KARACHI: Thirty-year-old Mushtaq Masih has visited many health facilities to receive treatment for his severely infected swollen foot over the last eight months but has often been turned back, sometimes humiliatingly, simply because he is an injecting drug user living with human immunodeficiency virus.

“Whenever I disclosed my status, medical staff at health facilities treated me with utter disregard and often I was shown the door immediately,” he said grimly as shared his ordeal with Dawn .

Mushtaq’s experience at the Civil Hospital Karachi (CHK), where the provincial government runs an HIV treatment centre, is not much different.

He reported at the centre on June 1 where he was told that it provided support only for HIV treatment and then he was referred to the out-patient department of surgery.

Instead of examining him, the surgical OPD staff sent him to the orthopaedic department when they came to know about his medical status, he said. Here again he failed to receive treatment and was then referred to the emergency department.

According to Mushtaq, no member of the medical staff at the emergency section was willing to attend to him. Finally, a colleague — a member of the people living with HIV (PLWH) who had brought Mushtaq to hospital — cleaned the wound for dressing.

“Despite government efforts and many awareness campaigns, the fact is that life for people living with HIV either hasn’t changed in society or has become worse over the last 15 years,” said Dr Saleem Azam, whose rehabilitation centre for homeless drug addicts is currently looking after Mushtaq.

The doctor said the infection had become acute and he might require amputation.

“The wound is regularly dressed by our staff, but he required immediate examination by qualified surgeons,” he said, adding that the prejudice Mushtaq faced at the hands of medical staff was a common grievance of the people living with HIV.

A group of PLWH receiving support from the Pakistan Society, a non-government organisation running the rehabilitation centre, sharing their experiences of government health facilities with Dawn said they were “treated as outcasts”.

They said the medical staff observed no confidentiality in their cases and disclosed their medical status in the presence of others. Treatment was either delayed for hours or even refused.

“Whenever I visit any health facility for a blood test and disclose my medical status, I am asked to draw the blood on my own,” complained a person at the rehab.

They said since most of them also had hepatitis C they wanted the government to provide all relevant facilities, including free-of-cost diagnostic and treatment services for HIV and hepatitis C, at one place.

“None of us is receiving treatment for hepatitis C because we can’t afford the hassle involved in the long, complicated formalities to receive the medical treatment,” another said.

A few of them also complained about the poor attention being paid to them at the health facilities under the provincial government HIV/AIDS control programme. They said the staffers were not ready to address their concerns over side effects of HIV drugs.

“Some of us have developed abnormal masses on the chest probably because of the drugs we are taking in high doses. We have brought this to the notice of our healthcare providers but haven’t received a satisfactory reply,” one of them said.

When healthcare providers who were supposed to be the most educated about the disease were treating the HIV positive persons with utmost neglect what could one expect from the general public, they said.

People picked up from the street as an IDU and rehabilitated at the centre are now working at different positions as society is still reluctant to own them.Missing the target

According to experts, the disease that was earlier believed to be limited to a small group of people is now common in the community. One major reason for its spread, according to them, is lack of government focus on injecting drug users (IDUs), a high-risk group for HIV infection.

“The death rate in the homeless IDUs living with the HIV has increased,” said Dr Azam, adding that between eight and 10 such people died every month in Karachi.

He said: “Currently, there is no programme in the public sector for the rehabilitation of these people, though a few NGOs are working in the area. The rehab set up by the anti-narcotics force does not admit IDUs living with HIV.”

The organisation, he said, had received government and international funds for providing services to the IDUs and had registered 7,000 cases in Karachi, but the efforts were inadequate to meet the challenge.

“We run separate projects with their financial support. But there needs to be a comprehensive programme for their rehabilitation as it is the most difficult and critical area that needs to be focused,” he said.

According to official estimates, there are about 100,000 HIV positive persons in the country. However, the number of confirmed cases is only 8,000. Sindh has around 50,000 HIV positive cases, of whom only 3,926 have been identified so far. Around 40,000 HIV positive people are in Karachi.

There are about 25,000 to 30,000 IDUs in Karachi, 30 per cent of whom are said to be infected with HIV.

‘A giant leap’ needed

Dr Azra Ghayas Abro at the CHK HIV/AIDS treatment centre agreed that the admission of PLWH was still an issue though she contended that there had been some improvement in the attitude of medical staff over time.

“PLWH, in emergency conditions such as persistent diarrhoea, now get admission to the hospital. However, those without any obvious symptoms of medical emergency do have problems.

“While a small change has come in attitude, we need a giant leap if we really want to address the issue. A large number of people living with HIV die without being diagnosed and there is a dire need to create awareness and train health providers so that these people are diagnosed and provided with medical support,” she said.

The CHK, she said, was overburdened and there was a need to expand medical services to PLWH in the city. “The CHK is the only centre in the public sector in Karachi providing HIV treatment. The other centre is in Larkana. Two private hospitals, the Aga Khan University and Hospital and the Indus Hospital, collaborate in the provincial programme for AIDS control.”

She said the abnormal masses developed in some people were the side-effects of the high toxicity present in HIV drugs. “They are not dangerous and the PLWH have been told about it.”

Most general practitioners did not follow primary medical precautions for patient’s examination, said Dr Shobha Luxmi, who practises at the Indus Hospital, while citing a major reason for the problems faced in treatment and admission of people living with HIV.

“Medical precautions for examination such as using sterilised equipment should be a standard for all patients and not just for those with the HIV infection. There are certain modes of transmission for HIV and it can’t be spread from other means,” she said.

Deputy Manager of the Sindh Enhanced Programme on AIDS Prevention and Control Dr Qamar Abbas said that the government was attending to the IDUs on the street with the help of the non-government organisations working in the specified area. The prevention of AIDS was not just a health issue, he said, adding that it required joint efforts of different departments such as anti-narcotics force and social welfare department.

“A significant number of IDUs are registered with us and getting treatment. It is because of these efforts that the prevalence of HIV in IDUs has dropped from 29 per cent to 22 percent within a few years.” However, Dr Azam challenged the presumed drop in the HIV prevalence among homeless IDUs in Karachi and argued that it could have been a result of an increase in mortality rate of IDUs or due to the fact that they stayed at one place only for a short time.

The efforts of the government and NGOs had been inadequate to make a real difference, he remarked.

By Ishaq Tanoli