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Tuesday, July 16, 2024

HIV on the rise – environmental racism or criminal negligence?

The writer discusses the reasons for rising cases of HIV in Pakistan, especially in Sindh. The government needs to address the source of the problem which is hospitals being involved in corrupt practices like selling used needles.

HIV is the killer disease hiding in the underbelly of the COVID crisis. Lot of people are feared to have been infected and some already dead, due to the hidden nature of this epidemic and we are in the dark when it comes to real facts and findings.

The story of death has been told many times. Lately, the stories have become too real to ignore. In the remote corner of Pakistan, a small town in the province of Sindh in Pakistan has been burying its dead children and looking for answers.

Nowhere else has death been so vindictive for the suffering families, where they have no choice but to accept the deadly fate. Here, we cannot blame God or fate. We simply have to blame the people of the city.

More importantly, we know who the people are. They are the very people who are supposed to be the saviors. The battle for life is a struggle for many today.

Read more: The Rise of HIV positive cases in Larkana: Where is the Sindh government?

How fast can the government act?

The fateful truth was uncovered somewhere in 2019, where media reported a sudden rise in child deaths in the city of Rato Dero in rural Pakistan. Apparently, it was discovered that the cause of death was the human immune deficiency virus also known as HIV, in the small town in a backward province where health care was worst than in Yemen or Syria.

No, there was no war or conflict there at all. Just a blind invasion of thieves and looters in the health department- a corrupt systemic operation of the highest order, being fathered by the higher ups in the health department under the ignorant eye of the government.

When we talk about a welfare nation, do we really know what we are talking about? A welfare nation takes care of its children without discrimination. Deliberately killing off its population by extreme criminal intent is punishable even in the most barbaric nations. Is Pakistan really a welfare nation? Not yet.

Read more: Death of Capitalism: Re-emergence of Socialism & Rise of Welfare States

This is a classic case of ‘environmental racism’- a phenomenon that needs to be clearly understood today if we are to resolve this problem. The Prime Minister of the country is rightfully concerned about this but has not been able to clearly pinpoint the criminal mafia which operates in rural Sindh and is responsible for the negligence leading to so many deaths. Let me clarify further.

During famine war or a health crisis, people from poor cities migrate to more developed cities mainly due to lack of health facilities, medicines, clean water, lack of doctors and lack of medication. This creates the ‘birth of corruption’ as mafias – disguised as doctors and caregivers- start to hound those poorly constructed, neglected and abandoned hospital buildings and start this deadly business of death.

Read more: Doctor held for ‘spreading HIV’

The actual suffers are the poor people- simply because of the bad environmental conditions they are subjected to – leaving them no choice but to move their families to big cities, due to dismal health facilities for the sick and needy. This is called ‘environmental racism’- which has a direct link to human migration.

In 2018, after the 18th amendment laws approved through constitutional amendments, the subject of health care became a provincial matter despite being a national agenda and all accountability was in the hands of the provincial government.

Less than a year later over 30,192 cases of HIV were identified under the WHO health survey and testing through free health kits. Results were shocking. Out of the total tested population, over 82% infections of HIV were found in children.

Read more: UN, WHO & UNAIDS join hands with Pakistan to combat HIV outbreak

A senior WHO representative for Pakistan, speaking in a seminar the same year spelled out the emergency in the province. He specified that 85% of the people living with HIV need life-saving anti retro viral therapy but lack the affordability or the government support.

One of the reasons highlighted at the time was the lack of testing equipment available. In a country, where health is an emergency, the caretakers and administrators showed deliberate ignorance to undermine the severity of the matter.

Any state or government who is unable to provide basic health facility to its infant population is committing an act of treason. And how can a poor community of illiterate people identify the cause of the diseases in the first place, if the health care provides are guilty of malice and mass level corruption that involves major financial corruption and endangering human lives.

Question here is: Who is to blame? Investigations in 2019 were either slowed down or suspended under false pretence to hoodwink the public as social media also somehow failed to raise this issue on a bigger level. Why did media stop reporting this? Is there a mafia behind it?

Read more: Maryam slams PTI over Sahiwal incident, keeps mum on HIV outbreak in Sindh

The rising causes of death around the world

According to UN SDG agenda, world nations have pledged to eradicate HIV by 2030. Has Pakistan forgotten the pledge or have they opted out of the health care business.

I think international investigative agencies in line with global emergency health standard operating procedures, UN Health, WHO and local federal government authorizes must investigate the real cause behind this deadly diseases rising in Sindh and not in other provinces to such horrific levels.

The autonomous bodies like SHCC- Sindh Health Care Commission must intervene in the province and conduct an unbiased investigation in the matter as this is an emergency scenario that has been ignored by authorities since 2019.

Read more: Will Sindh government focus on upgrading health facilities across the province?

Further clinical research and development in the matter is the need of the hour. A major reason behind this rising epidemic is lack of identifiable evidence that can predict the behavior of the disease. Despite the odds, evidence points out to one deadly practice – usage of unsafe IV (intravenous injections).

As per law, second-hand usage of discarded or already used needles /injections is prohibited and severely punishable within our justice system. Someone is clearly by-passing the system and has complete medical knowledge of facts and is acting in connivance with criminals or mafias.

Every year, we talk about prevention of HIV by encouraging the general public to get tested while ignoring the source of the problem that lies within those hospitals and its management.

Another danger that lurks here is the mismanagement of ‘hospital waste disposal’. The faulty procedures have been identified as accurate. It all begins with the hospital involved in corrupt practices. Usually, mismanaged hospitals usually employ outside sources to get rid of the daily garbage.

