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Pakistan and India vs. HIV-AIDS

02 May, 2005

By Sardar A. Tahirkheli


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While Pakistani cricket fans were celebrating the victory against India in Delhi and while Manmohan Singh and Pervez Musharraf were delivering a joint statement of optimism, a painful truth was being revealed to the Indian nation at a different front. A truth that would silently claim more lives in the coming years than the combined casualties of all Indian wars in the modern history.

The executive director of the Global Fund to Fight Aids, Richard Feachem, declared that India has surpassed South Africa as the country with the most HIV positive and AIDS patients. He admitted that the spread of HIV-AIDS in India was so rapid that it has baffled the international organizations dedicated to fighting it. Mr. Feachem also said "The epidemic [in India] is growing very rapidly. It is out of control. There is nothing happening in India today that is big or serious enough to prevent it,"1.

Figures provided by the UNAids, in July 2004, show that South Africa had the highest number of people with Aids - an estimated 5.3 million - where as India was second to South Africa with an estimate of 5.1 million infected adults and children. Mr. Feachem believed that the official figures in India are wrong. He insisted that "India is in first place" with an estimate of 8.1 million with HIV+ / Aids. Mr Feachem warned that the illness would spread faster among India's Hindu population than among Muslims, because Muslims tend to get circumcised, which he said was "an acknowledged protective factor" against the Aids virus. He warned "India has to wake up, and India has to take this very, very seriously."
 
Indian officials, on the other hand, slam HIV infection claim2. According to them they have not overtaken South Africa, which has about 5.3 million infected people and India has just 5.1 million according to official statistics3. Moreover Indian population is much more than South Africa and therefore, India has 0.9% of infected population and South Africa 23%.

Unfortunately this "game of numbers" by Indian officials is self deceiving and does not actually reduce the burden of responsibility. The fact remains that ultimately this epidemic will claim more lives in India than any tsunami or act of terrorism or the combined casualties of all Indo-Pakistan and Indo-China wars. It will also put unprecedented burden on Indian economy and national pride. This problem could potentially become a serious threat to national security and a general threat to the comity of nations, at large. Therefore the threat must be dealt with appropriately.

There is however a ray of hope. The present Prime Minister Mr. Manmohan Singh has at least expressed his understanding of the magnitude of the problem. At the Afro-Asian summit, recently held in Indonesia, the Indian Prime minister stressed that global solutions were needed to meet the challenges posed by terrorism and HIV-Aids. The Prime Minister then shifted the burden of his speech towards combating international terrorism.

It is interesting to note that while India is the largest exporter to Africa for generic medicine of HIV-AIDS, this medicine is not easily available to common patients in India. A law that is currently before the Indian parliament will further threaten the supply of cheap drugs for HIV-AIDS to poor people in India and African countries. As a member of the World Trade Organization, India has to start recognizing patents on drugs and therefore cannot continue producing inexpensive generic drugs. It is also interesting to note that the majority of condoms produced in India are not used for their intended purpose. Instead, 75% of the condoms produced in India are used in Textile industry 4. It is indeed a task of a mammoth proportion to change the mindset of officials and the public!

What about Pakistan? The HIV-AIDS epidemic is at our doorsteps. Do we need to worry about it? Can we trust our conservative Islamic traditions and circumcised male population as a reliable defense against spreading the infection?  If Pakistanis feel safe and secure against the infection, than we are living in a fool's paradise. According to the World Bank Group and World Vision Report "Pakistan has a narrow window of opportunity to act immediately and decisively to prevent a wide spread HIV/Aids epidemic. Although the estimated burden is still low - around 0.1 percent of the adult population, the threat due to risk factors is significant. Without vigorous and sustained actions, Pakistan runs the risk of experiencing the over whelming social and economic impact of a full blown HIV/Aids epidemic."5

At present, the HIV-AIDS cases are relatively low in Pakistan - about 70'000 to 80'000. On the other hand, the country is facing a tremendous rise in Hepatitis-C and B cases, where 17 million people are Hepatitis carriers. 12 million people are suffering from Hepatitis -C, while another 5 million from Hepatitis-B. It is terrifying to realize that the risk factors for the spread of Hepatitis and HIV virus are about the same. Transfer of body fluid through sexual contact is not the only major risk factor; HIV-AIDS could spread in Pakistan through the same risk factors that helped Hepatitis to become a major epidemic.

The serious risk factors could be enumerated as follows:5

· Commercial sex
· Injecting drug users
· Inadequate blood transfusion screening
· High level of professional blood donors
· Migration and refugees
· Unsafe medical injection practices
· Low level of literacy and education
· Vulnerability due to strong social disadvantage
· Poverty - economic disadvantage
· Poor national and parental response
· Over drummed advantage of circumcision
· Despite helpful and active NGOs, only 5% of the vulnerable population has been reached

Inadequate blood transfusion screening, unsafe medical injection practices and non sterile dentist and surgery tools and the worst of all increasing number of kerb doctors & dental surgeons, are some of the most unfortunate causes of the spread of Hepatitis and HIV in Pakistan. According to a World Bank report, "about 40 percent of the annual 1.5 million blood transfusions in Pakistan are not screened for HIV. Whereas screening in the public sector has made progress, private blood banks lag far behind, with little enforcement of screening regulations."6 According to the World Bank Report, Pakistan has a high rate of medical injections, around 4.5 per capita per year. "Studies indicate that 94 percent of injections are administered with used injection equipment. Use of un-sterilized needles, at medical facilities, is also widespread. According to WHO estimates, unsafe injections account for 62 percent of Hepatitis B, 84 percent of Hepatitis C, and 3 percent of new HIV cases in Pakistan." 7 

