KARACHI: On May 30 this year a woman, who was sick for a long time, was murdered by her husband in Gharo Rind village in Sindh. Her body was left hanging from a tree as people stood there and made videos. Her sin: she tested positive for HIV in a screening drive by the provincial authorities.

Her husband accused her of infidelity. But her family and locals say she had received multiple injections and blood transfusions and was one of the victims of reused syringes.

Post arrest, the husband refused to take an HIV test. At her burial, many refused to come forward and assist with the task of carrying the coffin. To date, no one in the family is sure if the woman really had HIV because no further investigation was carried out by the health authorities.

As Pakistan commemorates World Aids Day today, the stats shared by UNAIDS are worth pondering over. Pakistan has 160,000 adults living with HIV, of which 48,000 are women of 15 years or more. “HIV treatment is less frequent among women than men, with 7pc of adult women living with HIV on treatment, compared to 11pc of adult men,” the UNAIDS factsheet adds.

The country also has an estimated population of 52,400 transgender persons, who have an HIV prevalence rate of 5.5 per cent. Though homosexuality is a criminal offence, men who have sex with men (MSMs) and transgender sex workers (TSWs) are an open secret. HIV high risk groups include injecting drug users (IDUs), female sex workers (FSWs), MSMs and TSWs along with migrant workers and prisoners. The spouses and partners of members of these high risk groups fall under the ‘bridge population’ — an often overlooked segment of population.

Never-ending abuse

“I curse my husband everyday for giving me this disease. We already had two teenage children and then he found out he had HIV. Just to make sure I would not leave him, he repeatedly forced himself on me. After two years, I tested positive for the virus,” says Haleema (name has been changed to protect privacy), a middle-aged woman who is HIV positive. Her husband worked as paramedic at a hospital and had a ‘bad’ drug habit.

“In 2006, he told me he was HIV positive. I was scared but he said he would be fine as medicine is available. I wondered how he was going to be fine when his drug habit never got cured all these years. He took me to a doctor who did some tests on me. I was fine, he said and sent me home with a packet of condoms, stressing that whenever I have sex next, I should use these,” she says. “At that point, I chose not to tell my children because they were preparing for their exams.”

After two years, she tested positive. “He looked relieved and said “ab tu kahan jaye gi?” she recalled.

Eventually she told her children. “Not many in my family know of my status. Those who do treat me badly but my children have been supportive and I have made it thus far because of them,” she says.

Haleema’s story is repeated by the wives and partners of many HIV+ men, who often do not disclose their condition to their spouses and partners and infect them knowingly. Many of the women say they have been barred from touching utensils and hugging and kissing their kids, simply becoming social outcasts.

Illiteracy

Dr Holaram Thakuria, chief of the HIV/AIDS Treatment and Care Centre, the CMC Hospital, Larkana, says low literacy rates and lack of awareness make it difficult for men and women to understand HIV. The centre currently has 2,105 men, 720 women, 34 transgender persons and 41 children registered.

“Eighty per cent of the women are infected by their spouses, many of whom are IDUs and migrant workers who visit sex workers, while the remaining had a history of unsafe blood transfusions,” he says.

“Women in rural societies are very different from the women in urban areas. They are more exposed to violence and harm while their illiteracy puts them and their children at a greater risk of contracting diseases, HIV or otherwise,” says Dr Thakuria while calling for a more humane communication strategy.

His stance is supported by Dr Anila Isran, women medical officer and coordinator of PPTCT, HIV Treatment Centre, Sheikh Zayed Women Hospital in Larkana.

“Some of the women are so innocent. They believe when their husbands when they tell them they got HIV because of a bad shave or mosquito bites. Many of these men work abroad or in other cities, some have a long history of drug abuse,” she says. Many of the men refuse to share test results and that is a clear giveaway that they infected their wives, she adds.

In some of the least literate areas of the country, including interior Sindh, Balochistan and Gilgit-Baltistan’s Diamer and Astore regions, awareness about STDs remains low. A large number of men from GB region move to other parts of the country looking for work and often indulge in risky behaviour. So far almost a dozen HIV+ individuals from GB have registered with the Aids control programme and receive ARVs.

Among the provinces, Sindh has taken the lead for preventing deliberate exposure to HIV, at least on paper. The Sindh HIV and Aids Control Treatment and Protection Act, 2013 says any person who “deliberately exposes others to the risk of transmission by non-disclosing his HIV AIDS status shall be liable to be punished with imprisonment of five years and with fine which may extend to two hundred thousand rupees”. Sections 269 and 270 of the Pakistan Penal Code shall be applicable, the act adds.

But how does one prove deliberate exposure to the virus? It’s very difficult to prove, admitted the healthcare providers reached by Dawn. Till the time more awareness about health issues, including HIV/AIDS, is raised among the general population, women will continue to be vulnerable.

Published in Dawn, December 1st, 2019