The AIDS Debate
Have Pakistanis finally woken up to the harsh reality of HIV/AIDS and what are they doing about it?
In last year’s critically-acclaimed biopic Dallas Buyers Club (DBC), Hollywood heartthrob Mathew McConaughey gives a grittily truthful performance as Ron Woodroof, a rather unscrupulous, working-class American diagnosed with advanced Human Immunodeficiency Virus (HIV) during the HIV/AIDS epidemic of the 1980s.
Having been denied medical assistance, Woodroof finds himself travelling the world to acquire pre-approved, illicit drugs to help ease his condition and to sell them to fellow patients who cannot access proper care. After a prolonged legal struggle with the Food and Drug Administration (FDA) and the US National Institute of Health, Woodroof finally manages to have Peptide T – an experimental HIV inhibitor – approved for importation.
But while the world went ablaze with appreciation for McConaughey’s artistry, few realised the social implications that the movie highlighted: a general lack of compassion towards HIV in ’80’s America. Based on a true story, DBC is an adequate representation of the discrimination HIV patients faced everyday as a result of the disease being attributed mainly to drug-addicts and sex-workers. They were ostracised by their families, expelled from classrooms and laid off from their jobs. Misconceptions regarding the infection being transmittable by touch discouraged many doctors from helping patients lest they contract it as well.
Although the world has improved its attitude towards HIV over the past two decades, the improvements have been sporadic in comparison to the spread of the infection. In Pakistan, HIV still remains somewhat of a social taboo, partly based on the notion that it possibly cannot exist in a conservative society like ours. In contrast, a study conducted by the UN-AIDS programme in 2012 shows that there are approximately 1, 60,000 people living with HIV in Pakistan, with the prevalence rate highest amongst women and young adults. “Until recently, Pakistan was classified as ‘low prevalence high risk’, but now it is in the ‘concentrated phase’ of the HIV epidemic,” says UN official Shafeeq Rehman. “Up to 5% people suffer from the infection now, in at least eight major cities.” Despite this, people remain unaware of HIV and its impending repercussions.
“HIV infects the cells of the immune system such that the patient develops impaired cell-mediated immunity,” says Dr Shaukat Ali Sheikh, a surgeon at the Islamabad Medical and Dental College. It germinates as a common cold with standard flu-like symptoms, the only difference being that the symptoms don’t subside due to the weakened immune system. From here, the virus can seep into the body fluids and spread via blood-to-blood or sexual contact. In some instances, it can pass down to newborn babies via pregnancy and while feeding.
The HIV virus attacks the immune system, destroys its cells and multiplies rapidly, thereby becoming a permanent condition. Over time, it can destroy the immunity cells so thoroughly that the human body is unable to counter other infections and diseases anymore, leading to Acquired Immunodeficiency Syndrome (AIDS). “Under these circumstances, even the most minor infections become very serious,” adds Dr Shaukat. “The transition from HIV to AIDS can take a few months or even up to 10 years.” If not managed properly, HIV can lead to other infections like tuberculosis, cancer and neurological disorders.
One must note that there are many other factors that can cause the infection to spread, coitus being just one of them. According to a study conducted by Dr Yasmin Bhurgri from the Department of Pathology at Aga Khan University Hospital, out of all patients diagnosed with HIV/AIDS during 2006, about 11.73% of the cases had caught it due to contact with contaminated blood or blood products (used syringes, needles and sundry medical/dental equipment). Other modes of transmission including Injecting Drug Use (IDU) contributed to 2.02%, abnormal and unsafe sexual activity at 4.55% and mother-to-child transfer at 2.2%. Transmissions of unknown origins comprised about 26.9% of all cases.
Although there is no medication that can reliably eliminate the HIV virus within, there have been substantial advances in treatment and therapies that have improved the lives of people with HIV greatly. Scientists have developed drugs which can successfully curtail the growth of the virus, if not rid of it altogether. Various vaccines are being developed and tested across the world and it is expected that we will have access to effective immunisations by the end of the decade.
