HIV and AIDS: Expanding at an Alarming Rate in Pakistan

HIV and AIDS: Expanding at an Alarming Rate in Pakistan

Mazhar Ali Dootio

[My this article is published in theleader.com.pk]

http://theleader.com.pk/hiv-and-aids-expanding-at-an-alarming-rate-in-pakistan/?fbclid=IwAR0HQooMSIqL_niFZPVI863uHIVdlbQ0XMKcXAdIUuvnxm7GzLUNDqn23dg

Pakistan was long considered a low prevalence country for HIV, but the disease is expanding at an alarming rate, particularly among intravenous drug users and sex workers. HIV is a virus that attacks cells in the immune system, which is one body’s natural defense against illness. The virus destroys a type of white blood cell in the immune system called a T-helper cell, and makes copies of itself inside these cells. T-helper cells are also referred to as CD4 cells. As HIV destroys more CD4 cells and makes more copies of itself, it gradually weakens a person’s immune system. This means that someone who has HIV, and isn’t taking treatment, will find it harder and harder to fight off infections and diseases. If HIV is left untreated, it may take up to 10 or 15 years for the immune system to be so severely damaged that it can no longer defend itself at all. However, the rate at which HIV progresses varies depending on age, general health and background.  According to Wikipedia, HIV is recognized as a health concern in Pakistan with the number of cases growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the HIV epidemic to take hold in Pakistan, mainly among injection drug users (IDU), male, female and transvestite sex workers (MSW, FSW and TSW) as well as the repatriated migrant workers. HIV infection can lead to AIDS that may become a major health issue. The Wikipedia page, which was last edited on 6 March 2019 at 02:24 (UTC), presents the sample distribution of high risk groups in the following table.

Province	IDUs	MSWs	TSWs	FSWs
Punjab	2,248	1,439	1,786	3,347
Sind	2,213	1,440	1,337	1,472
KPK	325	436	718	712
Baluchistan	730	359	338	345

The National AIDS Programme’s latest figures show that by the mid of first decade in new millennium, the number of HIV cases have increased to approximately 0,102 million (http://www.nacp.gov.pk/). This number was estimated little over 4,000, as the HIV cases reported since 1986. The UN and government estimated the number of HIV/AIDS cases around 97,000 ranging from a lowest estimate of 46,000 to a highest estimate of 210,000

HIV stands for human immunodeficiency virus. People with HIV can enjoy a long and healthy life by taking antiretroviral treatment which is effective and available to all. Once a person has HIV, the earlier they are diagnosed, the sooner they can start treatment which means they will enjoy better health in the long term. It’s possible for antiretroviral treatment to reduce the level of HIV in the body to such low levels that blood tests cannot detect it. People living with HIV whose viral load is confirmed as undetectable cannot pass on HIV. Regular testing for HIV is important to know the status of patient. HIV is found in semen, blood, vaginal and anal fluids, and breastmilk. Therefore, using condoms during sex is the best way to prevent HIV and other sexually transmitted infections. If someone inject drugs, always use a clean needle and syringe, and never share equipment. If someone is pregnant and living with HIV, the virus in her blood could pass into her baby’s body, during birth or afterwards through breastfeeding. HIV infects white blood cells in the body’s immune system called T-helper cells or CD4 cells. The virus attaches itself to the T-helper cell; it then fuses with it, takes control of its DNA, replicates itself and releases more HIV into the blood. Knowing how HIV infects the body helps people understand prevention and treatment options, and why it’s important to start antiretroviral treatment as soon as possible after testing positive. HIV cannot grow or reproduce on its own. Instead, the virus attaches itself to a T-helper cell and fuses with it. It then takes control of the cell’s DNA, replicates itself inside the cell, and finally releases more HIV into the blood – continuing the multiplication process.  In this way HIV weakens the body’s natural defenses and over time severely damages the immune system. How quickly the virus develops depends on a person’s general health, how soon after getting HIV they are diagnosed and start antiretroviral treatment, and how consistently they take their treatment. (Source: https://www.avert.org/about-hiv-aids/what-hiv-aids)

AIDS is a set of symptoms or syndrome as opposed to a virus caused by HIV. A person is said to have AIDS when their immune system is too weak to fight off infection, and they develop certain defining symptoms and illnesses. This is the last stage of HIV, when the infection is very advanced, and if left untreated will lead to death. AIDS stands for acquired immune deficiency syndrome; it is also called advanced HIV infection or late-stage HIV. AIDS is a set of symptoms and illnesses that develop as a result of advanced HIV infection which has destroyed the immune system.

