Is Pakistan Doing Enough to End the HIV/AIDS Prevalance in the Country?

It’s 2021, but the world is still struggling to put an end to the spread of HIV/AIDS. According to UNAIDS, “37.7 million people globally were living with HIV in 2020”. The epidemic continues to prevail due to misconceptions and misinformed opinions, which regretfully result in an increased risk of transmission. Since HIV and AIDS is a global issue, countries including Pakistan need to systematically address it, keeping cultural values and social norms in mind. The spread of HIV/AIDS is indeed a human rights issue, which impacts the well-being of human beings as well as their quality of life, which is why, on World AIDS Day, it is essential to address the current state of affairs concerning this treatable chronic medical condition in Pakistan.

Misconceptions And Identifying Key Populations

Misconceptions about the disease are more evidently seen amongst people with less access to media, the elderly, the less educated, people living in rural areas, and those who have poor economic conditions. Over population, poverty, misconceptions about HIV transmission, gender inequality, high levels of transactional sex are also pertinent factors which also contribute to the spread.

Contrary to popular belief, HIV and AIDS is not a disease that is limited to the lives of homosexual people nor is it limited to the act of intercourse. Unfortunately, there are various reasons that lead to this very transmission and those include, unsafe sexual intercourse, intravenous injections with contaminated needles, unscreened or contaminated blood transfusions, and poor infection control in hospitals and clinics. Further transmission can be due to an infected mother passing it on to the new born child during pregnancy, delivery or through breastfeeding. The spread can also be due to internally migrant men indulging in extramarital affairs with multiple partners, men having non-marital sex in their lives with male or female partners as well as transgender sex workers and the lack of condom use especially by those who already have STIs or STDs. Key populations identified in Pakistan are as follows:

1. Men who have sex with men (MSM)
2. Male sex workers (MSW)
3. Female sex workers (FSW)
4. Hijra sex workers (HSW)

It is indeed unfortunate that people who are already compromised economically are those who are highly affected, not to mention their lack of access to prevention, care and treatment. The most common group to be affected are adolescents, that too, in their most productive years, highly impacting their chances at personal and professional development, households, communities and economic growth of nations in the wider picture. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and other serious problems.

Education As A Pivotal Method To Control HIV Spread

According to UNICEF, having correct knowledge about HIV transmission increases safe sexual behavior and is considered to be an important step towards behavioural change altogether. However, in a country like Pakistan, where an overall conservative mindset prevails, especially regarding matters of the body and sex in particular and where sex education is banned in schools, it is extremely difficult to convey messages and lessons about safe sex, even if they are intended to be strictly educational. 

Ultimately, the lack of education has direct effect on the sexual and reproductive health of the population and can result in grave hindrances for policy makers, making it problematic for them to prepare adequate responses in light of budding information about the new generation. Therefore, there is a dire need for appropriate legislation that ensures and enables stakeholders, particularly the education and health sector to actively work towards the prevention and protection from HIV/AIDS without any fear. Implementing HIV/AIDS prevention education at schools as a serious commitment needs to be considered if the population’s sexual and reproduction health and rights (SRHR) are to be protected. Even though programs such as the National and Provincial AIDS Control Programs have been initiated for HIV treatment, better integrated HIV preventive health manuals, and other learning materials need to be made part of school curriculums.

Social Stigma And Discrimination Faced By People Living with HIV (PLHVI)

The biggest hindrance in addressing the issue openly is the stigma attached to the infected key populations and the discrimination that comes with it. The same kind of widespread discrimination exists among health care providers and at the community level which ultimately create barriers to accessing basic services.  Which is why it is extremely important to invest effectively in the training and sensitisation of health care providers. If a significant amount of attention and budgets are allocated to NGOs and CBOs (community-based organisations) in a way that services are physically delivered to the key populations in the community by the community. It is also severely important that testing and counselling is delivered in a non-judgmental manner that respects clients’ confidentiality, through experienced CBOs and active participation of members belonging to the target population. Not to mention, the services need to be delivered on the basis of informed consent, which means that the decision to get tested rests completely with the client. Furthermore, keeping the population’s working hours and locations need to be considered while delivering services so as to not interrupt their daily schedules. Health care providers and institutions need to extensively address HIV treatment and services for adults and children, which includes free antiretroviral treatment (ART), which is the main drug that treats HIV, managing the outbreak of other occurring infections and voluntary counselling and testing (VCT) services.

What Is The International Community Doing To Improve The Lives Of PLHVI?

The international community is committed to making the lives of HIV+ better. In fact, Goal 3.3 of The United Nations’ Sustainable Development Goals (SDGs) aims to eliminate AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases by year 2030. As per UNAIDS, one of the fast-track commitments in order to make that goal a reality includes the 90-90-90 treatment which includes the following: 

1. By 2020, 90% of all people living with HIV (PLHVI) will know their HIV status
2. By 2020, 90% of all people diagnosed with HIV infection will receive sustained antiretroviral therapy
3. By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression

According to a report compiled by Sharaf Ali Shah, Arshad Altaf, and Sten H. Vermund earlier this year, Pakistan is quite behind. Considering that in 2018, only 14% of PLHIV in Pakistan were aware of their HIV status and that there were 22,000 new infections that same year indicates that Pakistan still stands short in fulfilling the 90-90-90 treatment. 

Socio-Economic Implications Of Contracting And Living With HIV In Pakistan

In 2019, the mass outbreak of HIV in Sindh among babies and children was recorded as one of the worst cases ever heard. A popular child specialist, Muzaffar Ghangro in Rato Dero was accused of re-using dirty needles, causing this ruthless chaos. However, because of the disappointing conviction rate of criminals in this country, he is out on bail and not much has changed since the outbreak took place. Majority of the victims in this case belong to low-income families and continue to suffer today while fighting for health benefits for their wrongly infected children. Another outbreak caused by the same actions broke out in a village named Kot Imrana in Punjab the same year, infecting many middle and low-income people who were unaware of the existence of such a disease and its modes of transmission. Once completely oblivious of HIV, these people now are forced to live with it and its complications. 

Contracting the disease has socio-economic implications as well. Whereas, testing and counselling may be provided by the government, additional medicines such antibiotics and vitamins, which are also necessary to help build immunity are not covered and are generally not affordable by the common person. Accessibility to and from the testing centres is another feat considering families have to choose between paying for the travel fare and food.

Conclusion And Recommendations

With the spread of the COVID-19 pandemic, the delivery of health care and prevention services has been affected worldwide, including Pakistan. PLHIV who are not already not being treated are more vulnerable to catching COVID-19. The reasons behind some recent deaths of PLHIV cannot be verified as most people have not been tested for COVID-19. Thus, it cannot be said with certainty just how badly the pandemic has affected people already living with HIV/AIDS.

Needless to say, if we are to improve the quality of life of Pakistani citizens living with HIV, serious measures and commitment is needed to punish the criminals and culprits that exist within the health sector. That includes doctors with official qualifications. Existing programs aiming to disseminate appropriate training to health care providers and facilities to patients need to make sure HIV treatment centres that enable ART access exist not only in cities but on a district level as well. Professionalism needs to be a top priority for doctors to protect patient confidentiality, which would make it easier for patients to develop trust in the system, resulting in a higher number of patients who register and get tested for HIV. After all, everyone has the right to live a life of equality and non-discrimination.