HIV/AIDS in Pakistan: the context and magnitude of an emerging threat

STUDY OBJECTIVE: The objectives of this review were to: (1) assess the nature and comprehensiveness of information regarding HIV/AIDS in Pakistan; (2) to evaluate the extent of HIV/AIDS in Pakistan by epidemiological estimates; (3) to indicate the implications of the results for health policy in Pakistan and other regions at a similar stage in the epidemic. DESIGN: A structured review of published, unpublished, and government literature was undertaken to collate all available information and present a descriptive epidemiological profile of HIV/AIDS in the country. SETTING: Pakistan, a developing country in the South Asian region. National and regional information and analysis are presented in so far as the data allowed. Sample sizes varied from 1.35 million people screened at the national level to smaller studies of fewer than 100 screened. RESULTS: Data pertaining to HIV/AIDS in Pakistan showed the best national estimates of HIV prevalence as 64 per 100,000 (0.064%). Within patients with sexually transmitted diseases the seroprevalence was as high as 6100 per 100,000 (6.1%); in men with extramarital contacts, 5400 per 100,000 (5.4%) and was as low as zero in some studied populations as well. The average age of onset was reported as 30 years. It is estimated that if all incident cases of AIDS were to die, there would be at least 5000 deaths annually attributable to HIV/AIDS. CONCLUSION: Coupled with the extremely low awareness of HIV/AIDS in Pakistan, as well as growing number of cases, the AIDS epidemic is poised to take a hold in Pakistan. The presence of additional risk factors such as unscreened blood, and low condom use rates make the situation fertile for AIDS to become a major public health issue. Pakistan's health policy must be proactive in tackling this emerging health threat.

hiv rash

Measles, a viral infection characterized by a rash and malaise, can become a complicated case that involves meningitis (inflammation of the tissues surrounding the brain) or multi-organ involvement. Death can and does occur, luckily, no one has died of it in the United States. Still, about a quarter of a million children die from it in under-served parts of the world where vaccine and/or treatment for measles is not available.

You may be asking yourself what the big deal is about 131 cases in a country of over 300 million. The real answer is that 131 is likely an underestimate of the true number reported to the health departments all over the country. Other cases may go unrecognized. People who are immune-compromised or sick with other conditions may develop measles and not know it. They may die from it and not know it. Other than the rash, there are few other ways to recognize it beyond lab tests that may take too long or be to costly to perform. Also, because measles is so rare, few physicians may recognize it on symptoms alone.

The other reason why this is a big deal is that measles is perfectly vaccine preventable. In the United States of America, in 2008, there should be no cases of measles. Living for your faith and beliefs is one thing; dying because of them is another. The worst offenders in the non-vaccination campaign are misinformed individuals who, with all the evidence to the contrary in peer-reviewed study after peer-reviewed study, still believe that vaccines cause diseases like autism or auto-immune conditions. The truth to this is that they might cause something, but the overwhelming evidence is that they don't. So slacking on measles means that they have been slacking in other vaccines, and that's a scary proposition.

The modern HIV epidemic

When the gay & bisexual community talks about the HIV epidemic, they talk about it in past tense. They talk about it as something which plagued the gay & bisexual community during the 80’s and early 90’s. Claiming the lives of countless friends, sons and loved ones.

At the time conservative hard-liners cackled with glee at this gay-plague which in their mind was cleansing society of the sodomites. Meanwhile we watched with sadness and despair as our friends battled with and died from a disease that society didn’t seem to care about.

25 years on and the world is a very different place. In the western world we understand very well how HIV is transmitted, that it isn’t just a risk for gays and bisexuals but for the whole world. Anti-retroviral treatments (where available) have proved effective in prolonging both the duration and quality of life of those suffering from HIV.

Yet we have become complacent.

HIV epidemics are springing up the world over and infection rates are continuing to soar. This is particularly true in Africa, (where the Pope has recently reiterated the Catholic Church’s shameful opposition to condom use) but epidemics are not limited to developing countries. Washington DC has just reported that 3% of over 12’s are infected with HIV/AIDS. This puts the US capital on a par with Uganda for HIV/AIDS infection rates.

Everyone who is sexually active has a duty to behave responsibly. To be aware and to consider the possibility that they or the person who they are sleeping with might carry the virus. This is irrespective of your sexual orientation, though we have to acknowledge that those of us who regularly engage in unprotected anal sex are most at risk.

Remember whilst HIV is no-longer the death sentence it was in the 1980’s. Living with HIV is not easy. The slightest infection, even a common cold can complicate itself into a life threatening condition.

