AIDS is taboo in Pakistan. Every time the topic comes up, the general attitude is one of denial. People say that AIDS does not exist in Pakistan. How could it! This is an Islamic country, and the ‘illegal, immoral’ activities generally associated with HIV/AIDS are just not a part of our social fabric.
According to the National AIDS Control Program, about 100,000 Pakistanis are living with AIDS. This number is most likely an under-estimate as most patients with HIV don’t even know they are infected. One is compelled to wonder where all these cases are coming from.
Like many other countries, the most important reason for the spread of HIV in Pakistan is sexual promiscuity. We may not like to admit this, but prostitution has been a part of our society for a long time. The ‘diamond market’ in Lahore was a thriving enterprise long before the Badshahi Masjid was built. In addition, a growing number of young adults are engaging in sexual activity before marriage. Don’t believe me? Just visit my office the next time I have an unmarried teenager in my office waiting anxiously for a pregnancy test result.
There are of course several other reasons for the spread of HIV. Pakistan has a major IV drug abuse problem. By some estimates more than a million Pakistanis are addicted to drugs. These people often do drugs in the company of their peers, and they are very likely to share needles. Injecting drugs into your veins is bad enough; worse yet to do so with a previously used needle.
Another important and under-recognized manner for the spread of HIV is through transfusion of infected blood. While the screening of blood donors for HIV has been mandatory for several years, many health care facilities still use outdated disk methods to test for HIV and Hepatitis. These methods have high false negative rates. Consequently HIV positive blood donors are often not detected in time, and an unsuspecting patient gets HIV through no fault of his own. These are some of the saddest cases of HIV, but sadder still are the babies who are born with HIV because their mothers have the disease.
In the end it doesn’t matter much how a patient got infected. What is more important is what to do about it. We must educate patients and the general public about HIV and AIDS, about how this disease spreads, and also how it doesn’t spread. The last thing an HIV patient needs is to be treated like toxic waste; shaking hands with a patient will not kill you. World AIDS Day is a great opportunity to talk about this illness, read about it and discuss it with friends and family. A hundred thousand patients is a small number in a country of many millions. But this number will continue to rise unchecked unless we do away with our collective hang-ups and start talking about it.