In South Africa, where a quarter of its population slipped into the grip of HIV-AIDS, two important lessons were learnt. Firstly, though foreign aid and support is vital, it is not a solution on its own. Unless the country is ready to squarely face the challenge, the problem cannot be effectively dealt with the foreign aid alone. For a long time the South African leadership remained defiant to accept the realities of HIV-AIDS. Unfortunately, valuable time was wasted in acquiring the appropriate mindset to substantially fight the menace.  The second bitter lesson learnt was that HIV-AIDS does not confine its reach to the poor and down trodden population, dwelling at the lower rung of the society, only. Progressively, the epidemic affects the entire nation at all social levels. Even Nelson Mandela, who steered his nation out of the morass of apartheid, could not protect his close ones from the grip of this epidemic.  In January 2005 Nelson Mandela's son, Makgatho Mandela, died of AIDS. Last year Mandela lost his daughter-in-law, Zondi Mandela to Aids.8

 It is very much obvious that a reality of such a magnitude cannot be swept under the carpet. India & Pakistan would have to launch massive programs to educate their populace and also, watchfully observe & eradicate the wrong practices, leading to these epidemics. Money allocated for this purpose must not be dissipated in other directions.

1.     BBC News, 19 April, 2005, “HIV is 'out of control' in India”
2.     Gulf Daily News, 21 April,2005, “India slams HIV infection claim”
3.     Indian HIV – AIDS Statistics
4.     Redstate.org, 26 April, 2005, “Behavior, Not Condoms”
        BBC News, 30 July, 2004, “Condoms oil wheels of industry”
5.     World Bank report, “Preventing HIV/AIDS in Pakistan”
6.     Pakistan: Focus on Blood Banks and HIV/AIDS
7.     Unsafe injections main source of Hepatitis spread
8.     BBC News, 15 Jan, 2005, “Mandela mourn his son”

Reader Comments:

update

Very up to date reports please do keep me informed with all the latest.
thanks

sudip dikshit, Hungary - 03 May, 2005

It's high time India adopt a national policy of cicumscision. If circumciseing can help then it should be followed. Experienced countries like pakistan, saudi arabia and bangladesh that has got access to the adavanced technology should share with the rest of the world for common benefit.

Manmohan dubey, Pakistan - 05 May, 2005

Alarming

Taherkheli has drawn
attention to a grave problem. It is really an alarming situation and intellectuals of both the countries must join hands against the challenge posed by the worst kind of disease.True, the number in India is growing by leaps and bounds. Something must be done to combat HIV/AIDS. Circumcission may help but would it perfectly save a person? The problem is:there is always a risk of transmission through infected blood. It may need political will to fight the menace out.

Dipak_Dholakia, Hungary - 08 May, 2005

Warning for visitors

It doesn't matter if India is number one or number two in Aids infected population. Sure it is not possible to know the exact number of infected people. In India, HIV infected person comes on record only when he surface at hospital in case of extreme sickness.
Indian government and the rest of the world should take it seriously. The countries in Middle East are at high risk of importing this virus via untested mass people trafficking.

Karrar Siddique, Pakistan - 16 May, 2005

Another Miracle

I agree that Circumcision is the best remedy for preventing HIV/AIDS and WHO and countries like India should make Circumcision manditory along with Rubella and Polio vaccines.

Also Circumcision is more cheaper and can easily be implemented. Doing Research on HIV/Aids Cure is gross waste of MONEY, TIME & OTHER RESOURCES.

But along with advantages there as inherent Disadvantages of Circumcision which should considerd by both Hindus and Muslims.
1. Some men who were circumcised in infancy feel that they have been mutilated and deprived of an important structure without their consent and they are just as obsessional about this as those who clamour to be circumcised

2. As with any other operation there are theoretical risks of bleeding, infection, surgical error and death under the anaesthetic.

3. It has been suggested that the operation may cause psychological harm if it is performed at an unsuitable age. It may well be that separation from parents and not the operation is the factor because I have never been able to find any evidence of psychological trauma. Also if circumcision is not explained the child may be disturbed to find he is different from his brothers and friends. Life may also be made miserable by remarks from his uncircumcised school-fellows in the showers about the shorn state of his organ. Conversely in a society where infant circumcision is the rule it is the uncircumcised scholar who is made to feel inferior by his class-mates.

4. If an uncircumcised infant gets a nappy (diaper) rash his foreskin becomes inflamed but his glans is protected. In the circumcised infant if the glans becomes involved, a sore (meatitis) develops at the opening of the water pipe (meatus) and passing water is painful

5. A number of men complain that a loss of sensitivity or dryness of the glans following circumcision has spoiled their . At the other extreme are those who seek the operation to achieve these changes in the glans to enhance their sex lives. These complaints are similar to the mutilation obsession because men with naturally short foreskins are not troubled by having the glans exposed.


7. Patients are in agony for weeks after the operation. There is obviously some discomfort for a few days and the scar is a bit tender for a couple of weeks but that is about all. If there is active balanitis or the prepuce has been adherent to the glans then there is more post-operative discomfort.



Arjun Reddy, Hungary - 17 December, 2005

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