Still, there is hope. Whilst where antiretroviral therapies are available, such as in the UK. A person diagnosed with HIV aged 20 can expect to live another 49 years. Not bad when you consider average life expectancy in the UK is 80. However, this statistic only holds true for those who have their HIV infection diagnosed early, not for those who remain oblivious to their HIV status for years.

The solution:- get tested - know your status. You stand the best chance of living a long and healthy life that way.

Meanwhile in Africa where antiretroviral drugs are not freely available, people are dying needlessly and the epidemic is getting worse.

I`m HIV positive and i’m pregnant. What should i do?

The human immunodeficiency virus (HIV), or sometimes referred to as AIDS virus, attacks the body’s immune system and render it too weak to cope with infection and certain tumours. The latter stage when this happens is called AIDS (acquired immune deficiency syndrome). The progression to full-blown AIDS can now be controlled with modern-day antiviral therapy. HIV is acquired through sex and through blood such as when needled are shared between intravenous drug abuser.

Being HIV positive has tremendous implications to both the mother and her baby. HIV does not usually worsen in pregnancy. There is no evidence of pregnancy increasing the risk of progression of the disease. However, women with HIV tend to have an increased risk of miscarriage, intra-uterine growth restriction, premature births and low birth-weight babies. These complications reflect more on the mother’s state of health rather than the virus itself. The current antiviral treatment does not appear to cause any foetal abnormalities

Many issues need to be considered in an HIV positive woman who is pregnant. Combined care with an HIV expert is essential to reduce the risk to both the mother and her baby.

Based on the New York Heart Association’s classification

Indonesia, South Asia Key Fronts in AIDS Fight: Experts

India, Indonesia and Pakistan have become key fronts in Asia's fight against HIV/AIDS, health experts said ahead of the International Congress on AIDS in Asia and the Pacific next week.

Delegates from 65 countries will gather on the Indonesian resort island of Bali from Sunday to Thursday to discuss strategy and "renew our commitment to fight the disease," congress chairman Zubairi Djoerban said.

Two of the main talking points are expected to be how to reach the 75 percent of sufferers who are not receiving treatment, and how to stop the disease spreading among intravenous drug users.

But Djoerban said that, without a matching commitment from governments to tackle the disease that killed 380,000 people across Asia in 2007, the conference would achieve little.

"We can discuss prevention and treatment but with no leadership and commitment from countries and the community, we won't achieve much," he said.

An estimated five million Asians are living with HIV, especially in southeastern countries such as Thailand, Cambodia, the Philippines and Indonesia, according to a UN report released last year.

While there are some bright spots, such as Cambodia, where HIV prevalence has declined through condom use, new infections are growing steadily in populous countries such as Bangladesh and China, the report added.

In Indonesia and South Asia, Djoerban said the biggest threat was the lethal combination of dirty needles and unprotected sex.

"We're concerned about India, Indonesia and Pakistan, where there is overlapping of drug injecting and unprotected sex... this includes sex workers taking drugs and drug users not using condoms," he said.

HIV and Injecting Drug Use: A New Challenge to Sustainable Human Development

The HIV epidemic is a new, complex phenomenon in the world today. It is challenging accepted ways of understanding health and human development, and is demanding new forms of expertise and a more integrated and collaborative development practice. It is raising significant conceptual, ethical and programmatic issues.

From the beginning, the HIV and Development Programme has drawn attention to the complex and dynamic relationship which exists between the HIV/AIDS epidemic and development. Many of the commonly acknowledged impediments to development, such as social and economic inequality, environmental degradation, political instability, civil disorder and the absence of good governance are also key driving forces behind the spread and unfolding of the HIV epidemic.

Through its extensive range of publications, and in particular through its series of Issues Papers, the Programme has encouraged consideration of the epidemic in relation to critical (and sometimes neglected) aspects of development. This tradition is continued here in a paper which explores different aspects of the relationships between HIV, injecting drug use and development.

This paper is the result of extensive review of available documentation and dialogue with a range of partners in the field. It is neither exhaustive nor definitive, nor is it intended to be so. As an Issues Paper, it is most appropriately considered a 'working draft': the distillation of experience, reflection and observation from the perspective of an experienced, engaged practitioner.

The paper has been reviewed and revised several times over, with each new version generating further questions and discussion: providing some indication of its success as a trigger for discussion and as a tool towards enhanced understanding of UNDP's role in relation to them.

As with all Issues Papers, the views expressed in this paper are those of the author and they do not necessarily reflect those of the United Nations Development Programme. We encourage reproduction of the material and welcome acknowledgement, comment and feedback.

