Alarming rise in HIV-AIDS cases shows Pakistan took no lessons from 2019 Sindh outbreak

Pakistan is witnessing a troubling surge in HIV (human immunodeficiency virus) cases, sparking concerns among health officials and international organizations. 

The recent rise in HIV cases has exposed that the country did not take any lesson from the 2019 HIV outbreak that occurred in the southeastern Sindh province, where at least 895 HIV cases were confirmed, with children making up 80 percent of the number.

Local media reports said that Pakistan has seen a significant rise in HIV infections, particularly over the past few years, and this alarming trend has been attributed to several factors, including inadequate healthcare infrastructure, lack of awareness, stigma, and unsafe medical practices.

According to an editorial published in Pakistan’s leading English daily, the Dawn, the country’s government’s inability to put its people first, a rickety health infrastructure, and ignorance among health professionals have contributed to a situation where Pakistan is staring at an impending HIV epidemic.

Pakistan has over 220,000 people living with HIV, with thousands of new cases reported each year, according to recent data from the National AIDS Control Programme (NACP) and the World Health Organization (WHO).

Last year (2023), the South Asian nation recorded a substantial rise in HIV infections, especially in key populations such as injecting drug users, sex workers, and transgender individuals. 

According to reports, the Sindh and Punjab provinces are among the most affected, with certain areas witnessing localized outbreaks.

The HIV epidemic in Pakistan is considered “concentrated” in high-risk groups, with the virus predominantly spreading through unsafe injecting practices, unprotected sex, and inadequate blood screening procedures. 

However, the rising number of cases among the general population suggests that the virus is expanding beyond these groups, raising concerns about a potential escalation into a broader epidemic.

Community health experts said unsafe medical practices in Pakistan are a key reason behind the rising cases of HIV.

According to them, one of the major drivers behind the HIV surge is the widespread use of unsterilized medical equipment, particularly in rural areas, while poorly regulated healthcare practices, including the reuse of syringes and improper blood transfusions, have led to the spread of the virus. 

They said the 2019 Sindh HIV outbreak was also linked to unsafe injections administered by unlicensed practitioners, affecting hundreds of children.

Additionally, injecting drug use remains a key factor contributing to the spread of HIV in Pakistan. 

With limited access to harm reduction programs like needle exchange services, many drug users are exposed to contaminated needles, increasing the risk of transmission. 

While some efforts have been made to address this issue, they remain insufficient to curb the rising number of cases.

Meanwhile, the social stigma surrounding HIV/AIDS continues to be a significant barrier to effective prevention and treatment. 

Many Pakistanis, especially in rural communities, are reluctant to get tested or seek treatment due to fear of discrimination. 

According to experts, this lack of awareness and education about the virus further contributes to its spread, as people may unknowingly transmit the virus to others.

Experts said while injecting drug use remains a leading cause, sexual transmission of HIV is also on the rise. 

Limited access to sexual health education and contraception, as well as the societal taboo around discussing sexual health, have exacerbated the problem, as per reports. 

Vulnerable groups such as sex workers and transgender individuals face higher risks of contracting the virus due to limited resources and lack of healthcare support, experts said.

According to the Dawn editorial, while HIV/AIDS cases decline globally, Pakistan has the second fastest rate of HIV increase in the Asia-Pacific region “due to the spread of the virus from the key populations to the general population through sexual network”. 

The Global Fund has named Pakistan a sub-recipient of its $72 million aid for HIV, which will be routed through the United Nations Development Programme (UNDP) and the private sector. 

The Lancet projects HIV prevalence to be under 0.1 percent in the general population; some 165,000 people live with HIV but key populations — drug addicts, male and female sex workers, trans people, and same-sex partners — are in the grip of the affliction, the Dawn editorial read.

These alarming figures highlight that a large portion of the population remains at heightened risk of HIV transmission, as only a small fraction of patients have received the required antiretroviral therapy.

The editorial also opined that the Pakistani government must initiate preventive strategies on a war footing. 

“Battling the stigma attached to HIV is the first step, followed by an expansive testing programme for vulnerable populations to reduce the positivity rate, alongside awareness about volunteering for testing,” according to the Dawn editorial. 

The editorial noted that Pakistan’s collective approach needs to transform so that health services can be accessed without shame. 

“Providing healthcare, information, and resources is the state’s responsibility, not the people,” the editorial said. 

“Policies should be built around the vulnerable to break the poverty cycle, keep girls in school and make health facilities safer. Social inequality cannot imperil a healthy future,” it further opined.

Community health experts too said the rising HIV cases in Pakistan pose a serious public health challenge that requires immediate and coordinated action. 

While efforts have been made to address the issue, more needs to be done to ensure that the virus does not spread further, they said, adding that by strengthening healthcare infrastructure, promoting harm reduction, and raising awareness, the country can work towards reversing the alarming trend and protecting its population from the devastating impact of HIV/AIDS.

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