HIV has broken out in Larkana, from the sound of a news report filed last week. 157 people have tested positive for the virus, of which 127 are children and 30 are adults. Authorities are unsure whether this is because of reusing infected syringes, unscreened blood used in transfusions or some ‘other’ cause, but UNAIDS and the National Aids Control Program (NACP) is taking action—probably because 140 cases were found in Hyderabad earlier this year, and World Health Organisation (WHO) statistics indicate that Pakistan has the highest HIV incidence in the region, with 25,000 cases registered annually. It’s about time someone woke up.

For us non-medical folks, I did some reading. HIV is the pre-AIDS virus; it is a virus that attacks the body’s immune system. If untreated, it reaches a point where the body’s natural defences are almost entirely compromised and that’s when it becomes AIDS. It’s important to know that HIV cannot be transmitted through casual contact, like a handshake or a hug. You can’t get it from a toilet seat or sharing food with someone who has HIV- it isn’t transmitted through saliva, only blood or sexual fluids. There is medication available that won’t cure HIV, but will keep it under control, and people with the virus have to take this medication every day for the rest of their lives. When it’s properly looked after, HIV positive people have a little-to-none risk of transmitting the infection to their partners or children, which is amazing. This is all vital information, but the issue still remains: where is this coming from? And the answer is, quite simply, from secrecy.

HIV infection is not new to this part of the world. It’s not new to any part of the world, quite honestly, but other countries have been able to better address the spread of the disease by breaking taboos surrounding the discussion. We are masters of “Never Speaking of Anything Directly”, and so there are children with HIV in Larkana, Hyderabad and who knows how many other cities in the country. It’s a complicated cycle to break—the most likely reason children have HIV is because they were born with it, which means their mother is HIV positive. Women can catch HIV from infected partners in a heartbeat, and vice versa. The symptoms of HIV are not particularly marked or frightening; they’re like having a bad flu—which is the usual set of responses the body has to viral infections. If you aren’t aware of a reason why you should be tested for HIV, you’d never even know you had it. More than actually having HIV, what seems more terrifying is never knowing you have it, and unwittingly bringing babies into the world already sick. It is terrifying to think of HIV-positive men transmitting it to perfectly healthy wives when there are ways to protect them from it.

In order to tackle HIV, we need to talk about so many things. We need to talk about drugs. We need to talk about sexual health. We have to talk about homosexuality, pre-marital and extra-marital sex. We have to talk about sex workers and unsafe sex practices in general. We have to talk about rishtas and marriage, and how in a country where even discussing a nikahnama is so fraught with insecurity and volatility, how can one broach the subject of a blood test before signing the marriage contract? People end marriages over haq mehr amounts; one can only imagine what they would do with the suggestion of medical screening. And yet, what is more important than health? What is more important than healthy couples who have healthy babies? People’s lives have been saved by blood transfusions and organ donation; imagine either of these coming from an HIV infected person. Imagine screening protocol missing even one person; imagine what screening protocols are like in small towns and under-funded government hospitals. Imagine a casual encounter making you sick for life when it was so easy to protect yourself, had you known.

The only way to deal with any situation that threatens our security and health is to tackle it head-on. The time for squeamishness has passed. Pakistan’s HIV rate is the highest in South Asia; that fact alone is shocking. The time to judge and pretend that ‘these things’ don’t happen in ‘our society’ is long, long passed. Everything happens in ‘our society’, as it does everywhere else in the world. The only difference is that our pretence and denial puts us all in danger, be it drug use, unsafe sex and all the other ‘things’ we stubbornly deny. How can you tell your child to never share a needle if you can’t acknowledge that they might, even hypothetically, be in a situation where drugs and needles will coincide? How can you ensure your grandchildren are healthy if you can’t protect your child first? Remember that how someone contracts HIV is not the point. Having HIV doesn’t make you a badmash that should be thrown in the trash. The point is helping to contain the disease, to educate others and to work together to make all our lives safer and healthier. What’s done is done; how we move forward is what will make all the difference.