AIDS-The case scenerio in Pakistan
Since the first case in 1987, the number of officially reported HIV positive persons and AIDS cases has grown to 1,787 with 207 AIDS and 1,580 HIV positive cases as of 31st March, 2001 among 2, 58, 662 million tests carried out since 1986 on the basis of four recommended categories for HIV antibody testing. The categories recommended by the WHO/UNAIDS include: (I) before transfusion of blood or tissue transplant (ii) Research and Surveillance (iii) Diagnosis and (iv) Volunteers.
Heterosexual transmission account the majority (37 percent) of reported HIV cases, with infection through contaminated blood or blood products the second most frequent mode of transmission (18percent). The remainder of reported HIV cases are linked to infection though injecting drug abuse (4%), homosexual or bisexual sex (6%) and mother to child transmission (1.3 %). Transmission modes for 35 % of the reported HIV cases are unknown or unreported. Based on existing data, an estimated 60,000 to 74,000 infected individuals may be present in Pakistan.
The story of Pakistans Government response to the HIV/AIDS crisis is one of good intentions thwarted by limited and varied political resolve and a scarcity of financial resources. In 1987, soon after the diagnosis of first HIV/AIDS cases in the Pakistan, the Ministry of Health established the Federal Committee on AIDS(FCA). Shortly afterwards, in 988, the National AIDS control program (NACP) based at National Institute of Health, Islamabad was launched.
In 1990, the first Government funded plan was developed for NACP and budgeted for three years at a cost of Rs. 20 million. Subsequently the program was expanded and made more programmatic through the approval of a PC-1 of Rs. 774.35 million for 1994-97. The required amount however, could not be made available to the program annually because of continual economic constraints and the duration of original PC-1 was extended to 2003.
In spite of all limitations, the NACP has played an important role in establishing provincial units, raising awareness about HIV/AIDS through variety of activities and launching AIDS and hepatitis B( a sexually transmitted disease) screening in public sector blood bank. A network of forty-six surveillance centers has been established from Gawadar to Sakardu. National guidelines on blood transfusion practice, clinical management and HIV testing and counseling have been developed. Over 8,000 health professionals have been trained through a number workshop. Although hampered by the scarcity of resources, research activities were also carried out to collect national data on HIV/AIDS. The first sero-prevalence study was conducted in 1996. Four studies of national importance are underway and will yield useful information by December 2001. These include (I) STI prevalence study (WHO sponsored) (ii) HIV Seroprevalence study (GoP sponsored (iii) External Review of the National AIDS control Program (GoP sponsored ) (Iv) Assessment of the knowledge, attitudes, and behavior (KAB) of people in response to AIDS awareness campaign (GoP sponsored)
In addition to the above mentioned achievements, the NACP with the collaboration of UNAIDS Pakistan has cared out an extensive strategic planning exercise, involving all stakeholders. The strategic planning framework is now being transformed to action plans and new PC-1s are being developed. Pakistan is the first country in Southeast Asia (SAARC) and WHOs eastern Mediterranean region that has gone through this exercise with a future vision.
International agencies particularly UNAIDS, WHO and World Bank have played a pivotal role in NACPs achievements through their technical and financial assistance for various ongoing projects.
The global burden of disease study predicted that AIDAS would rise to one of the top ten causes of mortality and disability by 2002 from 20th rank during the 1990s. Sandra Thurman, the top AIDS official in the Clinton administration, in an interview shortly before leaving the white house said, "people say that the more we learn about HIV, the more we realize we do not know a whole lot"
Although extensive research is ongoing to develop an effective and affordable drugs and vaccines, information, education and communication will remain the main prevention tools for yeas to come.
HIV/AIDS is a persistent global pandemic and will require a proportionate response to eliminate. It is the plague of our lifetimes and probably that of out childrens loves as well. Pakistan looks towards the international community for collaboration in the \successful implementation of its well-strategize future HIV control plans.