HIV/AIDS: A GROWING EPIDEMIC IN PAKISTAN

HIV is not currently a dominant epidemic in Pakistan. However, the number of cases is growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the AIDS epidemic to take hold in Pakistan, mainly among injection drug users, some male sex workers and repatriated migrant workers. AIDS may yet become a major health issue.Pakistan has seen an eight-fold increase in HIV cases between 2001 and 2012, said a UN report on the eve of the World AIDS Day. The report calls for a rapid increase of voluntary confidential community-based HIV testing and counselling for populations at higher risk in the region.

The report, ‘HIV in Asia and the Pacific: Getting to Zero,” released by the Joint United Nations Programme on HIV/AIDS, says that emerging epidemics are becoming evident in 12 countries in Asia and the Pacific region, where an estimated 4.9 million were living with HIV in 2012.

The 12 countries account for more than 90 per cent of people living with HIV and of new HIV infections in the region.

The countries are Cambodia, China, India, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Papua New Guinea, the Philippines, Thailand and Vietnam.

According to the report, Pakistan introduced the “third gender” option for identity documents and Nepal recognised “third gender” in the national census.

The report points out that inadequate focus on key populations at higher risk of HIV infection and geographical areas with higher HIV burden mean that most countries in the region are not progressing fast enough to reach global targets on HIV prevention, treatment, care and support.

While significant progress has been seen in some countries — with some reducing new HIV infections by over 50pc since 2001 — impact appears to be slowing with overall number of new HIV infections across the region remaining largely unchanged in the past five years.

Pakistan is the second largest country in South Asia that stands only a few steps behind India and Nepal in terms of HIV epidemic. Until recently Pakistan was classified as a ‘low prevalence high risk’ country but now Pakistan is in a ‘concentrated phase’ of the epidemic with HIV prevalence of more than 5% among injecting drug users (IDUs) in at least eight major cities. However, the country still has a window of opportunity as the current estimates, using the various latest prevalence estimation models; indicate that the HIV prevalence among general adult population is still below .1%. According to the latest national HIV estimates there are approximately 97,400 cases of HIV/AIDS in Pakistan. 

In a message on the AIDS Day, President Mamnoon Hussain said that as HIV is an issue of global concern it is important that the international community focuses on AIDS prevention and cure in the less developed countries and thereby help make Pakistan and the whole world HIV and AIDS free.

He said that promulgation of ‘Blood Safety Ordinance’ both at federal and provincial levels and supply of diagnostic kits and laboratory consumables and equipment to all provincial, AJK, Fata and federal centres are critical advances in the fight against the disease.

Globally new HIV infections have dropped so as Aids related deaths with effective interventions but in Pakistan new HIV infections have been increasing, according to government and international health organisation estimates.
Pakistan is a signatory to the MDGs; goal 6 of which states that Pakistan will “halt and begin to reverse the spread of the human immunodeficiency virus (HIV) that causes AIDS” by the year 2015. But the key challenges hampering the fight against the disease are stigma attached to the disease and financial constraints.
With global funding gradually decreasing for AIDS and diverting towards other health problems due to drop in cases internationally, the financial worries may turn worse when the government will have to support the AIDS control programme solely after 2015, said National Aids Control Programme (NACP) Manager Muhammad Javaid.
More than 130,000 people are HIV infected in Pakistan and only 7819 are registered. People Living with HIV (PLHIV) in various centres and of them merely 3700 have access to treatment with AIDS drugs – known as antiretroviral therapy (ART). The number has increased from 90,000 in 2011 to 130,000 in 2013, according to estimation of NACP, UNAIDS and World Health Organisation.
In Pakistan, proportion of reported to estimated PLHIV is lowest in the region (3.0 per cent); the ART coverage is approximately 9.8 per cent and number of Injecting Drug Users (IDUs) receiving ART per 100 HIV-positive IDUs (2009) is less than 1 per cent. In addition, laws protecting PLHIV against discrimination and preventing obstacles to access to HIV services for vulnerable sub-populations, are also not existent in Pakistan.
HIV treatment, care and support facilities are available to HIV infected people, in Pakistan, through 18 ART centers, 16 Voluntary Counselling and Testing (VCT) Centers and 7 PPTCT sites for pregnant women. Under Global Fund Round 9 till now 11 Community and Home Based Care (CHBC) sites has been established but majority of the treatment, care and support facilities are confined to key cities. In the cities too few people wish to register themselves and among the registered also very few turn up for treatment.
Though, the first case was reported in Pakistan by a migrant worker but the prevalence ratio is not alarming among them and one of the major causes of spread here is unsafe blood transfusion by private blood banks as aforementioned data show around 95 percent patients remain unidentified in the country due to lack of diagnostic and counselling centers and awareness.   Health experts also say that sexual behaviors changing in Pakistan like global trends and homosexuality is becoming one of the major risk factors for the infections here too.
Though, there has been an upward trend in HIV prevalence among  key population that are at risk but Hijra Sex Workers are at higher risk and in contrast to the common perception there has been slight increase in new infections among Female Sex Workers.
A 2011 NACP study has found prevalence of HIV infection 1.6 percent among Male sex workers (MSWs); and 0.6 percent among Female sex workers (FSWs). Amongst ‘Hijra’ & Transgender sex workers prevalence was at 5.2 percent and 27.2 percent among Injecting Drug Users (IDUs) while prevalence of HIV among General public is less than 1 percent.
There is no authenticated data on deaths available but according to registered patients with ART centers about 5800 died with HIV so far.
World AIDS Day is celebrated on 1 December (today) every year to raise awareness about HIV/AIDS and to demonstrate international solidarity in the face of the pandemic.
The day is an opportunity for public and private partners to disseminate information about the status of the pandemic and to encourage progress in HIV/AIDS prevention, treatment and care around the world, particularly in high prevalence countries.
Between 2011-2015, World AIDS Day has the theme: “Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths”.
There is a need to make aware population to protect future generations from this deadly disease since there is no vaccine or no definite cure of AIDS, said the programme manager. Prevention of HIV infection is the only answer and early access to treatment with AIDS drugs for those who test positive as providing AIDS drugs earlier for those infected with HIV would allow them to live longer and healthier lives, and help reduce the risk that they transmit HIV to others. And for this the government administration, religious groups, civil society and the media will have to work in tandem.

More information can be found at: http://www.unaids.org/en/regionscountries/countries/pakistan/