UNAIDS warns that ‘Pakistan is on the brink of a widespread HIV/AIDS epidemic’ and exhorts World Vision and its partners to act now.

Six years ago the agency estimated that 70,000-80,000 people or just under 0.1% of the population were infected with the virus. By December 2003 only 1,951 HIV positive and 246 AIDS cases had been reported to the government’s National AIDS Control Program.

Underreporting is rife due to the stigma attached to the virus, denial, inadequate surveillance and voluntary testing, as well as a lack of knowledge among the population, practitioners and policy-makers.

“Pakistan’s HIV infection rate is comparable to South Africa fifteen years ago. Now is the time to deny the virus a firm foothold,” said World Vision Country Director, Sigurd Hanson.

According to the World Bank, heterosexual transmission accounts for about 63% of reported cases, exposure to infected blood or blood products for about 7%, male to male sex for about 5%, mother to child transmission for about 3% and injecting drug use for about 1%. The remaining 21% is unknown.

To date, the majority of infected cases are among males, with a female ratio of seven to one, a ratio that is expected in the early stages of an HIV epidemic.

Until very recently the majority of HIV infections and AIDS cases reported in Pakistan were among migrant Pakistani workers who had been deported from the Gulf States. However an HIV outbreak amongst Injecting Drug Users (IDUs) recently reported in a small town in Pakistan’s southern Sindh province has demonstrated the country’s vulnerability and need to act upon warnings of HIV/AIDS experts.

Studies among Pakistani truck drivers have found that one in three has never heard of condoms and 19 out of 20 who bought sex from women did not use condoms, according to UNAIDS. Behavioural and mapping studies in three large cities found a Commercial Sex Worker population of 100,000 with limited understanding of safe sexual practices. Furthermore, sex workers often lack the power to negotiate safe sex or seek treatment for Sexually Transmitted Infections.

Another serious contributor to increasing HIV infections is unsafe medical injection practices. Studies indicate that 94% of injections are administered with used injection equipment and the use of unsterilised needles in medical facilities is also widespread.

“Pakistan has a fleeting window of opportunity to pre-empt serious outbreaks by promoting prevention among high-risk groups including sex workers, injecting drug users, men who have sex with men, truck drivers and street children. At the same time we must also focus on the needs of young people and give them information about how to protect themselves,” said Hanson.

Women and children are particularly vulnerable because of low literacy rates and their limited mobility that restricts access to information and preventive services. Large numbers of runaway children are forced into the sex trade to survive.

Country Director, Sigurd Hanson is in dialogue with the Coordinator for UNAIDS in Pakistan, who is urging World Vision and its partners to join other agencies who are addressing the HIV/AIDS problem in Pakistan and work together to implement a vigorous prevention programme, with a special focus on the North West Frontier and Punjab provinces.

Initially, the primary need is to build capacity on federal, provincial and local government levels, as well as among humanitarian organisations to implement a country-wide programme that addresses gender inequality, poor education and social disintegration that is both the cause and effect of dire poverty.

World Vision Pakistan is exploring ways to cooperate with local and international partners, including UNICEF and UNESCO and is seeking expressions of interest to fund a long-term comprehensive programme. World Vision believes that Pakistan can follow in the footsteps of other Asian countries such as Cambodia, where large-scale prevention progammes addressing the sexual transmission of HIV have seen significant reductions in high-risk behaviour and declining levels of new HIV and other sexually transmitted infections.

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11 States Have Waiting Lists for AIDS Drugs

Wed Apr 20, 2005 09:58 PM ET

WASHINGTON (Reuters) - More than 600 low-income AIDS patients in 11 U.S. states are on waiting lists for medicines as funding for assistance programs falls short, a report released on Wednesday said.

Ten other states have had to limit drug coverage or take other steps to control costs for their AIDS Drug Assistance Programs, or ADAPs.

Paid for mostly by the federal government, ADAPs often are the last resort for patients with no other funding for their medicines. About 136,000 people annually receive ADAP services.

Overall, ADAP budgets rose 11 percent in fiscal 2004 from the previous year, thanks to increased state funding, drug rebates and higher federal appropriations. Thirty-eight states were able to provide more people with medicines, the report said.

But 11 states had to close enrollment, leaving 627 patients as of March 2005 on waiting lists for prescription drugs to suppress the HIV virus that causes AIDS.

