ISLAMABAD: Pakistan is experiencing the second fastest rate of HIV increase in the Asia-Pacific region, largely due to the spread of the virus from key populations to the general population through sexual networks.

The Global Fund (GF) has designated Pakistan as a sub-recipient of its $72 million aid for HIV, with the funds now being channelled through the United Nations Development Programme (UNDP) and the private sector instead of the federal government.

Pakistan Institute of Medical Sciences (Pims) Radiology Department Head Professor Ayesha Isani Majeed shared this information while talking to Dawn.

“According to The Lancet, HIV prevalence among the general population in Pakistan is estimated to be less than 0.1 per cent, with around 165,000 people living with HIV. However, the epidemic is concentrated in key populations, including people who inject drugs (PWID), male sex workers, female sex workers, transgender individuals, and men who have sex with men,” Dr Isani said.

Over 165,000 people living with disease, marginalised group disproportionately exposed

“HIV prevalence is notably higher among prison populations compared to the general public. Factors such as unprotected sex, substance abuse, and needle-sharing are prevalent in correctional facilities, placing inmates at significant risk for HIV, hepatitis, and other sexually transmitted infections (STIs). Despite these known risks, the situation of HIV in prisons has been largely unexamined, with previous surveillance efforts excluding prisoners from cross-country studies. The National AIDS Control Program’s (NACP) initiative represents a crucial step towards addressing this gap in public health data,” she said.

She said that Pakistan lost GF’s primary recipient status in 2021. Concerns have been raised that a significant portion of the funds may be spent on management costs, leaving little for direct assistance to the people. She said the change has also sparked worries about the UNDP’s ability to respond effectively to outbreaks, particularly in remote areas, like Ratodero in Sindh.

The health ministry officials, however, expressed confidence in the UNDP’s transparency and claimed that Pakistan was striving to regain its primary recipient status to better manage the growing HIV cases before they escalate to become a national endemic, like hepatitis and tuberculosis.

Dr Isani said that in an unprecedented effort to address the growing concerns of HIV/AIDS among incarcerated populations, the NACP, under the Ministry of Health, conducted an HIV screening and testing camp at Adiala jail in Rawalpindi from October 25, 2021, to November 25, 2021.

“…the jail authorities facilitated the testing of 4,347 inmates out of a total population of 5,000, including 115 female inmates. The results of the screening revealed that 87 inmates tested positive for HIV, representing a 2pc positivity rate,” she said.

“The findings from the screening camp underscored the critical need for ongoing HIV prevention and treatment efforts in prison settings. While The Lancet reports that only 14.7pc of people living with HIV in Pakistan are registered with the NACP, the need for expanded services is evident. The current scenario suggests that the overall prevalence of HIV in the general population is likely under-reported, as key populations with high HIV prevalence often remain marginalised and underserved,” she said.

“A study published in the Pakistan Journal of Public Health found that only 17pc of respondents correctly answered all five questions regarding HIV transmission and prevention, while 22.8pc showed a more discriminatory attitude towards people living with HIV. Moreover, a 2023 study published in Health Science (a journal) reported that Pakistan has the second-fastest rate of HIV spread in the Asia-Pacific region, with approximately 210,000 people currently living with HIV. This figure includes 41,000 women and 170,000 men, with only 61pc of registered HIV cases receiving antiretroviral therapy (ART) through the NACP,” she said.

Dr Isani suggested that public health efforts must be inclusive of all populations, especially those most at risk. “To effectively combat the HIV epidemic in Pakistan, national and provincial AIDS control programmes must improve the quality of services provided at ART centres, increase coverage, and enhance outreach services for key populations. Additionally, efforts to reduce stigma and discrimination against PLHIV, along with initiatives to educate the public about HIV prevention and treatment, are essential,” she said.

Published in Dawn, September 15th, 2024