Islamabad warned over slow response to HIV/AIDS

Pakistan must expand the multi-sectoral response at all levels to avert the threat of an HIV/AIDS epidemic becoming established among the general population, according to a progress review mission. According to the findings of the HIV/AIDS joint review mission, the country no longer stands in the category of low HIV prevalence as a concentrated epidemic has already occurred among injecting drug users (IDUs), with a prevalence rate of about 7 percent in the provinces of Sindh and Balochistan. The joint review and scooping mission included representatives of the country's National AIDS Control Programme (NACP), UN agencies and other development partners. The mission identified eight key areas to be addressed as a priority, including the comprehensive behaviour change communication strategy for the general public, an idea strongly endorsed in the HIV/AIDS Asia Pacific conference held in early December in the Pakistani capital, Islamabad. "Most of the awareness raising advertisements are being made by profit-oriented media firms, who do not have a clear understanding of the issue. So how they can come up with an effective campaign for an issue considered taboo in society at large?" asked Dr Muhammad Zakir, manager of the HIV/AIDS programme at Greenstar Social Marketing, a health sector NGO. He was speaking to IRIN from the southern port city of Karachi, capital of Sindh province. Health experts say that HIV/AIDS is a very sensitive issue in Pakistan. "Media campaigners may come up with a good campaign to promote a commodity, but they do not have any doctors, any public health specialists in their creative department. That's why so far our media campaigns have been unsuccessful in delivering the all-inclusive message to the public, ultimately promoting stigma and discrimination," Zakir added. The five-year Enhanced HIV/AIDS Control Programme of the NACP, started in 2003, has four main components: expansion of interventions for vulnerable populations, HIV prevention awareness for the general public, prevention of transmission through blood transfusion, and capacity building of people dealing with the programme. The mission also sets out to involve sectors other than health, such as law-enforcement agencies and the corporate sector. Earlier this year the International Labour Organisation (ILO) conducted a sensitisation programme for policy makers, industrialists and trade union leaders. Under the HIV/AIDS project for workers' education, ILO also conducted some training workshops and seminars for more than 1,000 long distance truck drivers and more than 20,000 industrial site workers. However, no programme has yet been launched by the country's corporate sector. The review mission noted that aspects of confidentiality and human rights are not being observed when providing services to high-risk population groups and dealing with people living with HIV/AIDS. "Our hospital staff, and sometimes doctors themselves, are found to be involved in discrimination against HIV-positive people. Disregarding ethics, they sometimes leak the identity and bio-data of patients. As a result they [HIV infected] lose their confidence and ultimately die in unknown circumstances," Zakir said, stressing the need to train medical staff. A weak response to sexually transmitted infections (STIs), both at management and research levels, was another area of concern pointed to in findings of the review team. Affiliated with the Washington-based Population Services International (PSI), Greenstar Social Marketing has worked in the family planning sector since the early 1990s, with a network of basic health centres across the country. The practitioners at Greenstar maintain that although society now has some awareness of STIs, the acceptance of safe practices is still largely absent, even among the communities aware of the hazards. The mission's findings highlighted a serious coordination gap at various levels among service providers including government agencies, UN agencies and NGOs. The care and support of People Living With HIV/AIDS (PLWHA) was identified as an emerging challenge to the current response. The mission emphasised the need to improve the quality of life for PLWHA through the provision of medical, social and material support without stigmatisation or discrimination. An "Inventory of HIV/AIDS Control Activities in Pakistan", a publication of Pakistan UNAIDS Theme Group, noted that out of nearly 200 NGOs, only three or four are working with PLWHA. Pakistan is currently classified by WHO/UNAIDS definitions as a low prevalence but high-risk country due to a number of varied factors including a low literacy rate, a high prevalence of STIs, limited safety in blood transfusions, increasing number of injecting drug users and a highly mobile refugee population. According to the NACP, some 2,462 HIV/AIDS cases have been reported so far since the programme started in 1986, of which 286 were full-blown AIDS cases. The programme also records a 7:1 male to female ratio. However, UNAIDS estimates that there are 70,000 to 80,000 HIV/AIDS cases in the country.