Each year December 01 is celebrated around the world as International AIDS Day to renew the commitment of the world community to spread awareness and find ways to combat this disease. There are an estimated 36 million people currently living with HIV and AIDS worldwide, of which at least half are women and 98% of these women live in developing countries.
AIDS (Acquired immunodeficiency Syndrome) is a disease that weakens the immune system and makes the victim vulnerable to infections and cancers that may result in death if left untreated. AIDS is caused by the HIV (human immunodeficiency virus), and is spread through contact with infected blood or secretions. Since the HIV epidemic is largely connected to behaviours that expose individuals to the virus, studies have focused strongly on awareness and promotion of safe sex as being at the center of HIV prevention strategies. Risk factors that encourage the spread of disease in developing countries, especially in Asia which houses 60% of the world’s population, include low literacy rates, crippling poverty, high fertility combined with low contraception usage and topped by poor access to health and education facilities.
Pakistan is the second largest country in South Asia, and WHO and UNAIDS estimate the number of HIV/AIDS cases in Pakistan to be around 90,000, while national statistics report them to be at a modest 5,000 – the discrepancy points to the fact that a vast majority of cases go unreported due to social taboos about sex and victims’ fears of discrimination. Pakistan has been a low HIV prevalence country with only 0.1% afflicted among its general adult population, but is increasingly faced with a threat from a high number of injecting drug users (IUDs) and has now moved into what is known as the transition phase.
To respond effectively to this threat, Pakistan started its National AIDS Control Programme (NACP) in 1986, which has shown productive outcome in line with its objectives of “prevention of HIV transmission, safe blood transfusions, reduction of STD transmission, establishment of surveillance, training of health staff, research and behavioral studies, and development of programme management.” NACP program partners include World Bank, WHO, DFID, CIDA, GFATM, GTZ, UNAIDS, UNODC, UNFPA, UNICEF, UNIFEM, CDC Atlanta, Clinton Foundation and the GFA Consulting Group. The NACP through its centers across the country has made possible access to treatment and information to many victims, while maintaining data and providing research opportunities towards the larger goal of prevention and eradication despite facing challenges. The NACP is also providing free treatment to patients in its 20 centers across the country.
The modes of HIV/AIDS transmission in Pakistan relies largely on heterosexual transmission and contaminated blood or blood products as the most commonly reported vehicles. Other transmission methods include injecting drug use, male-to-male or bisexual relations and mother-to-child transmission, while HIV prevalence is 1% to 2% in high-risk populations such as female sex workers and long-route truck drivers.
Pakistan’s general population finds itself at potential risk through an general attitude of low compliance with infection control procedures including handling of blood transfusion and use of unsterilized medical instruments. Studies indicate that a high percentage of injections are administered with used injection equipment due to shortage of funds. According to WHO estimates, unsafe injections account for three percent of new HIV cases in Pakistan. It is also estimated that 40 percent of the 1.5 million annual blood transfusions in Pakistan are not screened for HIV. Moreover, in 1998, the AIDS Surveillance Centre in Karachi conducted a study of professional blood donors and found that 1% of them were infected with HIV.
IDUs remain at a considerably higher risk of contracting HIV infection in Pakistan because they often indulge in high risk practices of sharing syringes. Since Pakistan neighbours a major opium producing country, Afghanistan, a percentage of its vulnerable young-adult population has been addicted over the years. With a growing number of drug abusers, in 1999 the United Nations Office of Drugs and Crime (UNODC) had conducted studies in Lahore on changing methods of drug ingestion from inhaling to injecting, and warned of a rise in HIV cases. As predicted, the country saw an increase from 9% in 2005 to 21% HIV prevalence among injecting drug-users by 2009.
While there is little documentation about homosexual relations in men in Pakistan due to religious and cultural taboos, evidence from various studies suggests it is prevalent throughout the country. According to WHO, "Asia is believed to have the world's largest number of [MSM], estimated at 10 million.” Sexual activity between men is likely present in boys’ hostels and jails, and in the groups of transvestites, transsexuals and eunuchs who are known to engage in unsafe sexual practices due to their disadvantaged socioeconomic and educational status.
Gender inequalities are also known to facilitate the further spread of HIV/AIDS among women in male dominated cultures in Asia in general. The status of women in Asia makes them especially vulnerable to HIV, and they suffer from a lack of access to support systems for HIV too. The number of women infected with HIV in Asia rose to 20 percent between 2003 and 2005, compared with a 17 percent increase for the region's total population, (UNAIDS 2005).
Pakistani women in general have less socio-economic independence and have less decision-making power than men. Gender disparities are rampant in many fields, e.g. female literacy rate in Pakistan is at 35% for women and 59% for men. Despite social stigma, commercial sex is also prevalent in all major cities of Pakistan. Owing to their low social status, female sex workers (FSWs) are often exploited and abused, and have little legal recourse or protection. Many behavioral studies indicate that female sex workers have little or no understanding of safe practices which makes them more vulnerable to STIs and HIV/AIDS. Furthermore, these sex workers often lack the power to negotiate safe sex or seek treatment for STIs and one study indicated that only 2% of female sex workers said they used any form of contraception with clients.
A big hurdle in treatment options for women is, however, the stigma attached to being related to an AIDS patient. Many women are shunned by not only their neighbours, but also close family members for the crime of association. Sometimes, after losing the husband to AIDS, women become more vulnerable to abuse. They face open hostility, and their children also suffer social isolation. Many women are excluded from inheriting property, cast out of their homes by in-laws and end up with severe food insecurity and lack of long-term sustainable livelihood as well as lack of support and care systems for treatment and life-saving drugs. Children of these women, or those born to HIV positive mothers, suffer widespread discrimination too. UNICEF sources claim only 38% of children under 15 living with HIV in the developing world received antiretroviral treatment which is considered extremely important for sustainability of victims.
The epidemic of HIV/AIDS in the developing world requires a consistent focus of respective governments and constant support of the world community in employing effective strategies based on timely prevention of HIV transmission, safe blood transfusions, training of health staff, continuing research and development of program management on a large scale, supported by an enabling environment. Hopefully, the World AIDS Day will serve to keep the focus on this important issue alive.
SOUTHASIA, 'The AIDS Challenge, Dec 2010.