HIV-SINDH-Experience Epidemiological characteristics

Candle Light Memorial May 15, 2011

Dr. M. Rafiq Khanani

Associate Professor, Pathology Dow International Medical College Director, Dow Diagnostic Reference & Research Lab Dow University of Health Sciences (DUHS) Infection Control Society Pakistan Pathologist Citilab Email: rafiqcitilab@hotmail.com r.khanani@duhs.edu.pk www.duhs.edu.pk: www.infectioncontrolsociety.org

CURRENT SITUATION OF HIV/AIDS IN SINDH

Sindh province has unique position in the country due to Karachi being most populous city of Pakistan with population more than 17 million. People from all parts of country come to Karachi for employment opportunities and better diagnostic and treatment facilities.

HIV in Sindh
HIV was first diagnosed from Karachi in 1986 in a blood sample of a drug addict who was also a donor (professional blood seller) . [Ref: Khanani, M.R., Hafiz, A., Rab, S.M., and Rasheed, S.,
Human Immunodeficiency Virus Associated Disorders in Pakistan. AIDS Research and Human Retroviruses. (USA) (1988) 4(2):149 - 154.]

Number of cases are continuously increasing since that report Sindh Province is worst affected in Pakistan and Karachi is the worst affected city In several countries the pattern of spread is : initial introduction of HIV in sex workers or Intravenous Drug Users. If introduced in sex workers it reaches IDU clients. Than it rapidly circulate in IDU population and gradually keep infecting more and more sex workers both male and female. As 50% of IDUs are also married they infect their wives as well. 50% of sex workers both male and female in Sindh are also married and therefore they infect their spouses. In this way infection spill over to general population. At this stage it becomes vey difficult to contain the epidemic. Pakistan was implementing HIV prevention program which was successful in containing the epidemic (Pakistan is one of the few countries in the world with lowest number of HIV infections). Unfortunately this program was stopped in sindh in Dec 2009. Sindh government sustained it till June 2010. Since than NO Preventive Services are available and this could cause a devastating epidemic (just like hepatitis B and C- which Pakistan is experiencing)

HIV in Sindh
Some of IDUs and Sex workers also sell blood or donate blood and HIV infection may also spread by this route. As HIV transmission occurs by only three routes ie. Mother to child, sexual intercourse, needle pricks or sharing of injections it can be prevented by appropriate interventions. We can not count the number of people suffering from HIV/AIDS as diagnosis require testing and not every one is tested. Estimated number of HIV infection in Sindh is 4565000. Number of people coming from HIV treatment in Sindh from the government facilities is about 250. We do not have the figures getting treatment from private sector. Private laboratories report increasing number of HIV positive results.

HIV in Sindh
Sentinel surveillance is being conducted in estimate the number of people likely to be infected. People most likely to get infected are Commercial Sex Workers (Male, female and Hijra), IDUs and recipients of blood transfusions or needle pricks from infected persons. Previous studies of persons belonging to these risk behavior groups indicated high prevalence in Sindh. Some of these figures are:

High Risk Behaviors in Sindh

SINDH FSWs
>25000

IDUs
>20000

MSW
>25000

Hijras
>20000

All these subjects are more likely to get HIV infection. Presently in Sindh HIV prevalence among IDU is more than 22%, MSW > 5% and Hijras > 3.0%. Among Female sex workers it is less than 0.3%

CHALLENGES

Conti..

Large population of immigrant workers, injecting drug users, sex workers, truckers, & prisoners. Above high risk populations frequently move from smaller towns to big cities. More challenges for HIV/AIDS prevention in Sindh than rest of the country. Sindh has reported maximum number of HIV/AIDS cases in the country. (4003 cases out of which 1921 are HIV+ve and 2082 AIDS cases. About 1200 have died and ____are currently on ARV therapy). Remaining -------have lost to follow up.
It is estimated that more than 6000 HIV infected individuals have not been reported to AIDS control program for various reasons.

CHALLENGES
Poverty, Illiteracy Demographic vulnerability Low status of women in society

Vulnerable populations and high risk groups are difficult to approach for HIV/AIDS prevention interventions in Pakistan.
Illegal status/ marginal social status/ limited education.

Conti..
Difficult to talk about sex openly in Pakistani societies. Difficulty in allocation of resources for HIV/AIDS prevention in presence of enormous visible health problems.

Prevalence of HBV and HCV, in Pakistan is one of highest in the world. HIV another blood borne pathogen has similar modes of transmission. Pakistan has large drug user population (more than eight million) recent studies indicate increasing number of drug users are shifting to i/v drug use.

Conti.. High risk sexual behaviors, such as sexual promiscuity exchange of sex for money, homosexuality exists in the country, at least in some segments of population use of condom for disease prevention is extremely low. Overseas Pakistani workers has emerged as high risk group for HIV infection and majority of reported cases or deported Pakistanis who were working in gulf countries.

Conti.. Blood transfusion services both in public and private sector are still unsafe.

There is irrational use of injections multiple use of syringes and needles is common.
The STI management services are not accessible, affordable and easily available. HIV/AIDS is spreading at faster rates in south, and south east Asia than rest of world.

OPPORTUNITIES and SUCCESSFUL Approaches

Effective proven strategies available.

Voluntary HIV Counseling and Testing

Treatment Infections of sexually Transmitted

Condom use for disease prevention Screening of a blood before transfusion Antiretroviral Treatment-Early Diagnosis and treatment save lives and contain the epidemic

OPPORTUNITIES

Conti..

Increasing number of NGOs/CBOs working on HIV/AIDS prevention. Political commitment to control HIV/AIDS in Pakistan. Support from UN and donor agencies. Enhanced HIV/AIDS control program was implemented in the country with the support of world bank. ( NOW THIS SUPPORT IS WITHDRAWN IN SINDH IN december2009THERE IS A STRONG POSSIBILITY THAT THIS WILL RESULT IN A VERY SERIOUS EPIDEMICthis epidemic is already on the HORIZONThere are increasing number of cases seen in clinics) Role of media, increase in number of television channels and radio stations.

HOW TO ADDRESS ISSUE OF HIV/AIDS IN PAKISTAN? Coordinated, Collaborative efforts Public-Private Partnership Use of Electric and Print Media Use of Religious, Community and Political Leaders Reduce Stigma and Discrimination Provision of services to vulnerable population To reduce the vulnerability for HIV/AIDS

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