HIV (Human Immunodeficiency Virus) incidence in Pakistan has reached the level of concentrated epidemic from high-risk groups since 2004. By UNAIDS’ estimate, Pakistan has approximately 170,000 HIV patients.

Concentrated epidemic means HIV prevalence is consistently over 5 percent in Pakistan and it has spread rapidly in one or more defined subpopulation but is not well established in the general population.

The Ministry of National Health Services submitted a report before the Supreme Court bench in August 2018 that Pakistan has an estimated 150,000 HIV patients of which approximately 75,000 are in Punjab, 60,000 in Sindh and around 15,000 of people living with HIV (PLHIV) are based in KP and Balochistan. However, the total number of registered HIV/AIDS patients since 1992 is 22,000 across the country.

The number of new HIV patients is increasing by 20,000 a year. Nevertheless, Supreme Court dismissed the report and asked Ministry of National Health Services to file a comprehensive and well-researched report with accurate data.

The World Bank which is the largest financer of HIV/AIDS programme in Pakistan indicates serious risk factors that put Pakistan in danger of facing a rapid spread of HIV if immediate and vigorous action was not taken.

Several factors, including low literacy, high poverty, and unsafe blood transfusion have made Pakistan more vulnerable to HIV spread. Additionally, extramarital affairs, sexual intercourse with sex workers, particularly male and transgender persons, injection of drugs and same-sex relationships are possible reasons for spread of HIV/AIDS in Pakistan.

UNAIDS’ 2017 estimates show that approximately there are 228,787 female sex workers in Pakistan with 3.8 percent HIV prevalence; approximately 832,213 men had sex with men who have 3.7 percent HIV prevalence; 5.5 percent of 52 646 transgender people carry HIV.

The report published by UNODC (United Nations Office on Drugs and Crime) considers approximately 4.25 million people drug dependent. The Pakistan Field Epidemiology Training and Laboratory Training Programme (FELTP) investigated and found use of same syringe on multiple patients by quacks to be the source of infections.

A social worker and Director Programme and Operation Akhuwat, Dr. Izhar Ul Haq Hashmi expresses his discontentment on the policies governments have opted in the past to counter HIV epidemic in the country. "HIV is equally or more dangerous than Polio or Hepatitis B&C. Certainly, no country can fight a silent killer like HIV with bad strategies and methods.

"It’s unfortunate that the departments established to cater to HIV patients and issues linked to this disease have done little in the last couple of years except for organising few seminars or walks annually. We need serious efforts to tackle the probable threat this concentrated epidemic poses to the general public."

Spokesperson Punjab Aids Control Programme Sajjad Hafeez has a different perspective and disagrees with the phenomenon of increasing HIV patients in the country. "Numerics presented by the World Bank and UNAIDS do not reflect the actual picture. According to the World Bank the prevalence should be less than 0.1percent of the population but we have 0.03percent.

"Apart from providing treatment in established centres across the province, two types of awareness campaigns are being run consistently; advertisements and campaigns on mass media through advertisements, and interpersonal counseling programmes with targeted groups. These efforts are indeed helping to bring the number of HIV patients down in the province."

According to a government report, certain parts of Punjab, including Lahore, Dera Ghazi Khan, Multan, Rawalpindi, Gujrat, Faisalabad and Sargodha are among the vulnerable areas.

Dr. Sikandar Warraich works in District Headquarter Hospital Sargodha and treats HIV patients in the district. He expresses serious concerns over the claims Sajjad Hafeez makes. "Number of HIV patients is undoubtedly on the rise in the district but there are only two centres -- insufficient to treat patients. In addition, not a single dialysis machine is available for HIV patients -- many have died waiting for treatment.

"Majority of HIV-infected persons are unaware about their own disease. They are not getting any treatment or taking precautionary measures that can avoid the spread of the disease."

World Health Organisation (WHO) points out blood transfusion as another source of spread of HIV in Pakistan. It is estimated that 40 percent of the 1.5 million annual blood transfusions are not screened for HIV. About 20 percent of the blood transfused comes from professional donors.

Faisalabad-based Dr Arshad Bashir believes that not all private blood banks screen blood for HIV. "These private blood banks do not screen blood for HIV and Hepatitis just to save money which is a serious crime."

"Moreover, concerned authorities pay little attention to practices at the dialyses and thalassemia centres where blood recipients and those undergoing dialysis are at huge risk of contracting HIV. Precautionary measures must be ensured in these centres," Dr Bashir stresses.

Widespread use of one syringe for more than one patient at clinics has also put a large number of population at risk of contracting HIV. Pakistan has a high rate of medical injections, around 4.5 per capita per year. "94 percent of injections are administered with used syringes."

According to WHO estimates, unsafe injections account for 62 percent of Hepatitis B, 84 percent of Hepatitis C, and 3 percent of new HIV cases.

Constant vigilance of the dynamics of HIV prevalence is important in estimating, regulating, and implementing prevention programmes. "Unfortunately, there is no mechanism available in Pakistan to ascertain the number of HIV patients. Therefore, the claim Sajjad Hafeez makes regarding decreasing number of HIV patients is unrealistic," says Dr Sikandar Warraich.

At least 54 NGOs are believed to be involved in creating awareness of HIV/AIDS in the public and also, how to care for and support persons living with HIV/AIDS. These NGOs serve as members of the Provincial HIV/AIDS Consortium, which has been established in all four provinces to coordinate HIV/AIDS prevention and control activities.

These NGOs are reaching out to less than 15 percent of the vulnerable population. People in the rural areas of Pakistan are mostly uneducated which is one of the possible reasons for HIV spread. There is hardly an example of being effective at grassroots level to promote preventive measures or create mass awareness regarding the stigma prevailing in the society towards HIV patients.

This stigma keeps HIV positive individuals from disclosing their status and they are unable to receive treatment from healthcare providers.

The Ministry of National Health Services also suggested in the report a bill on speedy treatment of HIV patients and the establishment of a framework to reduce stigma and discrimination. Based on the suggestion, the Supreme Court ordered to launch awareness campaign at once.

Dr Hashmi says there should be immediate mass level awareness campaigns focusing on promoting tolerant and caring behaviour towards people living with HIV. This will help in reducing social stigma; otherwise the under-reported groups have a potential to spread this to the general population.