‘Frontier province has 191 registered cases of AIDS’

Official says PACP curing HIV patients at special clinics: About 37.2 million people the world over were reported HIV/AIDS victims in 2006

By Muhammad Shahid 

PESHAWAR: The HIV/AIDS has spread throughout the world and the developing countries like Pakistan lack resources to contain the disease.

NWFP Aids Control Programme (PACP) Project N Manager Hashmat Babi told this scribe that there were 191 registered cases of AIDS in the province. In November 2006, he added, the reported number of HIV/AIDS infected people was 37.2 million the world over, in addition to 2.3 million HIV infected children.

About treatment of AIDS victims, Hashmat Babi said the PACP had set up special clinics for the patients’ treatment.

There are many reasons for the spread of the deadly disease and some of them are given in the following lines:

High risk behaviour among Injecting Drug Users (IDUs): IDUs are at a high risk of acquiring HIV and other blood borne infections because they often resort to unsafe practices such as needle and syringe sharing. Pakistan is a major transit and consumer country for opiates from neighbouring Afghanistan, the world’s largest producer of opium.

As far back in 1999 the United Nations Office of Drugs and Crime had conducted studies in Lahore that revealed that addicts were switching methods of drug ingestion – moving from smoking or “sniffing” or inhaling to injecting polydrug cocktails. This, the UNODC had warned could lead to increase in HIV as needle sharing and use of non-sterile equipment was common.

The number of drug dependents in Pakistan is currently estimated to be about 500,000, of whom an estimated 60,000 inject drugs. It is also unlikely that outbreaks which have been witnessed in 2004 are likely to be contained or limited to one area. Many of these injectors move from city to city (21% of the Karachi users had also injected in other cities) and a very high proportion of them use non-sterile injecting equipment (48% in Karachi had done so in the week before the survey was conducted). Risk behaviour in Lahore city is even higher: 82% of injectors had used non-sterile syringes in the previous week, 35% did so all the time, and 51% had injected in another city in the previous year, according to Pakistan’s Ministry of Health. An HIV epidemic among injecting drug users was reported in 2004 in Pakistan’s Sindh province, in the town of Larkana where almost 10% of drug injectors tested HIV-positive. Knowledge of HIV among injectors (and sex workers) is extremely low. In Karachi, Pakistan’s main trading city, more than one quarter had never heard of AIDS and many did not know that using non-sterile injecting equipment could result in infecting them with HIV, according to Ministry of Health’s findings.

Unsafe Practices among Sex Workers: Female sex workers (FSWs) and female migrant workers are often exploited and abused, and have little recourse due to their low social status and limitations in legal protection. Commercial sex is prevalent in major cities and on truck routes. Behavioral and mapping studies in three large cities found a sex workers population of 100,000 with limited understanding of safe sexual practices. Further, sex workers often lack the power to negotiate safe sex or seek treatment for STIs.

Recent findings indicate that although HIV prevalence remains below 1 percent, FSWs and their clients report low condom use. Meanwhile, in Karachi, one in five sex workers cannot recognise a condom, and three-quarters do not know that condoms prevent HIV (in fact, one third have never heard of AIDS), reports UNIADS Update 2005. It is therefore little wonder that only 2 percent of female sex workers said they used condoms with all their clients in the previous week.

In addition to the lack of knowledge and low use of condoms, there is a high degree of sexual interaction between drug injectors and sex workers. Ministry of Health findings reveal that over 20% of female sex workers in Karachi and Lahore had sold sex to injecting drug users and condom use was very low during those encounters. Among injecting drug users in Lahore, almost half had had sex with a regular partner in the previous year, one third had paid for sex with a woman (11% used a condom consistently) and almost one quarter had paid for sex with a man (5% used a condom consistently). Male sex workers also trade sex with injectors, 20% of whom reported buying anal sex in the previous year (and only 3% of them used a condom consistently).

Men who have Sex with Men (MSM): While there is little documentation about the extent to which men engage in sexual activity with other men in Pakistan, the limited evidence available suggests that such activity does occur throughout the country. Anecdotal evidence indicates that sexual activity between men occurs relatively frequently in boys’ hostels and jails; additionally, research suggests that sex between men is often practiced among long distance truck drivers. Finally, there is a small but highly mobile population of transvestites, transsexuals and eunuchs known as the hijra, who are known to engage in unsafe sexual practices. Lahore had an estimated 38,000 MSM in 2002. The MSM community is heterogeneous and includes Hijras (biological males who are usually fully castrated), Zenanas (transvestities who usually dress as women) and masseurs. Many sell sex and have multiple sexual partners.

Inadequate Blood Transfusion Screening and High Level of Professional Donors: The collection and transfusion of blood and blood products, the use and re-use of unsterilised medical instruments (especially needles and syringes) and the generally low level of attention to standard infection control procedures are important potential avenues for the spread of HIV in Pakistan’s general population. In 1998, the AIDS Surveillance Center in Karachi conducted a study of professional blood donors: people who are typically very poor, often drug users, who give blood for money. The study found that 20 percent were infected with Hepatitis C, 10 percent with Hepatitis B, and 1 percent with HIV. About 20 percent of the blood transfused comes from professional donors.

Large Numbers of Migrants and Refugees: Migration can create conditions in which people become vulnerable to infection. It is commonplace in Pakistan for men to travel away from their homes to find work, either within the country or abroad. This separation from their spouses, families and communities can result in loneliness and isolation, and can lead migrants to engage in social and sexual practices that put them at risk of exposure to HIV.

Unsafe Medical Injection Practices: Pakistan has a high rate of medical injections – around 4.5 per capita per year. Studies indicate that 94 percent of injections are administered with used injection equipment. Use of unsterilized needles at medical facilities is also widespread. According to WHO estimates, unsafe injections account for 62 percent of Hepatitis B, 84 percent of Hepatitis C, and 3 percent of new HIV cases.

Sexually Transmitted Infections (STIs): Personal awareness and knowledge of reproductive health issues is limited, and often erroneous, among the men and women of Pakistan due in part to the generally low levels of education, and also due to their limited access to effective reproductive health services.

The 2004 STI survey found that 4% of MSMs in Karachi were infected with HIV, as were 2 % of the Hijras in the city. Syphillis rates were also high with 38% of MSMs and 60 % of Hijras in Karachi infected with the disease. As a consequence, sexually transmitted infections rates are high: in Karachi, 18% of injectors were found to be infected with syphilis, as were 36% of male sex workers and 60% of Hijras or transgendered persons.

Gender Inequalities: This may also play a facilitating role in the further spread of HIV/AIDS in Pakistan. Pakistani women in general have lower socio-economic status, less mobility and less decision-making power than do men, all of which contributes to their HIV vulnerability. For example, because of gender disparities in educational enrolment, the female literacy rate in Pakistan is much lower than that of males (35% for women as compared to 59% for men according to the Government of Pakistan’s Economic Survey 1999-2000).

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