Countries failing their migrant population with potential for HIV and AIDS increase

The economic crisis and universal access to HIV services for Migrants.

Concerns are mounting that the current economic crisis will be a disastrous repeat of 1997-1999 Asian financial crisis with the potential for an increase of HIV and AIDS infection within the region. With economic growth declining from 8.8% in 2007 to 5.8% in Jan 2009 within Asia and the Pacific region, it has been estimated that over 25 million people are unemployed and this has raised concerns about the potential spillover effect on HIV prevention and treatment.

With countries such as Malaysia, Cambodia and Indonesia heavily dependent on exporting as part of their economy, the recent economic downturn has seriously effected employment rates and national Government's ability to finance HIV programs. Cambodia was reported to have had a decline in the garment industry of 31% and 70,000 jobs, mostly consisting of migrant women, have been lost.

The United Nations Development Program report highlighted the real concern of the economic crisis for migrant workers. On a national level, an economic slow down will cause problems for funding and cuts will have to be made, which many fear will target more localised programs. The report also highlighted that during an economic crisis it is common for governments to adopt a well publicised anti-immigration policy. In Malaysia, the Government has placed a freeze on the re-issuing of work visas and revoked work visas for 55,000 Bangladeshis. If formal routes of movement are not open to migrants, this will mean that migrants will explore informal methods of movement and this can put them in conditions with a greater risk of vulnerability to HIV. Migrants' perceived risk, knowledge of HIV, and use of condoms are low, which puts them at high risk. However, when migrants start to explore informal routes of immigration this can result in illegal activity and further reduces their access to education and healthcare.

On an individual level, with high unemployment or lowered wages, it may not be possible for HIV positive people to continue their vital HIV treatment. Women who are made unemployed can consider to enter the sex industry as reported in Cambodia where the garment industry has declined and women are entering into an unsafe sex industry outside of the HIV prevention framework

Overall, the UNDP report on migration highlights the potential challenges that will arise during the economic slowdown and shows that in order to commit Universal Access it is necessary to confront the issues now before vulnerable groups are forgotten.

(UNDP 'The threat posed by the economic crisis to universal access to HIV services for Migrants' accessed 17/08/09)

WHO and HIV/AIDS

As the directing and coordinating authority on international health, the World Health Organization (WHO) takes the lead within the UN system in the global health sector response to HIV/AIDS. The HIV/AIDS Department provides evidence-based, technical support to WHO Member States to help them scale up treatment, care and prevention services as well as drugs and diagnostics supply to ensure a comprehensive and sustainable response to HIV/AIDS.
HIV drug resistance is the ability of HIV to mutate and reproduce itself in the presence of antiretroviral drugs. Consequences include treatment failure, increased health costs associated with the need to start more costly second-line treatment, the potential spread of resistant strains of HIV and the need to develop new anti-HIV drugs. The extent of HIV drug resistance resulting from recent antiretroviral therapy scale-up in resource-limited countries is being monitored by National Drug Resistance Working Groups with technical support from WHO.

What Is It?

AIDS is one of the most serious, deadly diseases in human history.

More than 20 years ago, doctors in the United States identified the first cases of AIDS in San Francisco and New York. Now there are an estimated 42 million people living with HIV or AIDS worldwide, and more than 3 million die every year from AIDS-related illnesses.

AIDS is caused by the human immunodeficiency virus (HIV). HIV destroys a type of defense cell in the body called a CD4 helper lymphocyte (pronounced: lim-fuh-site). These lymphocytes are part of the body's immune system, the defense system that fights infectious diseases. But as HIV destroys these lymphocytes, people with the virus begin to get serious infections that they normally wouldn't — that is, they become immune deficient. The name for this condition is acquired immunodeficiency syndrome (AIDS).

As the medical community learns more about how HIV works, they've been able to develop drugs to inhibit it (meaning they interfere with its growth). These drugs have been successful in slowing the progress of the disease, and people with the disease now live much longer. But there is still no cure for HIV and AIDS

Hundreds of U.S. teens become infected with HIV each year. HIV can be transmitted from an infected person to another person through blood, semen (also known as "cum," the fluid released from the penis when a male ejaculates), vaginal fluids, and breast milk.

The virus is spread through high-risk behaviors including:

• unprotected oral, vaginal, or anal sexual intercourse ("unprotected" means not using a condom)
• sharing needles, such as needles used to inject drugs (including needles used for injecting steroids) and those used for tattooing

People who have another sexually transmitted disease, such as syphilis, genital herpes, chlamydia, gonorrhea, or bacterial vaginosis are at greater risk for getting HIV during sex with infected partners.