HIV – a national and growing crisis

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There is a burgeoning national emergency that grows almost by the day and it is HIV. Ask the averagely educated man or woman in the street what HIV is and there may be some awareness that it is associated with AIDS and that it is an STD – a sexually transmitted disease. It is, but in the case of HIV that is only a part of the story. It is in the headlines nationally and internationally because over 520 people, the majority of them children, have tested positive for HIV in the Ratodero district of Larkana. There is no suggestion that these children, now condemned to a life of illness and ostracism, were in any way sexually active – so how did they become infected? And what about the 20,000 reported new HIV cases in 2017? Are they all the result of sexual activity? No they are not.

According to the UN Pakistan has the second-fastest growing HIV population in south Asia and the rate of growth shows no sign of diminution, indeed the opposite. The causes are multi-factoral, no single factor dominates but there is an area where intervention could be made positively. The Sindh Assembly in the last week has seen a heated exchange when there was an attempt to get the Ratodero cases discussed which descended into disorder – which is about the last thing the crisis is in need of.

There is no shortage of evidence that one of the issues at the core of the spread of HIV is the use of unsanitary and unsterilised equipment, the re-use of syringes and other implements or tools that should be single-use, and rampant malpractice both by doctors who are qualified and ought to know better and quacks who could not care less one way or another.

The current hubbub which is generating more heat than light was triggered by a single case – Fatima was the 16-months-old child to be first diagnosed in the Ratodero epidemic. The local child specialist Dr Muzaffar Ghangharo (his medical qualifications are unconfirmed) who examined or treated all of the children has AIDS and has been arrested. Police are trying to establish whether he infected children maliciously or by bad practice, re-using cannulas and needles. Four children in the village have died, 435 are tested positive at the time of writing and the area is enveloped in fear, entirely justifiably. Sixty percent of those diagnosed are under 5 years and Imran Akbar, the doctor who first diagnosed Fatima, is on record as saying that these cases are likely to be ‘the tip of the iceberg’.

The Sindh government established an AIDS control programme in 1995 but it has been largely inactive since inception, and the responsible authorities have failed to disseminate information either to medical professionals and paramedics, including information on best and safe practice to qualified doctors. Ear and nose piercing is believed to be the source of much of the infection, as well as unsafe sex – the failure or refusal to use a condom – in both homosexual and heterosexual relationships.

The Guardian newspaper in the UK started asking questions and was informed by the Pakistan health ministry that there are 23,000 HIV cases registered across the country – but with 20,000 new cases reported in 2017 alone this seems to be a gross underestimation by the ministry that ought to have accurate data at its fingertips.

Another factor in the spread of HIV which is almost never debated is the role played by new technology and social media. In many countries these have been used in the fight against HIV but in Pakistan they have reportedly led to an increase in infections in young people as new paths open for social encounters. This is especially true for gay men and gay sex workers whose smartphones allow them contacts with partners without going to the streets. A 2017 survey by the National Aids Control Programme established that 39% of those infected with HIV found their sexual partners via their mobile phones. It must also be noted that the same effect is noted in the west, and warnings are issued in both the UK and the US as to the dangers of using dating apps such as Tinder or Grindr to set up casual meetings that become sexual.

With sex education virtually non-existent in Pakistan schools and the perceived shame associated with being gay or HIV positive, it is not difficult to see a national problem reaching epidemic proportions in short order.

There is virtually no public discourse around the subject of HIV/AIDS. The state is completely unprepared to cope with this at any level federally or provincially. That said and as referenced above there is a positive intervention that can be made that will have an immediate impact – a nationwide drive to reduce the re-use of single-use medical equipment and concerted efforts to raise awareness of the dangers of doing so among all those practicing any sort of medicine, and that includes the many hakeems and quacks. That at least may start to reduce the incidence of HIV. Do nothing and pay the price. Grasp the nettle and just maybe avert a national catastrophe.