"The growing number of people who need HIV medications, and rising drug costs, continue to exceed available resources," said Jennifer Kates, director of HIV policy at the Kaiser Family Foundation, a nonprofit health research organization.

The foundation compiled the report with the National Association of State and Territorial AIDS Directors.

Boy suffering from diarrhoea lies in hospital in the Bangladeshi capital Dhaka. File photo by JAYANTA SHAW

"The problem with infectious agents is that whilst we are getting new ones, the old ones don't go away," the World Health Organisation's Anarfi Asamoa-Baah told Reuters AlertNet.

"We need to not just look at the new ones that attract attention but the old ones need to be taken care of," the WHO's assistant director-general in charge of communicable diseases said in an interview with AlertNet, the humanitarian Web site run by the Reuters Foundation.

Keeping an eye on familiar killers did not mean the world should neglect emerging infectious threats. But he cautioned that, small outbreaks of new illnesses could act like terrorist attacks in striking fear across the globe:

"The last 30 years, almost every year we have a new infectious disease that used to affect animals, now affecting human beings," Asamoa-Baah said.

"The infectious diseases of the future are not necessarily going to be those that we know, and that is the worrying part.

"They are going to act like terrorists: a few cases can create a climate of fear. The problem is going to be global, for developing countries and for developed countries as well."

New viruses spread faster and further than ever before because of increased travel and climate change, he said.

Even well-developed health systems were ill-prepared to respond, according to Asamoa-Baah, since sophisticated hospital equipment provided a good environment for some germs to thrive.

He blamed modern methods of meat production for some new diseases, like BSE -- bovine spongiform encephalopathy -- and said that transplanting animal parts to human beings for medical purposes was emerging as a source of infection.

QUIET KILLERS

But while much world attention is on new viruses that kill in horrific ways, dozens of more common infectious diseases have never been eradicated in the developing world.

"SARS did not kill that many people compared to how many people die from malaria and HIV, but it created a lot of panic because nobody knew where it was going to end and what was going to happen," Asamoa-Baah said.

In fact, despite the multiplication of new viruses, fewer people die of such diseases than 30 years ago, he said: "But because we live in a 24-hour news time, 20 cases of flu becomes big news."

Yet it is pneumonia, diarrhoea, malaria and HIV/AIDS that are the main threats in poorer countries, WHO data show.

RANGE OF THREAT

"If you look at the killers of most people in the world, it's more the non-communicable diseases -- the heart, diabetes, cancers -- but infectious diseases remain the number one killer in Africa," Asamoa-Baah said.

The WHO definition of communicable diseases includes illnesses spread by mosquitoes or contaminated water.

"Infectious diseases come in different shapes and different forms," Asamaoa-Baah said, citing HIV, tuberculosis and malaria as well as childhood dangers like measles and mumps.

Tropical diseases like river blindness and leprosy, wiped out in most of the world, still cause misery in remote corners.

"Even in poor countries you don't find them in the capitals. You find them in neglected communities. They don't kill but they deform people. Some cause blindness and deafness, and they affect children's ability to learn," Asamoa-Baah said.

"If you are lame, the chances of being in poverty are high."

Asamoa-Baah said that diseases affecting women and children had long been neglected. The WHO's annual report, released in mid-April, highlighted mothers and infants.

"The idea is to bring that back into the focus, because really the health of the child is dependant on the health of the mother, to a large extent," Asamoa-Baah said.

Ill health had a knock-on effect on economic development, causing a vicious circle: "They (poor countries) are not producing enough children who are active and intellectually bright to take some of those development challenges forward."

The destructive impact of HIV/AIDS on productive adults in developing countries is clear. But Asamoa-Baah said the world should also pay more attention to childhood illnesses that decimate infants before they reach the age of five:

"The future of most (underdeveloped) countries is in jeopardy because the children are either born unhealthy or die very young."

JOHANNESBURG, May 2 (Reuters) - White, wealthy and proudly gay, Judge Edwin Cameron is hardly a typical face of the AIDS pandemic ravaging southern Africa.

But Cameron, a member of South Africa's Supreme Court of Appeal and the only senior public servant in the country to publicly disclose he has HIV, shares one thing with millions of other Africans fighting the virus: a strong desire to live and a deep anger over halting efforts to fight the disease.

