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Why Is HIV a Concern in pakistan?

Author: Sehar Salim Virani

Currently in Pakistan, 42563 individuals are registered cases of HIV out of which only 24606 cases are receiving Anti-retroviral therapy. However, it is estimated that around 0.18 million people must be infected with HIV but many cases have not been reported to the stigma associated with the disease and the fear of discrimination.

The recent surge in HIV infected individuals in Larkana, in July 2019 raising concerns, as majority of the cases were in children under 15 years of age. This clearly showed poor health practices and lack of sterilization that lead to this surge.

WHAT IS HIV AND AIDS?

Our immune system consists of components that help us fight against infections. HIV is a type of virus that weakens our immune system making us vulnerable to a lot of other infections, increasing the risk of developing serious conditions with opportunistic infections such as pneumonia.

HIV infection has three phases. Initially, the acute phase is characterized by fever, weakness, rash and other symptoms mimicking flu. The second phase is latent phase when the patent doesn’t usually show symptoms. Lastly, AIDS is the final stage of HIV infection that is characterized by an extremely weakened immune system and multiple complications.

Currently, there is no cure for HIV. Anti-retroviral therapy (ART) helps to prevent extreme weakening of the immune system and occurrence of opportunistic infections, keeps the level of virus very low in the body so that it is not able to detect it, decreasing the risk for transmission. Thus, ART is greatly effective in improving the length and quality of life after diagnosis of HIV, but it doesn’t cure the disease and the risk for infections and complications remains.

STIGMA AROUND THE DISEASE

In Pakistan, individuals infected with HIV have to face a lot of discrimination in their workplace and society because of their disease status. These individuals along with their family members and people who care for them or work in this field face a lot of negative attitude, injustice and inequality in terms of income, education, access to health facilities and housing. The lack of awareness and illiteracy has given rise to various myths in the society about HIV infection that has contributed to the stigma. Various studies have shown that this stigma has led to feelings of guilt and shame, stress, anxiety and depression.  

Another factor that has contributed to the stigma is denial of the spread of HIV in Pakistan.  Pakistan is an Islamic republic where religion plays a very important role in every aspect of the society. Since Islam prohibits homosexuality and sex outside of marriage, together with taboos against homosexuality and HIV being considered as the disease for ‘sinful’, strengthened by social and cultural norms have led to the belief that HIV is not a threat in Pakistan. This has augmented the lack of awareness and development of myths related to the infection.

MYTHS ABOUT HIV INFECTION

1. If diagnosed with HIV you have a very short time to live.

As, previously mentioned that Anti- retroviral therapy is effective in improving life expectancy and preventing transmission.  Deaths due to AIDS are rare because of the efficacy of its treatment.

2. You can get HIV by being around an HIV infected individual

HIV is a blood borne infection. This means that it can be transmitted by contact with body fluids (blood, semen, vaginal or rectal fluids and breast milk) of an infected individual. Examples of transmission include, vaginal or anal sex, sharing needles or syringes with an infected individual (most common in injection drug users and less commonly through tattooing), during breastfeeding, during pregnancy or delivery from mother to infant, transfusion of infected blood, etc.

HIV does not spread by skin to skin contact, shaking hands or hugging, air or water, sharing food or drinks, sharing toilets, mosquitos or insects.

3. An HIV positive individual cannot plan a safe pregnancy

If the infected individual is on ART as recommended by health practitioner, then the risk for transmission can be reduced to less than 1%. This is possible because the therapy reduces the level of the virus in the body to negligible so that it cannot be transmitted.

4. Pakistan is an Islamic state so HIV is not an issue in this country

The Larkana example shows that HIV is not transmitted sexually only. Further there are many individuals that inject drugs and are at a high risk for infection. Currently there are 7693 HIV infected people who use injection drugs and are receiving treatment for HIV. Many of injection drug users are not reported. Sex workers and same sex contacts are also practiced secretly in Pakistan. This population is at the highest risk for infection

5. One can get infected with HIV only by sexual contact with sex workers or same sex contact

This myth has given rise to the negative attitude infected individuals face resulting in stigma associated with the disease. However, it has already been mentioned above that the infection can be transmitted by other methods as well and it can infect anyone, not just a group of people in the society.

These are few of the many myths that are found in our society. With the infection becoming more common, it is essential that we take steps in order to control it.

HOW CAN WE DEAL WITH HIV EPIDEMIC?

  • Awareness regarding the transmission and prevention of the disease will greatly help to control the spread of the disease. High risk populations and rural areas should be specifically targeted.
  • Introduction of screening and monitoring access to treatment is essential.
  • Promotion of safe sex practices such as the use of condoms.
  • Prohibiting the use of unsterilized needles especially in small neglected health facilities in rural areas and blades in barbers’ shops.
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