Ashfaq Yusufzai
PESHAWAR, Jan 2 2006 (IPS) – Raheela is relieved that she can finally avail of free anti-retroviral therapy (ART) in Pakistan, where people living with HIV/AIDS are viewed with suspicion rather than sympathy.
I can now hope to live for some more years and look after my child, who is just three now, said Raheela, whose husband was deported from the United Arab Emirates (UAE) after he tested positive and eventually died.
Raheela is a beneficiary of Pakistan s National AIDS Control Programme (NACP), that is being run with collaboration with the World Health Organisation (WHO) to provide treatment to those living with the disease in the country.
We have established four treatment centres in Islamabad, Peshawar, Lahore and Karachi where medicines for 30 patients have been sent to each centre. Doctors and nurses have already been trained in India, said Dr Quaid Saeed, WHO programme officer.
According to Saeed, ART is needed to treat 3,077 infected persons, reported so far and the aim was to reduce the risk of transmission to susceptible people.
We have long been demanding that the government start the ART programme and finally the government has done it, said Nigat Kamdar, who runs an non-governmental organisation in this town, close to the Afghan border.
She said AIDS patients in these parts faced social stigma and doctors were not prepared to admit them into hospitals. There have been cases of pregnant women being forced to deliver in hospital corridors after being refused admission to labour wards.
Now, we hope for better treatment for AIDS patients, she told IPS explaining that the ART programme indirectly helped better social understanding of the disease.
ART reduces chances of HIV transmission, slows the progress of the infection and improves the quality of life, Saeed said, adding that therapy had the potential of reducing HIV infection from being a death sentence to a lifelong medical condition.
Pakistan is rapidly changing from being a low prevalence country into one with an impending epidemic and high-risk population sub-groups such as injecting drug users and male sex workers needed attention, he said.
Saeed said inadequate surveillance, pervasive social stigma, lack of knowledge among the general population and medical practitioners and the limited number of voluntary counselling and testing centres may be contributing an underestimation.
We have devised a plan under which prevention and treatment programmes must go hand in hand. Unfortunately, prevention programmes take time to produce results and high-risk sexual behaviour is not easily changed, Saeed said.
Using mathematical models the NACP has calculated that there could be approximately 36,000 HIV infected persons currently in Pakistan. Assuming that 20 percent of these patients will be eligible for starting ART over the next three years, we may be looking at care for about 7,200 patients, Saeed said.
Pakistan s health care infrastructure, he said, did not have the absorptive capacity to incorporate ART for such large numbers. Therefore we are at present focusing on development and scaling up of staff capacity and health infrastructure, such as diagnostic facilities, treatment support and home-based services before scaling up ART.
We anticipate that once the treatment and care centres are fully operational, additional demand for ART will be generated through increased voluntary counselling and treatment , mobilisation of people living with HIV/AIDS and better access to HIV care, he added.
The cost of generic ART (three-drug regimen) is 300-500 US dollars per patient annually, while the total annual cost would be 1.5 million dollars. Most of the 40 million HIV infected people live in the developing world and do not share this improved prognosis. It is estimated that only eight percent of the people in the developing world are on ART.
Yasin Malik, who is in charge of the ART centre in Peshawar, said over the last one month, he had admitted six patients. While two died, the rest were doing well.
I have seen 5,000 patients in India. All were getting treatment. They feel good, he said adding that in Mumbai he had seen patients who have been on ART for the last 15 years.
Pakistan has a wonderful opportunity to act decisively and scale up on ART along with on-going HIV prevention programmes and behavioral change communication, Malik said.