In a new book Cameron dissects Africa's AIDS crisis, a public health emergency that the United Nations estimates could infect up to 89 million more Africans by 2025.

It is a disaster he blames in part on African "AIDS Denialism", the prism that some leaders including South African President Thabo Mbeki have used to downplay or dismiss scientific knowledge on AIDS.

His book, "Witness to AIDS", is an indictment of Western drug firms which he says kept AIDS medicine out of reach of most Africans for far too long and the failure of South Africa's leaders to face up to the debacle.

"We have had leaders referring to AIDS in their families, but never in themselves," Cameron said in an interview. "We still don't have the heartfelt, unambiguous, insistent quality of leadership on AIDS that one would want."

South Africa in 2003 bowed to domestic and international pressure and launched a public programme of anti-retroviral (ARV) drug treatment, a sign of hope for millions.

But implementation has been slow, thousands are still dying, and AIDS remains both politicised and stigmatised.

ONE VICTIM AMONG MILLIONS

Cameron's career -- not just his HIV status -- makes him uniquely qualified to examine South Africa's response to AIDS, increasingly depicted as a human rights issue for the estimated 5 million South Africans infected with the disease.

A human rights lawyer, Rhodes scholar at Britain's Oxford University and one of Nelson Mandela's first appointments to South Africa's High Court following the end of apartheid in 1994, Cameron had for almost a decade been publicly out as a gay man, a rarity in South Africa at the time.

He was also operating with the private knowledge that in 1986 he was diagnosed with HIV.

Cameron's personal struggle with HIV reflects the terror that surrounded the disease before life-prolonging ARV drugs were introduced in the early 1990s.

"AIDS put a short, sudden and shocking limit on my life," he wrote in the book, which will be published in Britain, China and the United States later this year.

"In December 1986 it was for me what for tens of millions of Africans it still is today -- an imminent term of death."

Cameron remains the only prominent South African public official to go public with his HIV status, despite widespread speculation that other senior figures including MPs may also be infected.

Mandela, who has become an outspoken AIDS campaigner since stepping down as president in 1999, sought to combat the stigma this year when he publicly announced that his own son Makgatho had died from AIDS-related causes at the age of 54.

But the fear surrounding AIDS in southern Africa remains a huge obstacle to fighting the disease, with a lack of clear government leadership fuelling the sense that HIV is a shameful private burden rather than a public policy emergency.

DISASTER SPREADS

Cameron enjoyed more than a decade of good health despite being HIV-positive, and when he did eventually fall seriously ill in 1997 he was able to afford ARVs to keep himself alive.

Millions of other South Africans were not so lucky and the government dragged its feet on introducing ARVs in the public sector -- a delay activists say cost countless lives.

South Africa's AIDS crisis has been exacerbated by the poverty of much of the population, where the legacy of apartheid has limited the spread of basic nutrition and health care.

But Cameron says the Mbeki government veered wildly off course in the early 2000s under the influence of "denialists" who saw the basic scientific building blocks of the epidemic as a racist conspiracy to promote dangerous drugs.

Mbeki questioned the link between HIV and AIDS, and left the impression his government regarded discussion of the AIDS crisis as an attempt by white Westerners to denigrate black Africans by questioning their sexual morality.

"African AIDS denialism remoralised the debate," Cameron said. "It wrongly ascribes the medical model of HIV virology to some kind of condemnation of Africans."

At the same time Cameron charges Western drug firms with unfairly holding up ARV prices until forced to reduce them by lawsuits and political pressure.

He is clearly angry the country has lost valuable time in fighting AIDS and may still be moving too slowly. "I believe massive errors have been made," Cameron said.

But despite the escalating AIDS death rate and the government's opaque attitude toward the disease, Cameron remains guardedly optimistic the tide can be turned.

ARVs, once derided by officials as unnecessary and dangerous, are increasingly available and more and more South Africans are going public as HIV-positive.

Cameron's message, to his fellow South Africans and to the world, is that AIDS provides an opportunity for both individuals and societies to unite in fighting an epidemic

"We cannot allow our grief and our bereavement to inflict a further loss upon us: the loss of our own full humanity, our capacity to feel and respond and support," he writes. "AIDS beckons us to the fullness and power of our own humanity."

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