In April 2019, Pakistan witnessed an alarming rise in HIV cases in the province of Sindh, with a number of under-aged children being identified as carriers of the virus. The media reported an influx of Human-immuno-deficiency virus (HIV) amongst children in Ratodero-Larkana. During the next four months, a total of 30,192 people were tested for HIV with WHO-certified testing kits. Out of the total, 876 cases were found to be HIV Positive, with 82% being children.
Emergency activation teams led by the WHO and health authorities were dispatched by the provincial government in the area for a full-scale investigation on the matter.
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According to a report by the regulatory authority on healthcare in the province, a special task force was established on the directives of the Provincial Health Ministry and the Government of Sindh. SHCC- SindH Healthcare Commission (SHCC), the regulatory compliance body also dispatched tier teams which accompanied the WHO teams to identify unauthorized healthcare practitioners (HCPs ) better known as ‘Quacks’ , who may have been responsible for medical negligence leading to the crisis.
A micro-investigation in the matter conducted by the SHCC team in collaboration with external medical experts (EMEs), paramedics, district administration teams and law enforcement agencies also revealed that children under the age of 3 years, with no history of viral transmission, were being identified as HIV positive.
On-ground investigations further lead the teams to Larkana city, where the majority of the cases had been recorded. The list of medical practitioners in the areas provided by the health department was screened with close precision over a 30-day period, finally resulting in identifying the culprits.
After a successful crackdown on over 50-60 illegal healthcare establishments (HCEs) in the area, a healthcare practitioner working for a government hospital was found to be privately running an illegal healthcare operation where he was directly responsible for administrating injections to patients, using infected needles.
The majority of the children who traced positive for HIV had been taken to this clinic. Findings also indicated that the doctor was mentally unstable after medical examination revealed that he himself was HIV positive and did not care much about the consequences.
Root-cause Analysis
According to WHO representatives in Pakistan, there were several seminars conducted on the subject which highlighted that there were over 85% of people living with HIV in the region who were in need of life-saving anti-retroviral therapy but are unable to afford the medication due to a lack of awareness of their own infection and failing to obtain the course of treatment required to save their lives.
One of the major factors that led to the rise of HIV cases was due to medium of transmission of the disease. From unsafe intravenous injections and unchecked child delivery procedures to unhygienic practices at blood banks, poor IPCs (infection prevention controls) and the improper storage, segregation and disposal of hospital waste, more efficacy measures need to be in place across all healthcare facilities.
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Accepting that HIV is present in large numbers and curtailing the spread of HIV are two different and difficult challenges. We talk about it year on year in front of the general public to engage them to get tested but we now have to make this a compulsory requirement for each citizen of the country to have tests conducted for HIV prevalence in order to limit the effects of the disease.
Proactive, not Reactive
Preventive measures by the government would have to be the need of the hour. United Nations is fully committed to eradicating HIV or the AIDS (Acquired Immune Deficiency Syndrome) by 2030, as one of the key sustainable goals, to improve good health and well-being (Goal 3). Despite the facts, some nations may still end up far from the desired target results due to a reactive approach.
Prevention is better than cure. Yet, we rely on hindsight without properly showcasing the various causes of the disease across public forums or through media. This may be seen as an administrative failure above all else. The role of good governance needs to be prominently highlighted to bring on critical healthcare issues like HIV onto mainstream public focus through campaigns and programs via television, radio and print media.
Preventable measures sent on all public platforms to pre-inform the public may be the first step in this direction. Beyond that, a proactive health care policy must be approved on the provincial level in view of the 18th amendment, engaging stakeholders like PMA (Pakistan Medical Association), SHCC and credible media, on board the policy-making process. The same must be made public for the benefit of the average citizen.
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Provincial healthcare budgets have been inadequate in the past and the allocation of the budget has been less than completely transparent. The majority of healthcare initiatives have not kicked off successfully, due to many factors such as the price monopoly of the commercial pharmaceutical sector, weak price regulation policies, non-availability of standard testing at hospitals and poor advocacy campaigns by major media outlets and the state. Even Insurance companies can be directed to cover the treatment of HIV as part of the product-benefit suite.
Misconception
The majority of the public believes that it is almost like a death sentence but the fact is that HIV is treatable and containable. People with HIV can lead healthy lives if treated timely. Early detection is possible and that is the focus area for healthcare establishments and the medical fraternity.
Testing for HIV is relatively easy as a lot of government and private hospitals offer the required test but the public motivation needs to be driven at the government levels to counter this epidemic.
Transmission of this disease is another challenge as unprotected sex in insanitary conditions raises the percentage of STD-sexually transmitted diseases such as HIV. The ordinary sex worker does not seek treatment due to fear of social victimization and criminal prosecution by law enforcement authorities. This puts people at more risk than otherwise anticipated. In our society, men seeking such illicit practices end up being carriers and bringing this disease to their spouses and eventually to their children.
Discussing sex as a subject is discouraged in our society as it is considered a taboo. This is one of the major future challenges that we as a community need to resolve through a common consensus on drafting a media-education drive as well as a compulsory subject for doctors to consult with visiting patients.
Way forward
By large, we are a country with a cultural divide on this issue. Some believe that we need to ensure advocacy at a massive level while others still feel that educating the masses on the subject of HIV can be further delayed as a non-priority. Pakistan as a country needs to calculate the rising population numbers versus the availability of health care units to cater to its populace. Educating women and children as part of the ECE (early childhood education) is also a good step. Teenagers need to be properly tutored on the subject of HIV, as drug use and drug abuse are also increasing all across the country.
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A combination of education, advocacy, treatment and law enforcement initiatives must be devised in the long run to take punitive action against illegal medical practitioners to avoid future incidents like the one we witnessed in 2019. Elsewhere, we need collective action by investing heavily in the primary health care sector and ensuring proper and permanent disposal of medical waste through strict vigilance and accountability.
Summing up, poor health care, lack of awareness of HIV and a casual carefree attitude by lawmakers and health authorities on the subject of HIV awareness and prevention in most parts of the county would mean that HIV will remain a major threat to our coming generations. All children are equally important and have the right to life, safety and good health, living in urban or rural settings. Equitable access to basic preventive healthcare is a basic human right. The laws in place have to be effectively implemented at large.
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Zeeshan Shah is a healthcare specialist and tweets @zeeshan82445998. The views expressed in this article are the author’s own and do not necessarily reflect the editorial policy of Global Village Space.