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Pakistan’s ‘window of opportunity’ to prevent HIV

WASHINGTON: As a major World Bank-sponsored conference on AIDS-HIV in South Asia gets underway in Sri Lanka this month, the bank says Pakistan still has a “window of opportunity” to act decisively to prevent the spread of HIV.

The banks says that although the estimated HIV burden is still low at around 0.1 percent of the adult population, there has been an outbreak of HIV among injecting drug users (IDUs) in Sindh. Without vigorous and sustained action, Pakistan runs the risk of experiencing the rapid increase in HIV among vulnerable groups seen elsewhere.

According to UNAIDS estimates, about 85,000 people, or 0.1 percent of the adult population in Pakistan, are infected with HIV. Officially reported cases are much lower, however. As of September 2004, only 300 cases of AIDS and 2,300 cases of HIV infection were reported to the National AIDS Control Programme. As in many countries, under-reporting is due mainly to the social stigma attached to the infection, limited surveillance and voluntary counselling and testing systems, as well as the lack of knowledge among the general population and health practitioners.

Although overall HIV prevalence is low in Pakistan, there is growing evidence of substantial high-risk groups, which could contribute to local concentrated epidemics. The bank notes that the combination of high levels of risk behaviour and limited knowledge about HIV among IDUs and sex workers could lead to the rapid spread of HIV. Evidence from a baseline survey of high-risk groups in Lahore and Karachi conducted from March-July 2004 indicated a concentrated epidemic among IDUs and men who have sex with men (MSM) in Karachi.

The survey found 23 percent of the 402 IDUs and 4 percent of the 409 MSMs sampled were HIV positive. There were alarmingly high syphilis rates among hijras, or eunuchs, in Karachi (60 percent) and Lahore (33 percent). The survey also found very low condom use among these groups, particularly amongst MSM, and low use of sterile injecting equipment among IDUs. More recent data from Karachi confirms these trends and indicates a slight increase in prevalence of IDUs (27 percent), and in MSMs (7 percent) and for the first time some female sex workers have also tested positive. Preliminary results of a survey of selected cities in Punjab conducted in May 2005 found HIV prevalence among IDUs in the range of 2.5 percent to 11 percent. There are serious risk factors that put Pakistan in danger of facing a rapid spread of the epidemic if immediate and vigorous action is not taken, the bank warns. Besides the government, as many as 54 non-government organisations are involved in HIV/AIDS education, and in the care and support of people living with the disease. khalid hasan

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