When 10-year-old boy Ali Raza was found to be minified with a fever at his home in the dusty, largely neglected district of Larkana in Sindh province on 16th May 2019, Pakistan, Rehmana Bibi, the mother of Ali did not appear to grasp the gravity of the situation. She, however, took her son to a doctor for a diagnosis. Having been prescribed generic medicine and being told, ‘Nothing to worry’, she took a sigh of relief. The relief was short lived as she learnt that many kids who initially came down with a fever had tested positive for Human Immunodeficiency Virus (HIV) in nearby villages.
Alarmed, Bibi took Ali to a hospital, where medical tests confirmed, the boy was among about 500 people, principally kids, tested positive for the virus, which could lead to Acquired Immune Deficiency Syndrome (AIDS). A physician named Muzaffar Ghangharu, who himself was infected with AIDS, has been arrested and is being investigated on suspicion of injecting patients’ bodies with deadly virus by design.
Pakistan was long thought of, a low prevalence country for HIV. The recent statistics suggest otherwise. Indeed the disease is expanding at an alarming rate in the country. The occurrences are reported more among intravenous drug users and sex workers. With about 20,000 new HIV infections reported in 2017 alone, Pakistan presently is the country with the second-fastest growing HIV rates across Asia, according to the United Nations.
The Human Immunodeficiency Virus (HIV) infection is fast becoming a prevalent disease in Pakistan, and its death toll has been steadily increasing each year since 1987. Although nearly 100,000 individuals in Pakistan are living with HIV/AIDS, there are only 23,000 documented persons suffering from this illness. Furthermore, the death toll has also been on the rise. The number of deaths caused by HIV/AIDS in Pakistan increased from 350 to a staggering 6,200 between 2005 and 2017.
There are many reasons that make treatment of HIV/AIDS infections extremely challenging in Pakistan. The reasons listed below are elaborated upon, in succeeding paragraphs.
- Shady Medical Practices
- Sexually Transmitted Diseases
- Widespread Poverty
- Conservative Attitude and Ethical Dilemmas
- Gender Inequality
- Insufficient Government Response
- Lack of Sex Education in Schools
A common practice in Pakistan is to go to the quacks for medication rather than a qualified physician. Subsequently, the results of such treatments are devastating, because these so-called experts sitting on the pavements create havoc for patients.
The treatments on offer, range from cures for diseases of the ear, nose, teeth, skin and genital areas. According to the facts and figures provided by the government, there are over 14,000 quacks practicing illegally to treat various diseases throughout the country. But the actual number of these quacks exceeded an alarming 600,000 which is even more than the total registered number (2,46,000) of qualified doctors in Pakistan.
270,000 of these quacks are operating in Sindh province alone, where Larkana is located. Provincial health officials also intimated that patients are at particular risk of contracting diseases or viruses at these clinics, where injections are often pushed as a primary treatment choice.
For the sake of saving money, these quacks inject multiple patients with a single syringe. This could be the main reason for the spread of HIV cases. A large number of unqualified doctors along with the reuse of syringes, unsafe blood transfusions, and other unsafe medical practices have all led to the increase in HIV cases in recent years.
The prevalence of Sexual Transmitted Diseases (STDs) is alarmingly high in Pakistan, especially in male individuals. Low awareness about protection against this deadly disease in poor and middle-class areas is increasing the number of incidents of STDs. These STDs are known to cause the sexual transmission of HIV/AIDS infection.
The most at-risk populations for transmission of HIV/AIDS infection in Pakistan are people who inject drugs (PWID), transgender persons, males, and female sex workers with a rate of 27.2%, 5.2%, 1.6%, and 0.6% respectively. There is strong evidence that new patterns of drug use and shifts to injecting, in particular, are important factors contributing to the rapid increase of HIV infection among drug users.
While HIV symptoms generally appear 2-3 months after the sexual intercourse with an infected individual, AIDS symptoms may take many years to appear.
According to the report by the Sustainable Development Policy Institute (SPDI), more than 58.7 million people in Pakistan are living below the poverty line. These individuals lack basic facilities such as healthcare and education due to low family incomes.
The average Pakistani makes 1555 USD (compared to the world average of 17300 USD) a year that means the average income is approximately 129.5 USD per month. Due to socioeconomic constraints, individuals from the lower and middle class, lack basic knowledge about physical health. They are either not aware of or cannot afford to buy contraceptives in order to prevent the transmission of any infections or diseases during sexual activity. Poverty and denial of education play a critical role in forcing women into becoming sex workers, which leads to higher rates of STD transmission in Pakistan.