It can be argued that a major factor which discourages people from opening up about HIV is the fear that AIDS is incurable and fatal, offering no opportunity for a normal life. “On the contrary, a person diagnosed at 20 can expect to live up to 70 – the same lifespan as a non-patient,” explains Dr Gary Blick, HIV Specialist and Founder of the World Health Clinicians. Under careful monitoring, patients can lead a normal life and even reproduce without running the risk of passing on the infection.
There are many fallacies which surround HIV/AIDS and fuel the discrimination surrounding it. As mentioned earlier, many patients are cast out by society for contracting AIDS – a disease they connect to stigmatised behaviours like drug abuse and promiscuity. Many like, 17-year-old student Ibrahim Gilani believes, “People who have AIDS bring it upon themselves as they can’t control their emotions. If they hold multiple relationships with different partners, they deserve to be sick.” Natasha Rahim from Rawalpindi reiterates Ibrahim’s perceptions by sharing the story of her neighbour who was shunned from his home for catching AIDS. “When the inhabitants of our town found out about his illness, they physically and psychologically forced him to pack up and leave,” she shares. “Everyone called him disgusting and immoral and attributed his fate to moral weakness and karma.” It is also wrongly believed that the HIV virus can spread via casual contact, such as sharing cutlery or lavatories.
The example of Asim Farrukh lends credence to the fact that HIV and AIDS are still frowned upon in Pakistan, due to prevailing misapprehensions. Upon diagnosis, which was actually the result of a poorly conducted dental treatment, Asim was let off from his job at a local bank. “There was so much hostility from everyone at my office,” he recalls. “People wouldn’t have lunch with me or shake my hand or even talk to me. I could tell I was constantly gossiped about and there were many negative assumptions cast upon my character which worsened my health a lot more than my HIV did.” Similarly, 24-year-old Mariam Hasan was divorced and thrown out by her own family after she contracted HIV following a surgical procedure involving unscreened blood. “Even though my disease isn’t contagious, I hide it from everyone because no one really understands.”
Unfortunately, AIDS-related discrimination prevents people from speaking about their conditions and hinders general awareness. “We have to be extra careful when conducting awareness campaigns or visiting homes to speak about HIV/AIDS,” admits social-worker Halima Shan. “Many times, we are accused of trying to brainwash local women and promulgate wrong, sinful ideas in society. Some families have extremely strong opinions regarding the topic and ask us to leave.” Fear of rejection and confidentiality concerns also discourage people from having themselves tested, meaning that they might spread the infection unknowingly. Such was the case of Farkhanda Inam, a domestic worker who was unaware of her disease until after marriage. “My husband didn’t know he had AIDS and neither did I,” she confesses. “I was devastated [to know] that he had other partners before me, but the fact that I have to bear the consequences for the rest of my life made it worse.”
Over the years, considerable efforts have been put into creating awareness about HIV/AIDS by individuals, non-profit organisations and doctors so that the disease can be prevented or treated in time. One such example is the Association of People Living with HIV in Pakistan which has been providing support to patients ever since its establishment in 2006. Shafeeq remains hopeful, saying that, “Pakistan still has a window of opportunity as according to current estimates, HIV prevalence is still below 1%.” This allows for ample time to educate the masses about the disease and how they might be able to prevent it. The situation may appear bleak but the right steps can lead us to an AIDS-free life and the efforts of Ron Woodroof will not become futile.
HIV 101
Symptoms of HIV
• Fever (most common occurrence in HIV patients)
• Swollen glands
• Rashes
• Sore throat
• Fatigue
• Muscle and joint pains
• Frequent headaches
How Does HIV Spread
• Indiscriminate transfusion of unscreened blood
• Non-sterilised medical and dental equipment
• Reuse of old or used syringes and needles
• Sharing of needles and syringes (as in IDU cases)
• Unhygienic equipment used by barbers and beauty parlours (razors and scissors, etc)
• Unsafe sexual practices
• Lack of awareness and education regarding health matters
Published in The Express Tribune, Ms T, June 29th, 2014.
