NationalVOLUME 14 ISSUE # 22

Pakistan’s HIV problem

Once Bill Gates said, “AIDS itself is subject to incredible stigma.” The Sixty-ninth World Health Assembly endorsed a new Global Health Sector Strategy on HIV for 2016-2021. The strategy includes five strategic directions that guide priority actions by countries and by WHO over the next six years.


The strategic directions include: Information for focused action, interventions for impact (covering the range of services needed), delivering for equity (covering the populations in need of services), financing for sustainability, innovation for acceleration (looking towards the future). WHO is a cosponsor of the Joint United Nations Programme on AIDS (UNAIDS). Within UNAIDS, WHO leads activities on HIV treatment and care, HIV and tuberculosis co-infection, and jointly coordinates with UNICEF the work on the elimination of mother-to-child transmission of HIV.

The strategy builds on the extraordinary public health achievements made in the global HIV response since WHO launched the Special Programme on AIDS in 1986. It continues the momentum generated by the Millennium Development Goals and the universal access commitments. The recent surge in detection of HIV-positive cases in just one taluka of Larkana district has painted a bleak picture of the existing healthcare system in Sindh, where a number of bodies exist to fight HIV and other diseases but the situation has turned alarming.


Larkana is considered to be the political capital of the ruling Pakistan Peoples Party (PPP) and increasing numbers of such ailments indeed reflect poorly as far as its tall claims of good governance are concerned. The situation calls for a thorough audit of the healthcare system and related aspects. The conditions at the primary and secondary level of health facilities are enough to make one worry.


Just a couple of years ago, close to 100 people, out of 13,600 measles patients, died in seven districts of upper Sindh after the Expanded Programme of Immunisation (EPI) had failed to achieve required vaccination coverage and dying children in Thar is another tragedy. Recent screening of 21,375 people for HIV, 681 found infected and 537 of them are children.


Without immediate and proper attention, the HIV emergence can develop into full-blown cases of AIDS. Also, quackery apparently is the leading cause behind the current outbreak of HIV-positive cases in Larkana, as quacks reused syringes for patients. If community screening is carried out elsewhere, as carried out in villages of Hyderabad district by Peoples Primary Healthcare Initiative (PPHI), it would end up in more HIV cases.


Sindh Health Minister Dr Azra Pechuho disclosed that Hyderabad district was another high-risk area for HIV/AIDS in Sindh. Initially, Sindh’s AIDS Control Programme manager Dr Sikandar Memon had claimed 10,000 HIV cases were there in Sindh. In Larkana, a doctor, who himself tested positive for HIV during screening, has been arrested. He was accused by the Larkana deputy commissioner “of infecting 15 children” but health services director general Dr Masood Solangi disputed the DC’s statement and termed the doctor “insane” though the DIG police rejected the claim. But, there is no explanation whether the 15 children were infected by him.


Bodies, like the Sindh Blood Transfusion Authority (SBTA), Sindh Healthcare Commission (SHCC) and the AIDS Control Programme, apparently work in isolation. Whereas they need to expand the scope of screening to other districts. The SBTA’s task is to curb unsafe blood transfusion through unregistered blood banks. However, over the last several years it failed to make its presence felt effectively until it was headed by Dr Zahid Ansari. The authority had even declined to run German-funded blood centres in Sindh.


Now, Dr. Dur-e-Naz Jamal as its new head, visited Larkana against the backdrop of the HIV-positive cases and got some unregulated facilities closed. The AIDS Control Programme has not been able to reduce the HIV burden and it is not sharing correct statistics of the disease that may otherwise enable the government to combat AIDS, lest it attains epidemic proportions in other parts of Sindh, too.

Reports said that the World Health Organisation (WHO)-recommended kits for blood screening were not used even at the privatised health facilities. “No third-party evaluation is done in respect of the BHUs, so far run by the PPHI to see what qualitative change it had brought about. While services were being privatised, the much-talked about change in the delivery of qualitative healthcare still remained a distant dream.

HIV continues to be a major global public health issue, having claimed more than 35 million lives so far. In 2017, 940 000 people died from HIV-related causes globally. A major factor that must be accounted for in the overall HIV transmission scenario is the rampant use of therapeutic injections, often with non-sterile injection equipment. There are an estimated 800 million therapeutic injections given annually in Pakistan or approximately 4.5 per capita. This is among the highest in the world. This has led to the prevalence of Hepatitis C infection.

HIV can be suppressed by combination ART consisting of three or more ARV drugs. In 2016, WHO released the second edition of the consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. By mid-2018, 163 countries already have adopted this recommendation, which covers 98% of all PLHIV globally. Expanding access to treatment is at the heart of a set of targets for 2020 which aim to bring the world on track to end the AIDS epidemic by 2030.

Ending the AIDS epidemic will require rapid acceleration of the response over the next five years and this can only be achieved through renewed political commitment, additional resources, and technical and programmatic innovations.

It will guide efforts to accelerate and focus HIV prevention, enable people to know their HIV status, provide antiretroviral therapy and comprehensive long-term care to all people living with HIV, and challenge pervasive HIV-related stigmatization and discrimination.