A barrier untouched in Pakistan
Generally, it is considered that Pakistan, being an Islamic country, is a low prevalence area for HIV/AIDS but when and wherever the blood screening of the people is conducted at a large scale, the picture becomes very different. For example, four years back, a Lahore based NGO (New Light) conducted blood screening of hundreds of residents of Muhallah Jogi Pura in a small town Jalalpura Jattan (JPJ), situated at 12km eastward from Gujrat city. The NGO declared through media that almost 250 persons were found HIV-infected in that small population (The Nation, November 14, 2008). The Programme Manager of the National Aids Control Programme, Dr Hassan Abbas Zaheer, told that on the basis of the initial information provided by the New Light, a team deputed by Provincial Aids Control Programme Punjab also conducted blood tests of 89 persons out of the 250 identified people and found that all the cases were HIV-positive (NACP FELTP report on HIV Outbreak in district Gujrat 2009).
Whatever the case, 89 persons were confirmed with HIV-infection. After only two years and three months, the figure reached 363 as revealed in a local newspaper of Gujrat, the daily Daak on 8 February, 2011. When I was conducting a study survey on HIV/AIDS in JPJ to complete my M Phil thesis, for that I collected confirmed data from the local public health office. It showed that number of HIV carriers was alarmingly increasing and up to July 2011 more than 400 cases had been confirmed by the Shaukat Khanum Clinical Lab, Lahore. The epidemic either prevailed or rapidly spread to the near villages and muhallahs. The data from Civil Hospital, JPJ, showed that the surrounding areas of JPJ with infected persons included urban area with Muhallah Haji Pura, Muhallah Jatt Abad, Muhallah Faiz Abad, Muhallah Imran Pura, Muhallah Nai Abadi, Muhallah Loharan, Muhallah Kashmir Nagar and Muhallah Islam Garh in JPJ city while the affected rural population comprised villages Nandpur, Kulachor, Meonwal, Chopala, Mehsam, Shahbazpur, Noashehra, Dhillu Sharqi, Langrial, Thhimka, Behlpur, Memoodabad, Fatehpur, Kot Miana and Daulatnagar etc. Even some patients belonged to nearby villages which fell in the area of Azad Jammu and Kashmir.
Jalapur Jattan could not be regarded as a single case in rapid spread of AIDS. The Dawn, dated 28 June, 2009, revealed that 54 out of 2,106 prisoners were found HIV positive in Kot Lakhpat Jail, Lahore. The screening was carried out on Chief Justice of Pakistan Iftikhar Muhammad Ch’s directions. A similar news story was witnessed in the daily Pakistan, Lahore, dated 16 December, 2010, which showed that there were about 280 HIV/AIDS patients in the jails of Punjab but no preventive measures were being taken to halt further spread of HIV/AIDS.
In Pakistan, the number of HIV/AIDS victims is around 97,500, as informed by the federal minister for health in the National Assembly session last year. Epidemiological Fact Sheet on HIV and AIDS 2008, available on the website of World Health Organisation (WHO), shows that average number of HIV positive persons in Pakistan is 96,000 which varies from 69,000 to 150,000. Among these, about 94,000 persons are adults aged from 15 to 49 years while 27,000 women are infected and about 5,000 deaths have occurred due to this disease.
Pakistan has committed to tackle the HIV/AIDS epidemic by signing “Declaration of Commitment (DoC)” at the United Nations General Assembly Special Session (UNGASS) on HIV/AIDS in June 2001, so our country has become a part of global consensus to achieve the sixth Millennium Development Goal of ‘halting and beginning to reverse the HIV/AIDS epidemic by 2015’. But the graph of infection is escalating almost vertically. On the other side, a latest report submitted by WHO on internet shows that further spread in Africa, wherein the disease originated, has successfully been halted. It means that by 2015 we have only two years to complete our commitment to halt or reverse the spread of disease, while the facts and efforts made by the government don’t seem optimistic.
Although a huge budget is spent on the public health communication campaigns to inform the people about causes, preventive measures and treatment of the disease but some very important aspects are not addressed which result in partial or whole failures of such campaigns. The most important of them is a clear difference between HIV and AIDS. HIV stands for “Human Immunodeficiency Virus” while AIDS stands for “Acquired Immune Deficiency Syndrome”. In fact, AIDS is a late and fatal stage of HIV infection. Someone infected with HIV is called “HIV positive”. He may prolong his normal life up to 20-25 years with the help of supportive drugs while the person who has acquired immune deficiency i.e., AIDS, cannot survive that long. Anti-HIV drugs can delay or prevent the onset of AIDS in most persons infected with HIV.
Despite a particular difference between the both, it was found that the term HIV and AIDS were being misperceived in the given study area. It is very crucial for both victim and non-victim to know this difference because it implicates a lot on treatment and aggravation of stigma. The patient at initial stage i.e., infected with HIV, can prolong his life up to 25 years with suitable treatment. During my survey it was found that even well-educated persons i.e., educationists, lawyers, bankers and civil servants, were unaware of this fact.
Once I met a young girl in a hospital of JPJ who was recently declared HIV carrier. She was physically healthy but she seemed quite disturbed and nervous. I asked her gently whether she knew that there was a large difference between HIV and AIDS. She said no. When I briefed her that she could live more than 20-25 years normally with the disease, she at once became calm and cool. After a while, she slept with her sweat fully dried. Even her three family members did not know about this. That’s why media must spread awareness about this fallacy, particularly in the high risk areas.
The other main barrier in this regard is misconception about catching the disease. People believe that the patient has got it through sexual intercourse, thus causing guilt and stigma for the patient. While many women, children and babies are innocent who get infected from their spouses or mothers. I went from village to village for my study. Whenever I came across an infected person, rather than accepting the truth, they would blame it on the doctor diagnosing them, saying that he was telling lies. With this heightened sense of stigma, many infected persons try to hide or conceal their disease, thus keeping themselves away from proper treatment.
The AIDS related stigma adds to the miseries of the residents of a locality in other ways too. I was told by some notables of Jogi Pura that “as soon as the news appeared on electronic media, we were swarmed with the news channels’ teams of reporters and health officials on a daily basis. But that’s not the main problem; the main problem is that since the news got out, we are being treated regarded as disgusting people. Some marriages have ended in divorce, engagements have been called off, regardless of the fact that the fiancé is non-infected. No one wants to purchase property here as property rates have going down the hill”.
Keeping the above in view above, it is necessary for media campaign designers that they should address the issue of stigma effectively; otherwise, the campaign may likely be fruitless causing the infected persons many social as well as physical hurdles in the way of their treatment.
HIV/AIDS is not a disease of the rich or well educated persons, rather it has created pockets where poverty, illiteracy, unhygienic environment, drugs addiction and unemployment has got roots. The poor is a prey to HIV/AIDS in Pakistan. So, if the government of Pakistan is sincere to its commitments regarding reversing the AIDS, it must give employment, education, healthy living conditions and drug free society to the poor of different areas, like JPJ.
The writer is Deputy Director, DGPR, Punjab, and a research scholar on HIV/AIDS. He can be contacted at: tonaim08@gmail.com