The earlier a person is diagnosed with HIV and starts treatment, the better their long-term health. Some people don’t get any symptoms during stages 1 and 2, but they can still pass on HIV. This is why HIV is often transmitted by people who don’t know they have the virus. The symptoms of HIV at each stage can vary in type and severity from person to person and some people may not get any symptoms at all for many years. Without treatment, the virus replicates in the body and causes more and more damage to the immune system. Around one to four weeks after getting HIV, some people will experience symptoms that can feel like flu. These may not last long and you may only get some of the flu symptoms or none at all. Experiencing these symptoms alone is not a reliable way of diagnosing HIV. Symptoms can include: fever (may be raised temperature), body rash, sore throat, swollen glands, headache, upset stomach, joint aches and pains, muscle pain. These symptoms can happen because body is reacting to the HIV virus. Cells that are infected with HIV are circulating throughout the blood system. The immune system, in response, tries to attack the virus by producing HIV antibodies. Timing varies but once someone has HIV it can take his or her body up to a few months to go through the seroconversion process. It may be too early to get an accurate HIV test result at this point, but the levels of virus in blood system are high at this stage. If HIV patient are not getting treatment then they may be more likely to get serious infections, or bacterial and fungal diseases that the body would otherwise be able to fight off. Symptoms can include: weight loss, chronic diarrhoea, night sweats, fever, persistent cough, mouth and skin problems, regular infections and serious illness or disease. (Source: https://www.avert.org/about-hiv-aids/what-hiv-aids)

The researchers and scientists believe that they can find a cure for HIV. They know a lot about HIV, as much as certain cancers. Scientists are researching two types of cure: a functional cure and a sterilising cure. A functional cure would suppress the amount of HIV virus in the body to such low levels that it can’t be detected or make someone ill but it would still be present. Some people think that antiretroviral treatment is effectively a functional cure, but most define a functional cure as something that suppresses the virus without the need for ongoing antiretroviral treatment. A sterilising cure is one where the HIV virus is eradicated from the body completely. There is only one known person who’s been cured in this way: Timothy Brown, also known as the 'Berlin Patient'. In 2007-08, Brown had chemotherapy and a bone marrow transplant to treat leukaemia. His transplant came from someone with a natural genetic resistance to HIV. He was cured of HIV but scientists don’t fully understand why. Also, because bone marrow transplants can be dangerous, they’re not practical as a wider HIV cure. However, this process has given researchers important information that they’re using to work towards a cure.

Pakistan's growing population suffers the burden of having insufficient access to quality healthcare. HIV outbreaks at Ratodero, a small city and Taluka of Larkana. "According to some government reports, around 600,000 quack doctors are operating across the country and around 270,000 are practicing in the province of Sindh," said UNAIDS in a statement. Provincial health officials have also noted that patients are at particular risk of contracting diseases or viruses at these clinics, where injections are often pushed as a primary treatment option. (source: https://www.aljazeera.com/news/2019/05/coming-dozens-hiv-outbreak-sparks-panic-pakistan-190516061341489.html).  The reuse of syringes, surgical instruments, instruments of barbers, unauthenticated blood transfusions, wrong sexual connections etc. may be sources to spread the HIV virus in Ratodero. According to VOA News, Pakistan is registering approximately 20,000 new HIV infections annually, the highest rate of increase among all countries in the region, warns the World Health Organization (WHO). The international body says mortality among Pakistanis living with the virus, which causes the deadly AIDS disease, is also rising, in spite of the availability of life saving antiretroviral therapy. The government figures show that only 16 percent of the estimated 150,000 people living with HIV had been tested and only 9 percent have access to lifesaving treatment. The remaining 135,000 people are walking around in the communities as carriers of (HIV) infection who are ready to transmit infections to those who are not infected, even to their unborn babies. The HIV epidemic in Pakistan remains largely concentrated among the key populations, including people who inject drugs, the transgender community, sex workers and their clients and men who have sex with men. Official estimates show that Pakistan has seen a 45 percent increase in new HIV infections since 2010. The number of new HIV infections will continue to increase dramatically if implementation rates of intervention remain at current levels. (Source: https://www.voanews.com/a/who-says-hiv-epidemic-spreads-at-alarming-rate-in-pakistan/4683295.html).

More complex challenges are determining how to integrate many of HIV activities within other health activities, improve planning to anticipate future direction of the epidemic and its response and to enhance efficiency and effectiveness of the interventions. The newspaper information shows a slower case detection and confirmation as well as any response services for the infected population.

“An ounce of prevention is worth a pound of cure”