Conservative Attitude and Ethical Dilemmas
Pakistan is a very conservative country with regards to the discussion of one’s sexual activities or family planning. Contraceptive commercials receive backlash from the country’s religious and conservative bodies calling such advertisements “Immoral” and against the religious norms of Islam. Pakistan Electronic Media Regulatory Authority (PEMRA) has also banned any advertisements for condoms.
This conservative attitude of Pakistani authorities creates images in the minds of the public that protected sex and condom usage is a deviant act that is inappropriate to talk about. Experts say that the dramatic increase of STDs in Pakistan is due to unprotected sex.
When considering HIV/AIDs from an ethical point of view, it is necessary to recall the stigma, societal disapproval, and consent across cultures in response to this disease. This is more so important specifically in countries in which religion controls much of the influence. Pakistan, being a conservative country, has a population of people who consider the topic of HIV/AIDs, sexual encounters, and safe sex to be a taboo.
While discussion of these topics is at a minimum, Pakistan continues to have a growing HIV/AIDs epidemic. In many Islamic societies, HIV/AIDs is noted to be associated with homosexuality and promiscuity. However, it is essential to take note that HIV/AIDs can also arise from unhygienic blood transfusions and unprotected sexual intercourse. A reason as to why the Pakistani population is majorly misinformed regarding the causes of the disease is lack of education.
Gender inequality is also a key reason for the spread of HIV/AIDS in Pakistan. Women in Pakistan generally face discrimination due to their lower socioeconomic status, lesser mobility, and low decision-making power as compared to Pakistani men, which leaves them vulnerable to HIV/AIDS. Due to gender inequality, the literacy rate for Pakistani women is only 45% compared to the literacy rate of 69% for Pakistani men.
Insufficient Governmental Response to HIV/AIDS
A few years ago, there was a commercial by a leading condom producing company promoting the use of condoms, the idea of protected sex, and the prospect of living better, healthier lives. Mere promotion of a contraceptive commercial stirred a significant controversy nationwide, and the PEMRA responded with banning the commercial immediately. In 2001, the Pakistani government developed a National HIV/AIDS Strategic Framework that established strategies for effective control of this deadly disease.
In the following years, the government’s biggest challenge was implementing this strategic plan, establishing effective partnerships, networking with the donors and NGOs, and neutralizing the stigma attached to HIV/AIDS. At least 45 non-governmental organizations (NGOs) were involved in the HIV/AIDS public awareness campaign. These NGOs supported and cared for patients living with HIV. They focussed on the population of sex workers in all four provinces of Pakistan. Although these NGOs are actively still working for the HIV/AIDS control in Pakistan, they are not enough in numbers to control the prevalence of HIV/AIDS in a growing population of Pakistan.
Lack of Sex Education in Schools
In Western parts of the world, sex education is an important part of the school curriculum. School years are a critical time when young individuals become sexually active and they experiment with their sexuality. In Pakistan, however, young individuals do not receive sex education, because it is considered to be something that is very private and personal.
Most parents do not educate their children or encourage them to attend any sex awareness programs. Children are generally told not to watch any advertisements that promote safe sex or condoms or contraceptives. Conservative mind-sets usually prevail because Pakistan is a relatively religious Muslim majority country.
It is considered unorthodox and unethical to educate children about protected sex practices and prevention of STDs in schools. Consequently, both children and adults exhibit little-to-no knowledge about safe sex, and the measures to be adopted prevent the spread of HIV/AIDS. If the government introduces sex education as a part of the curriculum in colleges and universities, it runs the risk of receiving a lot of backlash from the religious or conservative groups.
It is evident that any individual in Pakistan speaking openly about HIV/AIDS experiences societal disapproval and condemnation. In order to prevent further cases in which a person suffering from HIV is influenced by cultural stigmas, it is necessary to properly educate the populace about sexual education and to provide physicians with ample training to be able to handle these types of delicate situations.
The Higher Education Commission (HEC) in Pakistan could make a strategic plan to visit every college and university annually to conduct seminars about HIV/AIDS and aim to counsel and discuss its causes and its preventative measures. There is no harm in distributing condoms or contraceptives, along with a complete booklet or guide on HIV/AIDS amongst the students and the teachers and the staff.
The rise of HIV cases has raised harrowing health concerns in Pakistan. There is an urgent need to tackle this problem on a war footing. Following steps need to be taken on war-footing in order to contain the spread of HIV:
- Banning all doctors not having a proper medical degree
- Creating awareness programs
- Encouraging protected sexual activity
- Promoting the idea of sexual intercourse with a single-long term trusted partner
- Screenings of blood and bodily fluids
It is imperative that serious and immediate steps are taken to curtail the threat of HIV/AIDs in Pakistan and a multipronged approach with a heavy emphasis on education is carried out to successfully fight societal obstruction and negligence.
20 May 19/Monday Written by Naphisa