You & the rest of Pakistan should have been tested for HIV years ago
Every child, every man, and every woman should be screened. They should be screened in hospitals, schools, communities
The writer is a physician, freelance writer and public health researcher. He can be reached on twitter @asfandyar_kn
It happened in Botswana in 1985. In 1986, it happened in Lesotho. And, again, it happened in 1987 in Swaziland. One would imagine that countries and their people would have learnt by then. But, over the next decades, it continued to happen in scores of other countries: Zimbabwe, Namibia, Zambia, Uganda and Rwanda. One may wonder what is common among all these countries — widespread taboos, poorly designed public health systems, inadequate planning for limiting HIV/AIDS, denial of the existence of an HIV/AIDS epidemic, and, of course, a thriving HIV/AIDS epidemic. Also common among these countries are millions of lives lost, destroyed economies, and a generation crippled underneath the burden of HIV/AIDS.
UNAIDS, the joint United Nations Programme on HIV/AIDS, has classified Pakistan as a country at high risk of developing a generalised HIV epidemic. And with good reason — Pakistan has all the ingredients required for developing such an epidemic: widespread drug addiction, thriving sex work, a large migrant population, use of non-sterile medical equipment, low levels of health literacy, socially and culturally ingrained taboos, and — perhaps most importantly — denial that all of the aforementioned exist in the country. It is difficult to estimate the true prevalence of HIV/AIDS in Pakistan. Social taboos and illiteracy limit the willingness of people to get themselves tested for the disease. Even after the diagnosis is made, patients prefer to hide it out of fear of discrimination. In addition to causing difficulty in calculating the number of people affected by HIV, this also puts their spouses and children at risk.
From the limited data that we have available, it seems that HIV in Pakistan is still in the concentrated epidemic stage. This means that it is common only among high-risk groups: sex workers (both male and female), people with multiple sex partners, drug abusers, prisoners, long-distance drivers and migrants. Statistically speaking, 38 per cent of drug users in Pakistan are infected with HIV. If that isn’t itself alarming enough, HIV is also spreading at a worryingly fast pace with it being expected that 70 per cent of drug users will be affected with it by 2025. There is a set course that countries take when they develop a generalised HIV epidemic, so it isn’t hard to predict the future course. First, it will be the spouses of drug users, migrants and long-distance drivers, and people engaging in unsafe sex who will be affected. Then it will be the children of women affected with HIV. And then, it will be everyone else. This is when it will be too late. If Pakistan ever finds itself in the midst of a generalised HIV epidemic, the health system here is not well-equipped enough to withstand such a crisis. An example of failure of the Pakistani health system became evident in June 2008 in the city of Jalalpur Jattan, Gujrat. An NGO set up two HIV screening camps where residents were invited to voluntarily test for HIV and 36 per cent of the people tested turned out to be HIV positive. After receiving negative media attention, the NGO was forced by the residents of the area to shut the camps down. This highlights several important points: the sheer number of undiagnosed HIV cases, the negative effects of media attention, and the aggressive behaviour of the general public. There could be any number of other cities with similar large undiagnosed populations of HIV patients. An example came late last year when it was reported that 10 children with thalassemia from Islamabad and various areas of Punjab have been reported to be HIV positive after HIV-infected blood was transfused to them. Blood products are supposed to be tested for HIV routinely before being transfused. That these weren’t tested in this case, and are quite often not tested generally, is a failure of our healthcare system.
The French scientist Dr Francoise Barre-Sinoussi, who co-discovered HIV, recently said that a cure seems to her, an impossible mission. This places even more emphasis on the control of spread of this disease. Recently, a 39-year-old man in the US has received a sentence of 30 years in prison after knowingly exposing his partners to HIV. This raises the question: how many in Pakistan are knowingly and unknowingly exposing their partners to HIV? That question can only be answered after a thorough screening programme has been conducted.
Pakistan is a signatory to the UN’s Millennium Development Goals — one of which states that the spread of HIV/AIDS should be halted by 2015. However, it is clear that this has not happened. The use of condoms and other safe sex practices have been consistently low and do not seem to be improving. There also exists a vacuum in the knowledge of HIV/AIDS in society. Religious leaders and sociocultural taboos make open discussion of these issues and the providing of medical information publicly a difficult task. The lack of sex education in schools is another problem. Migrant workers, especially to the Arab world, are at a high risk of contracting HIV/AIDS because they stay away from their spouses for extended periods of time and are likely to engage with commercial sex workers. There are, of course, strategies that can be employed to improve the situation, but only after a generalised screening programme reveals the true extent of the disease in the country.
