The writer is a physician, a public health specialist and an AIDS activist trained in Pakistan and the US
Acquired Immunodeficiency Syndrome (AIDS) is labelled as the scourge of the century but Pakistan is fortunate that it does not have the problem of HIV and AIDS at a large scale. It is estimated that there are 98,000 adults and children living with HIV in the country, but compared to certain African countries where the HIV prevalence is greater than 20 per cent, Pakistan’s national prevalence is less than 1 per cent.
However, today’s focus is on Larkana — a city that has all the ingredients of heading towards an explosive outbreak of HIV among the general population. While it is known as the political city of the country, it has several other features. There is an unusual pattern of multiple commercial sex activities going on there; the city has a brothel where clients from all over the district as well as other cities engage female sex workers during the day for commercial sex. There are home-based sex workers as well, who go with clients on a regular basis. One of the main streets of the city is called the Station Road and has at least two motels in the middle of the city where transgender sex workers are provide paid services to clients. In this small city, it is estimated that there are a thousand drug users and female sex workers and more than 1,500 male and transgender sex workers. Research has indicated that they charge Rs50 to Rs150 often do not use protection which can prevent HIV transmission. Larkana has all the components that can lead to an exploding HIV epidemic in the near or distant future. The infection can be transmitted as clients of sex workers, particularly those who are married, can transmit an HIV infection to a spouse who does not carry any risk.
Concerned stakeholders must address this issue holistically on an urgent basis and take prudent measures to prevent HIV infection. Rehabilitation programs for drug users are required. Most recovery programs for drug users in Pakistan take short-term measures such as detoxification for two weeks to a month and then focusing on educating and counseling the person or occasionally their families. Such programs are of no use because they are missing a key component, opioid drug substitution therapy. Statistics have shown that any drug rehabilitation program without a substitution therapy does not produce meaningful results and the relapse rate remains as high as 80 per cent to 90 per cent. Availability of drugs must also be halted. The famous adage, ‘as long as there is a supply there will be a demand’, applies here very well. As for commercial sex workers, prevention programs have to have good outreach workers and peer educators who are trained should teach these high-risk groups how to adapt to safe behavior, especially use of condoms, to stop the spread.
The government provides free medicines called ARVs (anti-retroviral drugs) however, not all HIV positive persons in Pakistan or Sindh are receiving them. AIDS is an incurable disease and any HIV positive person has to take medicines for the rest of his/her life so prevention is the best strategy. However, changing behaviour is also one of the most difficult tasks for prevention programs, or otherwise there would not be a high prevalence of the HIV infection around the world. Changing behaviour is difficult but not impossible. Failing to act proactively can result in an undue burden on the healthcare system of the province.
Published in The Express Tribune, December 1st, 2013.
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Very informative article. If you look at the statiscs, around 69 percent of all people living with HIV reside in sub-Saharan Africa; the region carries the greatest burden of the epidemic. Epidemics in Pakistan have remained relatively stable and are still largely concentrated among high-risk groups. The most successful way to avoid Aids is using condoms when having sexual activity. I know South African government distributes condoms free to all which has helped reduce the disease considerably in the last few years. Unlike Pakistan, South Africans are very promiscuous which increases the risk of Aids spreading. It is important that this subject gets reported and men are encouraged to be more responsible in their sexual behaviour