Having been denied medical assistance, Woodroof finds himself travelling the world to acquire pre-approved, illicit drugs to help ease his condition and to sell them to fellow patients who cannot access proper care. After a prolonged legal struggle with the Food and Drug Administration (FDA) and the US National Institute of Health, Woodroof finally manages to have Peptide T – an experimental HIV inhibitor – approved for importation.
But while the world went ablaze with appreciation for McConaughey’s artistry, few realised the social implications that the movie highlighted: a general lack of compassion towards HIV in ’80’s America. Based on a true story, DBC is an adequate representation of the discrimination HIV patients faced everyday as a result of the disease being attributed mainly to drug-addicts and sex-workers. They were ostracised by their families, expelled from classrooms and laid off from their jobs. Misconceptions regarding the infection being transmittable by touch discouraged many doctors from helping patients lest they contract it as well.
Although the world has improved its attitude towards HIV over the past two decades, the improvements have been sporadic in comparison to the spread of the infection. In Pakistan, HIV still remains somewhat of a social taboo, partly based on the notion that it possibly cannot exist in a conservative society like ours. In contrast, a study conducted by the UN-AIDS programme in 2012 shows that there are approximately 1, 60,000 people living with HIV in Pakistan, with the prevalence rate highest amongst women and young adults. “Until recently, Pakistan was classified as ‘low prevalence high risk’, but now it is in the ‘concentrated phase’ of the HIV epidemic,” says UN official Shafeeq Rehman. “Up to 5% people suffer from the infection now, in at least eight major cities.” Despite this, people remain unaware of HIV and its impending repercussions.
“HIV infects the cells of the immune system such that the patient develops impaired cell-mediated immunity,” says Dr Shaukat Ali Sheikh, a surgeon at the Islamabad Medical and Dental College. It germinates as a common cold with standard flu-like symptoms, the only difference being that the symptoms don’t subside due to the weakened immune system. From here, the virus can seep into the body fluids and spread via blood-to-blood or sexual contact. In some instances, it can pass down to newborn babies via pregnancy and while feeding.
The HIV virus attacks the immune system, destroys its cells and multiplies rapidly, thereby becoming a permanent condition. Over time, it can destroy the immunity cells so thoroughly that the human body is unable to counter other infections and diseases anymore, leading to Acquired Immunodeficiency Syndrome (AIDS). “Under these circumstances, even the most minor infections become very serious,” adds Dr Shaukat. “The transition from HIV to AIDS can take a few months or even up to 10 years.” If not managed properly, HIV can lead to other infections like tuberculosis, cancer and neurological disorders.
One must note that there are many other factors that can cause the infection to spread, coitus being just one of them. According to a study conducted by Dr Yasmin Bhurgri from the Department of Pathology at Aga Khan University Hospital, out of all patients diagnosed with HIV/AIDS during 2006, about 11.73% of the cases had caught it due to contact with contaminated blood or blood products (used syringes, needles and sundry medical/dental equipment). Other modes of transmission including Injecting Drug Use (IDU) contributed to 2.02%, abnormal and unsafe sexual activity at 4.55% and mother-to-child transfer at 2.2%. Transmissions of unknown origins comprised about 26.9% of all cases.
Although there is no medication that can reliably eliminate the HIV virus within, there have been substantial advances in treatment and therapies that have improved the lives of people with HIV greatly. Scientists have developed drugs which can successfully curtail the growth of the virus, if not rid of it altogether. Various vaccines are being developed and tested across the world and it is expected that we will have access to effective immunisations by the end of the decade.
