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Low HIV prevalence in Pakistan is a misconception: report

By Zahid Hameed

ISLAMABAD: A report has revealed that the transmission of HIV-AIDS among intravenous drug-users is increasing at an alarming rate in Pakistan. It also warns that the epidemic could reach alarming proportions if comprehensive harm-reduction services are not implemented.

Nai Zindagi, a non-governmental organisation (NGO) organised a press talk on Wednesday to raise public awareness regarding the prevailing situation of the disease in the country. The organisation compiled the report in July 2005 to estimate the number of street-based intravenous and non-intravenous drug users, after conducting separate studies in Faisalabad, Lahore, Sargodha and Sialkot.

Nai Zindagi Chief Executive Tariq Zafar said that blood tests of around 6,000 intravenous drug users were carried out in the four cities, out of which 6.2 percent tested HIV positive, adding that HIV prevalence in the cities had increased from the status of ‘low’ to ‘generalised’.

According to the report, poly drug use was common in the four cities, where many drug users used hashish as a secondary drug, followed by inhalants and tranquillisers. It pointed out that HIV was highly prevalent among drug addicts in Sargodha and Faisalabad, where it was as high as 12 percent and 9.5 percent; while in Lahore and Sialkot, it was estimated at 5 and 1 percent respectively. The report revealed that most drug users in the four cities began injecting drugs between the age of 25 to 28 years, adding that intravenous drug use was also common among younger age groups. The sharing of contaminated and used syringes has been highlighted as the main cause of HIV infection among drug addicts.

“Condoms are hardly used with regular partners (wives), when compared to casual partners (sex workers),” said the report, adding that intravenous drug users were likely to transmit the disease to their spouses, the most common route of secondary HIV transmission. In the four cities, majority of the respondents had heard of the disease, but did not know about the various modes of transmission due to lack of information, said the report.

Zafar rejected the notion that Pakistan’s status was low-risk in terms of HIV/AIDS, adding that the statement was based on limited data and could not be generalised. He said due to limited surveillance and computer modelling, the United Nations had incorrectly estimated that around 70,000 to 80,000 people in Pakistan were infected by HIV. According to rough estimates, he said, the prevalence of the disease was as high as 10 to 15 percent among approximately 300,000 intravenous drug users.

The report urges rapid situational assessments of those infected by HIV in other parts of the country, so that interventions and resource allocation could be planned in view of factual evidence.

“Programmes in the four cities need to cover a minimum of 60 percent of intravenous drug users and provide them with comprehensive and regular street-based harm reduction services,” the report said, adding that those who were not involved in intravenous drug use needed to be prevented from shifting to it.

The report also stressed the need for mainstreaming the provincial healthcare system in collaboration with civil society to ensure health provision at the scale required.

During the talk, Zafar also highlighted how law enforcement agencies could gain drug users’ trust and confidence to make interventions more effective. “Sporadic police raids are often counter-productive and do not cover inaccessible areas,” read the report, adding that prison settings required harm reduction programmes as a significant percentage of intravenous drug users had been to jail. The report stresses increased HIV awareness among the public through the media, along with information regarding safe sexual practices to prevent secondary transmissions.

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