unlike most other parts of the world, where the rate of HIV infection are actually falling, the rate of new infections in Pakistan is increasing. Second, Pakistan is among the top 10 countries where 95% of new cases are found. With little recognition of the problem at the societal level, a general denial, and a health system that fails to prioritise HIV testing and treatment, the problem has the hallmark of becoming a truly Herculean challenge that can be devastating for society. Our insistence that HIV is not our problem, and that it goes against our societal norms, does nothing to prepare us against the impending crisis.

The crisis of HIV in Pakistan, unfortunately, also has all the markings of a deeper and systemic problem. This problem has to do with apathy, neglect and denial. Large-scale problems facing society are coming to the fore not because of an attentive government or a robust academia, but because international organisations or concerned foreign researchers are taking notice. A recent study showing that nearly 60 million Pakistanis in the Indus basin region are exposed to water with high arsenic content was not driven by our own government or regulators. The study was not led by Pakistani scholars, instead the senior authors of that study were scientists in Switzerland. Similarly, the HIV study and survey was funded largely by the Global Fund and UNAIDS. At some point we must ask the basic question of how much do we care about our own problems?

There is nothing fundamentally wrong in having international organisations and researchers analysing the health challenges facing the citizens. In fact, international partnerships are essential. There is also an opportunity for us to learn. However, if the majority of these reports, studies, analyses and surveys are not driven by us, it raises important questions about the strength and sustainability of our institutions. We should ask ourselves and those who show up on the talk shows every night, whether lack of interest, in our own problems, is driven by other priorities, apathy or denial?

The fact that rigorous studies and analyses lack local initiative and support leads to two other subsequent problems. First, because someone else is funding it means that the government has less interest in listening to the results, and creating better policy and solutions. Second, if the international funding were to disappear, what would this mean for us in identifying our own problems.

We have a pretty good example of what happens when we deny the problems we face and continue to neglect them even in the face of mounting evidence. That example is our national flag carrier, PIA. Despite continued indicators, for decades, that there were systemic problems, we continued to ignore them. We never owned the problem. The last thing we want is for our public health to be the next PIA.

Published in The Express Tribune, October 10^th, 2017.

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