Uncontrollable AIDS/HIV in Pakistan - Its alarming growth - Misuse of Global AIDs funding

While looking at the salient features of budget 2019–2020, I noted that there are hardly any substantive funds allocated to health and education sectors. The most detrimental disease, AIDs spreading in Pakistan by leaps and bounds but unfortunately, like the other fatal diseases it is also not being taken seriously in Pakistan hence no required funding in the budget.

Federation instead of working ways and means to control it has now started a blame game on provinces making the figures of the AIDS Patients as a dispute instead of finding counter measures.

It is not a dispute that highest number of AIDS patient are in Punjab or 2nd highest number of patients in Sindh. Blame game is not the solution whereas the solution is the level of combined counter measures to stop this growing monster. This disease is increasing at an alarming pace and we need to worry about it at all levels.

AIDS is the most advanced stage of HIV infection and it kills its victims. An HIV-infected person takes 10-15 years to develop AIDS. After developing AIDS it is usually observed that the victim dies in six months. There is no effective vaccine or treatment for AIDS; however, antiretroviral drugs (ART) can slow down the progress so which makes infected people enjoy few more years of lives.

I have discussed AIDS in this article and other two diseases will be discussed in my subsequent articles:

According to estimates, Pakistan is registering approximately 20,000 new HIV infections annually. It is the highest rate of increase among all countries in the region. There are 0.165 million estimated number of HIV patients in Pakistan (The actual undeclared number is much more). This statistical data does not include the real figures as the patients of AIDS avoid reporting it due to social problems/compulsions.

According to my available information the province wise distribution of patients reported till 2018 is as under:

1. Punjab – 75,000, 2. Sindh - 60,000, 3. Balochistan – 5000, 4. KPK – 15000.

It is unfortunate to state that Punjab has the highest number of patients which is equally alarming both in Punjab and Sindh and other parts of the country. The number of patients is rising even more increasingly as a shocking development in the country. The most alarming thing is that the list of new cases includes children as young as 16 months which is due AIDS infected mothers.

The reasons for the rising number of HIV/AIDS in our country include unlicensed medical quackery, and large-scale medical malpractice via the re-use of syringes and unsterilised medical tools, unsafe blood transfusions and use of contaminated multiple use of blades by the community.

Health and health-related issues are given low priority by the government and the seriousness can be seen as no serious funds have been allocated for AIDS control and treatment.

In 1987, a National AIDS Prevention and Control Programme (NACP) was initiated by Federal Health Ministry. Initially, the programme was only focused on blood screening and some health promotion and HIV education activities for the general public. Since then, the programme is suffering from a weak strategy as it does not address treatment services properly due to lack of funding and dull response to health sector.

In other parts of the world, the number of HIV patients is declining by the use of advanced technology followed by their prime focus towards health but Pakistan till remains the one with no focus upon health sector.

Recently, Dr Bashir Ahmed Achakzai, MD NACP National Programme Manager made an honest confession regarding the organisation that they do not have enough funds or resources at federal and provincial levels to curb this fatal disease.

Although 27 HIV/AIDS treatment centres and 22 community home-based testing centres had been established in all four provinces yet no resources have ever been allocated for other activities of HIV prevention as the only drug ARV that prevents AIDS is not available in Pakistan. The country is totally relying on HIV test kits which cost over rupees one lac and the hospitals do not have any sufficient budget to buy or import these kits.

In 2017, the government had announced free HIV testing system that was only available in three cities of Pakistan Islamabad, Karachi and Lahore whereas in order to fill this gap, the NACP took this step to avail the Aga Khan University Hospital’s (AKUH) 200 plus nationwide network of collection units to collect blood samples from areas that are far. NACP had decided to pay Rs1500 to Aga Khan Hospital per patient from the funds allocated to it by Global Funds against AIDS, malaria and TB while the private laboratories charge Rs15000-17000 for the same test.

As per my personal enquiry, the above mentioned plan remains only on papers as no such facility is now being provided to common people. According to a reliable senior official source, the real position reported to the state is that the total estimated HIV positives in Pakistan in 2018 were over 170,000 among which 24,331 cases have been registered in 35 centres only. Moreover, out of all these registered patients, only 17,149 are actually getting a treatment.

The diagnosis of this ever spreading disease requires community based testing and the govt should encourage the testing of this disease free of cost.

According to the Health Ministry, there is immediate requirement of funds as the estimated amount in national strategic plan for 5 Years is $266 million.

The Global Aid Funds is providing fund whereas the govt has provided resources through domestic resources. There is a gap of $201 million which are urgently required only to treat the reported patients.

In Pakistan, the HIV is in a concentrated epidemic which means that it is confined to 4 key populations where national prevalence is more than 5%. National prevalence in injecting drug users has risen to 38.4% of their population (150000).

Number of female sex workers has gone up to 2.2% (180000 estimated figures). The prostitution has increased in Pakistan due to increased economic issues and use of drug which forces young girls to adopt this profession for easy money.

According to a report, some organised criminals are running their business from big cities and the young sex workers are taken to Middle East on visit visas. They contract aid form these countries and so are responsible for spreading the disease increasingly.

The country is going through another social issue as the transgender community is jobless and they are also being used as sex workers. Transgender are also contributing 7.6% of AIDS infected patients. According to an estimate, there are (60,000-70,000) people from transgender community who are infected with this deadly disease.

It is unfortunate to note that the homosexuals contribute to 5.2% of the total population of Pakistan and are being another cause of spreading AIDS across the country which means there are about 85,000 added patients of AIDS from homosexual community as well. While making this matter as case study I decide not only to write but also probe into misappropriation of funds released at federal level for this very programme.

While continuing this probe I am presenting following suggestions to be paid attention to:

1. A legislation should be made in order to discipline the use of medical instruments to ensure hygiene among the patients.

2. There must be a complete ban over the reuse of syringes.

3. Use of auto disable syringes must be introduced.

4. All hospitals need to reserve at least 50 beds for AIDS patients along with the provision of extra budget.

5. An effective media campaign both at public and private media should be started with immediate effect.

6. The govt should strengthen NACP not only through funding but it should also be made responsible enough to ensure the provision of increased number of beds in the treatment centres and should also become the regulator of all matters related to AIDS treatment and control programme.

7. All drug addicts must be passed through AIDS tests and all the addicts diagnosed with AIDS must be sent to AIDS treatment centres.

8. There should be a compulsory drug addiction test of students studying at high school, colleges and universities as it will not only help in curbing addictions but also help in detection of AIDS too among the frog addicts.

9. All the provincial govts and federal govt should launch an SOS programme to curb all the factors contributing to this widespread disease.

Although I am very glad to have penned down such a vital national issue to increase awareness among the people but I’m equally disappointed to see how only the Sindh govt was blamed for the increase in number of patients whereas the above figures clearly show that Punjab has the highest number of AIDS patients in the province. It is not the matter of blame game but the irresponsibility of federal govt needs to be questioned as to why this dangerous disease is being ignored which is multiplying its patients by many folds. The Global Aid Funds have been misused badly which needs to be probed. The Govt is needed to act on SOS basis.

The writer is Chairman of think tank "global eye" & former interior minister of Pakistan, Email: rmalik1212@gmail.com, Twitter @Senrehmanmalik, @GlobalEye_GSA, WhatsApp +923325559393