HIV outbreak in Sindh: a case of acute negligence

Pakistan Peoples Party (PPP), one of the leading parties in the country, rules the southeast province of Pakistan, Sindh. The province has a history of security issues in Karachi, infant mortality challenges in Tharparkar and the plague of corruption seeped at every level.

In the past, the provincial government set new records of mismanagement and negligence. Sindh has a unique political framework, where the change of power is next to impossible. After the loss of one of the real leader of the soil, Benazir Bhutto, Pakistan Peoples Party has completely transformed into a royal dynasty where Bilawal Bhutto enjoys the status of a crown prince. Now Bilawal owns and runs PPP and Sindh. With the political focus of the young leader diverted towards saving the skin of his family members from several corruption inquiries, something very alarming that could potentially threaten the country’s present and the future remains neglected.

Larkana is the political capital of the ruling Pakistan Peoples Party where over 600 people – 75% of them children – were found infected with the human immunodeficiency virus (HIV). Back in the 1980s, it was thought that AIDS only affects particular groups such as homosexuals, or people using drugs in developed countries. However, it was discovered that HIV can spread through blood transfusion and multiple use of an infected syringe. It can spread between heterosexual individuals and can be transmitted from an HIV positive mother to her baby. The acquired immune deficiency syndrome (AIDS) is a global health challenge and so far approximately 77 million people have been found infected with HIV.

The healthcare department feared that HIV cases may turn into an epidemic in Sindh. Furthermore, according to the UNAIDS, in Pakistan, the HIV infection has increased by 57% from 2010 to 2018. With nominal health facilities and lack of check and balance, can we be sure that it will remain exclusive to Sindh? No. Alarmingly, it is expected that HIV may turn into an epidemic in the whole country, but Sindh Health Minister Dr Azra Fazal Pechuho, also Bilawal’s paternal-aunt, has no clear plans, answers or solutions to address the alarming situation.

HIV continues to affect youth disproportionately, particularly in developing countries. Moreover, in the poor countries, where the HIV affects different age groups, the women between 15-25 years of age are more likely, approximately three to five times, to have HIV as compared to their male counterparts.

In Larkana, the majority of the victims are children who have been affected by this disease. The number has grown manifold due to multiple use of the infected syringes.

Every HIV patient has holistic health needs, which can hardly be provided in the current situation as the patients are from an impoverished background and a remote area.

The highly active antiretroviral treatment (HAART) is considered a breakthrough in the HIV response, which was announced in Vancouver in 1999. It is a combination of three ARVs, which has reduced AIDS-related death by 60%-80%. On the other hand, not everyone can benefit from this innovative treatment because of the ARVs are expensive. Countries like Pakistan cannot afford to provide HAART to HIV patients through its public programme.

It is no secret that Pakistan has neither the technology nor the capacity to tackle such a big challenge in the healthcare sector. With the mist of economic crisis, an ongoing political tug of war, corruption’s past and future challenges and the IMF riddles, this horrifying issue is being pushed under the carpet by both the provincial and the federal governments. In addition to that, there is a huge network of quacks who make the situation more depressing.

A similar outbreak was witnessed in Africa in 2010. Today, a majority (97%) of the people infected with HIV are living in Sub-Saharan African countries. The African leaders refused to acknowledge AIDS existence in the region and demonstrated criminal neglect towards the issue. By the end of 2003, approximately 40% of Botswana’s adult population was infected with HIV.

In Pakistan, the rulers seem to be asleep at the switch. They are either ignorant of the potential and scope of the disease or they are ruthlessly playing with the nation’s future, its well-being and the very existence. There are no questions asked and no one held accountable for the outbreak till now. So far, neither any plan has been unveiled to counter such a huge challenge, nor any strategy has been made to save the people and quarantine this epidemic.

According to Dr Stefano M Bertozzi, the dean emeritus and professor of health policy and management at the UC Berkeley School of Public Health, the treatment and prevention of AIDS epidemic depend on the stage of the epidemic, and country’s potential to address it.

“At the same time, global pandemic needs proactive actions. In developing countries, the actions are taken in the absence of any specific data. Lack of useful data limits the scope of the tailored response, which limits its success,” he said.

To counter the challenge, it is critical to address the structural issues, increase access to health facilities and reproductive services. Needless to say, awareness about the disease plays a vital role in containing the infection from turning into an epidemic. Additionally, in the fight against the epidemic, overcoming stigmas and taboos play a key role. Though beating this challenge is difficult in Pakistan, but it is worth the efforts.

The disease spreads quickly in areas where the people remain neglected, underserved or unaware. In Larkana’s case, there is a complete absence of any form of hospital hygiene or infection control. Besides, the victims are also entirely unaware of hygiene or infection control requirements, resulting in the unchecked outbreak of AIDS. On the other hand, the question that how the government intends to help the poor infected people remains unanswered. The people infected with HIV are poor who can hardly afford one meal a day. Probably, the PPP’s government plans to cast them off from society and let them rot in their poverty. If not, then how the government plans to help them? Will they be left to die? Sadly again, there is no answer.

Indeed, the life in Pakistan is tough and in the coming years it might intensify, but this negligence on the part of the Sindh government has unleashed the disaster beyond human comprehension. Pakistan is not equipped to counter HIV epidemic and by all means, the situation is alarming. However, our rulers are criminally ignoring it. If such an attitude persists, it will result in exposing Pakistan and its people to a greater disaster. Still, a haunting question remains unanswered. Will Pakistan be left alone again to counter what is beyond its capacity?