Focus on blood banks and HIV/AIDS

Jamal Khan is so desperate to fund his drug habit that he sells his blood and begs in the streets of Pakistan’s southern port city of Karachi. "I can’t work, I can’t steal. What else can I do to buy heroin?" the 35-year-old asked IRIN, who routinely sells a bottle of blood to one of numerous blood banks in the North Nazimabad neighbourhood of Karachi whenever he can - sometimes as often as three times a month. His AB negative blood group has a market value of between US $7 to $10. His wife and two children left him soon after he stopped working as a taxi driver. "I tried my best to get rid of this addiction, but nobody helped," he said. Although he tested positive for hepatitis many years ago, he continues to sell blood unabated. There are thousands like Khan who sell blood as a last resort in order to eat and fund their drug habit in this South Asian nation. The problem is that inadequate screening of such blood means that whatever diseases the addicts may carry - including HIV/AIDS and hepatitis - are being passed on to the general population. "Some blood banks purchase blood from whomever goes to them without any proper screening," Saleem Azam, the president of the Pakistan Society - an NGO working with drug addicts and people living with HIV/AIDS - told IRIN from Karachi. The doctor noted there were around 100 blood banks in the city, but only 20 percent of them did the necessary screening, thereby becoming channels for the transmission of deadly diseases. In fact, a large proportion of professional blood donors like Khan have never been tested for HIV/AIDS. Azam believed there were half a million untested people nationwide currently selling bloods. "Those using drugs through intravenous injections pose the highest threat of transmitting HIV infection through blood for transfusions, and they are most likely to sell it," he said. It is estimated that between 70,000 and 80,000 of Pakistan’s population of 140 million is HIV positive. Official figures are much lower. Towards the end of last year, 1,942 cases of HIV and 231 of full-blown AIDS were reported to the National Aids Control Programme. While heterosexual transmission accounts for at least 40 percent of reported cases, exposure to infected blood or blood products accounts for about 19 percent. According to a World Bank report, about 40 percent of the annual 1.5 million blood transfusions in Pakistan are not screened for HIV. Whereas screening in the public sector has made progress, private blood banks lag far behind, with little enforcement of screening regulations. In 1998, the AIDS Surveillance Centre in Karachi conducted a study of professional blood donors and found that one in five were infected with hepatitis C, one in 10 with hepatitis B, and one percent with HIV. Birjees Mazhar Qazi, the national coordinator for blood transfusions at the National Institute of Health in the capital, Islamabad, told IRIN that, country-wide, there were some 170 blood banks in the public sector and 450 in the private sector. "These facilities are generally unsatisfactory, with extremes ranging from poor, fragmented services to state-of-the-art facilities meeting international standards," he said. Qazi added that in the government-run blood banks, the situation was much better. It is estimated that more than 90 percent of blood bags in the public sector are screened for HIV and hepatitis B and C. "The government is taking the issue very seriously and has introduced new legislation through the Safe Blood Transfusion Ordinance last year," he said, adding that this had initiated the establishment of federal and provincial blood transfusion authorities, which will ensure that there are organised, safe, blood transfusion services all over the country, with an increase in public awareness. And while the situation is particularly worrying in rural areas, some feel that there are even gaps in the capital. "There are insufficient equipment and testing facilities, and only a few institutions provide adequate safety measures," Aftab Alam, a lawyer with the NGO Consumer Rights Commission of Pakistan (CRCP), told IRIN. But despite critics saying new legislation on its own would have little impact, according to Abid Atiq, the national programme adviser for UNAIDS in Pakistan, the government was doing its best to improve the situation. "They have introduced a law for blood transfusion services. Hopefully things will improve further," he told IRIN in Islamabad. A visit to the state-run Pakistan Institute of Medical Sciences (PIMS) Hospital in Islamabad verifies such claims. About 900 blood donations take place at the hospital every month. According to Nasrullah Khan, who is in charge of the blood bank at PIMS, every bag is screened for HIV and hepatitis B and C. Just back from a ministerial HIV/AIDS conference in Nepal, where the spread of the disease through blood banks was highlighted, Pakistan's health minister told IRIN on Monday that untested blood was being eradicated from the system. "All hospitals by law cannot use the blood without the tests being carried out," Muhammad Nasir Khan explained, adding that all blood would be monitored closely by the health ministry. "We are also encouraging people to use blood transfusions from relatives," he added.