Authentic data is a prerequisite to designing interventions that can counter these multi-dimensional social and cultural issues. It is only after we know who is affected that we can prevent the further spread of HIV. A countrywide HIV screening programme in Pakistan is long overdue. This should have been carried out when the epidemic was still in its early stages; this was a decade ago. However, it’s better later than never. Every child, every man, and every woman should be screened. They should be screened in hospitals, schools, communities and everywhere else. This will have an enormous cost, but there is no putting a price on allowing 190 million lives to remain at risk. Very soon, we will be colliding head on with a disease that has destroyed many unsuspecting countries before. And we need to be better prepared, much better prepared.
Published in The Express Tribune, August 30th, 2015.
UNAIDS, the joint United Nations Programme on HIV/AIDS, has classified Pakistan as a country at high risk of developing a generalised HIV epidemic. And with good reason — Pakistan has all the ingredients required for developing such an epidemic: widespread drug addiction, thriving sex work, a large migrant population, use of non-sterile medical equipment, low levels of health literacy, socially and culturally ingrained taboos, and — perhaps most importantly — denial that all of the aforementioned exist in the country. It is difficult to estimate the true prevalence of HIV/AIDS in Pakistan. Social taboos and illiteracy limit the willingness of people to get themselves tested for the disease. Even after the diagnosis is made, patients prefer to hide it out of fear of discrimination. In addition to causing difficulty in calculating the number of people affected by HIV, this also puts their spouses and children at risk.
From the limited data that we have available, it seems that HIV in Pakistan is still in the concentrated epidemic stage. This means that it is common only among high-risk groups: sex workers (both male and female), people with multiple sex partners, drug abusers, prisoners, long-distance drivers and migrants. Statistically speaking, 38 per cent of drug users in Pakistan are infected with HIV. If that isn’t itself alarming enough, HIV is also spreading at a worryingly fast pace with it being expected that 70 per cent of drug users will be affected with it by 2025. There is a set course that countries take when they develop a generalised HIV epidemic, so it isn’t hard to predict the future course. First, it will be the spouses of drug users, migrants and long-distance drivers, and people engaging in unsafe sex who will be affected. Then it will be the children of women affected with HIV. And then, it will be everyone else. This is when it will be too late. If Pakistan ever finds itself in the midst of a generalised HIV epidemic, the health system here is not well-equipped enough to withstand such a crisis. An example of failure of the Pakistani health system became evident in June 2008 in the city of Jalalpur Jattan, Gujrat. An NGO set up two HIV screening camps where residents were invited to voluntarily test for HIV and 36 per cent of the people tested turned out to be HIV positive. After receiving negative media attention, the NGO was forced by the residents of the area to shut the camps down. This highlights several important points: the sheer number of undiagnosed HIV cases, the negative effects of media attention, and the aggressive behaviour of the general public. There could be any number of other cities with similar large undiagnosed populations of HIV patients. An example came late last year when it was reported that 10 children with thalassemia from Islamabad and various areas of Punjab have been reported to be HIV positive after HIV-infected blood was transfused to them. Blood products are supposed to be tested for HIV routinely before being transfused. That these weren’t tested in this case, and are quite often not tested generally, is a failure of our healthcare system.
The French scientist Dr Francoise Barre-Sinoussi, who co-discovered HIV, recently said that a cure seems to her, an impossible mission. This places even more emphasis on the control of spread of this disease. Recently, a 39-year-old man in the US has received a sentence of 30 years in prison after knowingly exposing his partners to HIV. This raises the question: how many in Pakistan are knowingly and unknowingly exposing their partners to HIV? That question can only be answered after a thorough screening programme has been conducted.
Pakistan is a signatory to the UN’s Millennium Development Goals — one of which states that the spread of HIV/AIDS should be halted by 2015. However, it is clear that this has not happened. The use of condoms and other safe sex practices have been consistently low and do not seem to be improving. There also exists a vacuum in the knowledge of HIV/AIDS in society. Religious leaders and sociocultural taboos make open discussion of these issues and the providing of medical information publicly a difficult task. The lack of sex education in schools is another problem. Migrant workers, especially to the Arab world, are at a high risk of contracting HIV/AIDS because they stay away from their spouses for extended periods of time and are likely to engage with commercial sex workers. There are, of course, strategies that can be employed to improve the situation, but only after a generalised screening programme reveals the true extent of the disease in the country.
Authentic data is a prerequisite to designing interventions that can counter these multi-dimensional social and cultural issues. It is only after we know who is affected that we can prevent the further spread of HIV. A countrywide HIV screening programme in Pakistan is long overdue. This should have been carried out when the epidemic was still in its early stages; this was a decade ago. However, it’s better later than never. Every child, every man, and every woman should be screened. They should be screened in hospitals, schools, communities and everywhere else. This will have an enormous cost, but there is no putting a price on allowing 190 million lives to remain at risk. Very soon, we will be colliding head on with a disease that has destroyed many unsuspecting countries before. And we need to be better prepared, much better prepared.
Published in The Express Tribune, August 30th, 2015.