ISLAMABAD – World Aids Day is being observed today (Saturday) with the theme for this year ‘Getting to Zero: Zero New HIV Infections. Zero Deaths From AIDS-related Illness. Zero Discrimination.’

This sounds difficult but is achievable keeping in view the fact that antiretroviral medicines used for the treatment of HIV and AIDS reduce the amount of virus in the blood which increases the chance they will stay healthy and decreases the risk they can pass the virus to someone else.

Similarly, these medicines prolong the life for years and the person stays healthy for decades. The most important and difficult thing is the discrimination that HIV positives are facing in this country both by the hands of community and health care providers that considerably increase their miseries and that has to be reduced.

According to World Health Organisation (WHO) in Pakistan, HIV epidemic is in second stage i.e. concentrated epidemic meaning that the prevalence in traditional risk groups has exceeded 5 per cent. In Pakistan 02 groups have surpassed this threshold namely injecting drug users (27% prevalence) and transgender (Hijra 6%) sex workers.

Of the estimated 150,000 injecting drug users nationwide, national surveillance data shows rates of infection ranging from 15 per cent to 50 per cent in most major cities of Pakistan including Sarghoda, Faisalabad, Peshawar, Quetta, Karachi, Larkana, Hyderabad, Mandi Bahauddin, Lahore etc. In addition, there has been “mini-outbreaks of HIV epidemics” in rural communities like Jalal Pur Jattan, district Gujrat as a results of alarming overlap between injecting drug use, unsafe hospital infection control practices/therapeutic injections, and commercial sex.

Number of estimated HIV positives in 2009 were around 98,000 (79,000 - 120,000) HIV + cases in Pakistan with an overall general population prevalence of 0.05%. Adults aged 15 years and up living with HIV were estimated to be 95,000 (76,000 -120,000) and women aged 15 years and up living with HIV were estimated to be 28,000 (23,000 - 35,000). Deaths due to AIDS were 5,800 (4,500 - 7,400). Since the onset of the first case in 1987 in Lahore, the spread has been progressive. Progressed from low prevalence to a more concentrated epidemic in the high-risk groups. Although prevalence in general population is low, yet there are some significant risk factors that raise concern for a wider spread of HIV in the country such as in Lahore, 13 per cent of internally migrant men reported extramarital sex with an average of 8 partners (38% non-commercial) in the past year. In another study, 30 per cent of men from the general population reported some non-marital sex in their lives and 11 per cent in the past 3 months. Only 16 per cent used condoms and 4 per cent had an STI.

Another significant concern is the fact that Pakistan has high rates of unscreened blood transfusions and a very high demand for therapeutic injections and poor infection control practices in hospitals and clinics nationwide. This has led to transmission of infection through unscreened blood transfusions, or re-use of syringes or use of un-sterilized medical equipment.

Pakistan responded to this threat in a significant manner with the establishment of enhanced HIV and AIDS Control programme in 2002 with the support of World Bank and UN agencies. The programme established a robust HIV surveillance system to monitor the trend of the disease in High Risk Groups. Similarly the next big achievement was the establishment of HIV treatment centers all over the country. Presently there are 17 such centers functional all over the country providing free anti-retroviral medicines and diagnostics free of cost and in some centers the analysis of the data show more than 95 percent success rate. This is a significant achievement, which is now mainly supported by Global Fund.

Globally, 34.0 million [31.4 million-35.9 million] people were living with HIV at the end of 2011. An estimated 0.8% of adults aged 15-49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults (4.9%) living with HIV and accounting for 69% of the people living with HIV worldwide. Worldwide, the number of people newly infected continues to fall: the number of people (adults and children) acquiring HIV infection in 2011 (2.5 million [2.2 million-2.8 million]) was 20% lower than in 2001.

The number of people dying from AIDS-related causes began to decline in the mid-2000s because of scaled-up antiretroviral therapy and the steady decline in HIV incidence since the peak in 1997.

 In 2011, this decline continued, with evidence that the drop in the number of people dying from AIDS-related causes is accelerating in several countries. In 2011, 1.7 million [1.5 million-1.9 million] people died from AIDS-related causes worldwide. This represents a 24% decline in AIDS-related mortality compared with 2005 (when 2.3 million [2.1 million-2.6 million] deaths occurred).

The scaling up of antiretroviral therapy in low- and middle-income countries has transformed national AIDS responses and generated broad-based health gains. Since 1995, antiretroviral therapy has saved 14 million life-years in low- and middle-income countries.