It can be argued that a major factor which discourages people from opening up about HIV is the fear that AIDS is incurable and fatal, offering no opportunity for a normal life. “On the contrary, a person diagnosed at 20 can expect to live up to 70 – the same lifespan as a non-patient,” explains Dr Gary Blick, HIV Specialist and Founder of the World Health Clinicians. Under careful monitoring, patients can lead a normal life and even reproduce without running the risk of passing on the infection.
There are many fallacies which surround HIV/AIDS and fuel the discrimination surrounding it. As mentioned earlier, many patients are cast out by society for contracting AIDS – a disease they connect to stigmatised behaviours like drug abuse and promiscuity. Many like, 17-year-old student Ibrahim Gilani believes, “People who have AIDS bring it upon themselves as they can’t control their emotions. If they hold multiple relationships with different partners, they deserve to be sick.” Natasha Rahim from Rawalpindi reiterates Ibrahim’s perceptions by sharing the story of her neighbour who was shunned from his home for catching AIDS. “When the inhabitants of our town found out about his illness, they physically and psychologically forced him to pack up and leave,” she shares. “Everyone called him disgusting and immoral and attributed his fate to moral weakness and karma.” It is also wrongly believed that the HIV virus can spread via casual contact, such as sharing cutlery or lavatories.
The example of Asim Farrukh lends credence to the fact that HIV and AIDS are still frowned upon in Pakistan, due to prevailing misapprehensions. Upon diagnosis, which was actually the result of a poorly conducted dental treatment, Asim was let off from his job at a local bank. “There was so much hostility from everyone at my office,” he recalls. “People wouldn’t have lunch with me or shake my hand or even talk to me. I could tell I was constantly gossiped about and there were many negative assumptions cast upon my character which worsened my health a lot more than my HIV did.” Similarly, 24-year-old Mariam Hasan was divorced and thrown out by her own family after she contracted HIV following a surgical procedure involving unscreened blood. “Even though my disease isn’t contagious, I hide it from everyone because no one really understands.”
Unfortunately, AIDS-related discrimination prevents people from speaking about their conditions and hinders general awareness. “We have to be extra careful when conducting awareness campaigns or visiting homes to speak about HIV/AIDS,” admits social-worker Halima Shan. “Many times, we are accused of trying to brainwash local women and promulgate wrong, sinful ideas in society. Some families have extremely strong opinions regarding the topic and ask us to leave.” Fear of rejection and confidentiality concerns also discourage people from having themselves tested, meaning that they might spread the infection unknowingly. Such was the case of Farkhanda Inam, a domestic worker who was unaware of her disease until after marriage. “My husband didn’t know he had AIDS and neither did I,” she confesses. “I was devastated [to know] that he had other partners before me, but the fact that I have to bear the consequences for the rest of my life made it worse.”
Over the years, considerable efforts have been put into creating awareness about HIV/AIDS by individuals, non-profit organisations and doctors so that the disease can be prevented or treated in time. One such example is the Association of People Living with HIV in Pakistan which has been providing support to patients ever since its establishment in 2006. Shafeeq remains hopeful, saying that, “Pakistan still has a window of opportunity as according to current estimates, HIV prevalence is still below 1%.” This allows for ample time to educate the masses about the disease and how they might be able to prevent it. The situation may appear bleak but the right steps can lead us to an AIDS-free life and the efforts of Ron Woodroof will not become futile.
HIV 101
Symptoms of HIV
• Fever (most common occurrence in HIV patients)
• Swollen glands
• Rashes
• Sore throat
• Fatigue
• Muscle and joint pains
• Frequent headaches
How Does HIV Spread
• Indiscriminate transfusion of unscreened blood
• Non-sterilised medical and dental equipment
• Reuse of old or used syringes and needles
• Sharing of needles and syringes (as in IDU cases)
• Unhygienic equipment used by barbers and beauty parlours (razors and scissors, etc)
• Unsafe sexual practices
• Lack of awareness and education regarding health matters
Published in The Express Tribune, Ms T, June 29th, 2014.