KARACHI: Health experts on Tuesday called for making HIV testing a routine test to destigmatise the infection, universal screening of all high-risk groups, including prisoners, and zero tolerance for discrimination based on HIV status, resulting in employment termination in the country.

At a seminar on ‘Reducing HIV Stigma’, it was highlighted that the HIV situation in Pakistan was alarming and needed enhanced surveillance, control, and destigmatisation.

The event was organised by the Medical Microbiology & Infectious Diseases Society of Pakistan (MMIDSP) in collaboration with the Association of Physicians of Pakistani Descent of North America (APPNA), Common Management Unit, National Institute of Health and the federal and provincial governments.

The need for active government support along with donor funding to curb the HIV epidemic in the country was stressed along with mandating HIV education in all medical colleges and universities. Destigmatisation trainings for general practitioners and family medicine physicians to treat HIV patients were also urged.

There are around 200,000 HIV positive people in country

“The China-Pakistan Economic Corridor has rapidly changed the [societal] dynamics, with the result that the country’s HIV risk has gone up while the infection remains grossly underestimated,” said Dr Malik Muhammad Umair, the CEO and founder of the Pak Public Health Forum.

In his presentation on “HIV/Aids stigma among health care providers (HCPs)”, Dr Umair highlighted that 65 per cent of HIV patients did not return for treatment due to the behaviour of HCPs, including doctors and nurses.

“Pakistan is at the top for hepatitis C, while hepatitis B cases are also rising as the mode of transmission is the same as HIV,” he said.

Dr Umair said that attitudes and actions, along with fear and lack of knowledge, were leading to stigmatisation.

There are an estimated 27,000 new infections while 200,000 HIV positive people are in the country. While the national and provincial AIDS control programmes are largely focused on key populations or high-risk groups, interestingly, 65pc of registered patients are from the general public.

Despite being the most vulnerable population, the adolescent population has been ignored and overlooked in awareness campaigns, Dr Shobha Luxmi from the National Institute of Cardiovascular Disease said. “Hamien bacho sey baat karna nahi aati (we don’t know how to talk to our children),” she said.

She stressed that there was a dire need to increase awareness in schools with regards to drug abuse and sexually transmitted infections.

MMIDSP president Prof Dr Bushra Jamil said that the HIV programme in the country was floundering due to inequitable distributions of funds between the centre and the provinces.

“The current existing infrastructure and available framework is failing to reduce the number of new HIV infections, increase treatment uptake, and reduce HIV transmission and HIV associated morbidity and mortality in Pakistan,” she said.

It is worth noting that treatment for TB, HIV and malaria in Pakistan is largely donor funded, with negligible contribution from the government. HIV-related deaths in Pakistan increased by 4.5 times between 2010 and 2018, in contrast to a global decline.

Dr Jamil said that ethical and social aspects are neglected; a large majority of our educated population and HCPs had never been introduced to the concepts of patient privacy, autonomy and other basic rights.

“Stigmatisation is a reflection of prevailing illiteracy and rudimentary emotional intelligence. HCPs may not even realise that patients are humans,” she said.

The statistics pertaining to HIV prevalence in Pakistan are deeply alarming. It is rather unfortunate that though testing is the vital first step in providing the initial diagnosis for people to learn their status and assess treatment options for HIV, stigma and alienation are barriers that prevent early testing and diagnosis of the disease, said Abdul Qayyum, Roche Diagnostics Country Manager, Pakistan & Afghanistan.

Published in Dawn, July 20th, 2022