Read more: Hospitals stole millions of zakat fund, reveals report

Somehow, due to the faulty governance of such hospitals, garbage disposal proceeds are illegally earned by people involved in such malpractice. The hospital staff turns a blind eye to the proceedings, as they somehow are indirectly involved get kickbacks out of the sale of proceeds earned through ‘illegal garbage disposal’.

Why is it such a dangerous practice?

It is because majority of used injections, needles and other infected equipment is not properly burnt or disposed off as per the laid down official medical procedures and is instead allowed to be illegally smuggled across through ‘scavengers’ or unofficial garbage collectors who then sell these infected needles to needy populations.

Here, it is important to highlight that the majority of these needles are then supplied to rural area clinics and hospitals where the law and order system is poor and medical facilities are few and far between.

Here is where the mafia succeeds in selling such sub-standard medical equipment promoting re-use- leading the rise of HIV infections due to ‘shared needles’ already infused with infected blood.

Read more: Will Sindh government focus on upgrading health facilities across the province?

The final danger to the population arises when these infected unsafe injections are given to pregnant women by the criminally negligent medical staff, the children born are already infected with HIV at the time of birth which is one of the reasons for the high infant mortality rate in children under the age of 5- probably one of the highest in the world.

Other such acts of medical negligence that falls under the ‘criminal injustice’ is the poor infection control procedures and unsafe blood transfusion practices at smaller clinics and above all the improper storage, segregation , collection and disposal of hospital waste- the biggest factor.

A dangerous misconception here about HIV is that it is untreatable. Nothing can be more incorrect. The WHO slogan ‘HIV is treatable’ needs to be drilled in the hearts and minds of the people. Majority of our society is ignorant on the subject on how to stay safe from the evils that surround this problem.

Part of the problem is the inefficiency of the government and health ministries, the law and order system that overlaps them and the weak justice system that fails to punish the criminals behind this epidemic. HIV can be contained and treated and patients can lead healthy lives if only they are well informed and timely educated before it is too late for them.

Read more: Op-ed: Criminal Justice System in Elitist States – A State Sponsored Drama Played by Salaried Puppets

Urban health care providers offer the required HIV test upon request but how do we reach out to the rural community where majority of deaths occur. People in villages and smaller cities have to travel miles away to get simple health checks and health care advice as there is a shortage of good, honest and educated doctors in rural settings. Unless firm steps are not taken by the government, the matter cannot be contained.

What the central and provincial government needs to understand that the health to the  GDP ratio in Pakistan is one of the worst in the world. Even if the population eventually gets access to free health care, the modus operandi covers the ‘ cure’ part of the equation but does very little to address ‘ prevention ‘ aspects of the epidemic. HIV is a taboo subject in the country and not enough is being said about its prevention.

Read more: Pakistan’s health care system in a severe crisis

We have learnt here that HIV is not just being transmitted through sexual misconduct but is predominantly being transmitted directly from mother to child, with no fault of the mother. Even if the disease is being sexually transmitted, the implications are on the lack of protection being used by the illiterate man who is infecting his entire family and his unborn child. Just like men in Pakistan have done during the COVID crisis, by disobeying basic rules of conduct.

Prevention is better than cure

In this case, prevention is the only option. We do not have vaccine to HIV and we may never find one. Sadly, we fail to comprehend the extent of the danger by failing to effectively highlight the impact of the epidemic to the public through social media or television media.

Health Authorities are too busy talking about COVID 19 to speak about a more deadly HIV problem. Provincial health ministry is either dysfunctional or corrupt. Sometimes, media reports the lack of budgets available to the ministry.

Read more: 60% of healthcare workers dissatisfied with government’s COVID-19 policy

Other prevalent issues include the monopoly imposed by the food and drug administration of Pakistan, failure to regulate drug prices, non availability of subsidized medicines and testing kits for HIV, lack of support on the issues by the pharmaceutical industry in support of reduction in relevant medication to combat HIV, poor advocacy by the media and the state government. Perhaps it is advisable that insurance companies be instructed to cover HIV treatment as part of their insurance policy.

Transmission of HIV through sex workers is also on the rise as sex workers have no rights as condemned citizens do not have access to any kind of health care partly because sex workers are not legalized as part of the community.

So STDs (sexually transmitted diseases) pose a huge risk to the client as well as the provider. These people loose primary access to health due to the criminalization of such activities. On other occasions, social victimization and criminal prosecution prohibits them from seeking early treatment to HIV and they end up dying in huge numbers.

Read more: HIV Claims One More Life: Is PPP Serious To Improve Governance In Sindh?

The latest rising threat of ‘infected needles’ is also being detected in the increasing number of drug users as lot of illegal drug dens are operating where these needles and injections are sold as scrap through mafia’s later being used by drug peddlers and onward direct drug users, who are unaware that they are going to die for HIV before they die from the drug overdose.

Finally, we must admit to the cultural dilemma that exists in our country. A man goes out and has unprotected sex and brings that back to his family, infecting his wife and kids as the transmitted of the STD.

In addition to the stigma and shame he brings to the family, he brings death. Similarly, a pregnant woman hospitalized in a small rural city like Ratedero, gets infected because the nurse or medical practitioner uses an infected needle on her, infecting her with a disease contaminated like HIV simply because the needle used was contaminated. This is criminally insane.

What should be done?

Summing up, we need to act on a war footing. The following immediate recommendations include:

We need to create an early detection plan. Rural hospitals and clinics must be investigated by LEAs for possible criminal negligence with regards to usage of dangerous substandard medical equipment.

State must enforce a state of emergency in hospitals to eradicate the problem with severe measures as per law. Ministry of Interior and the Health Ministry to form a joint investigation team of honest administrators to lure out the corrupt elements within the medical system.

Read more: The three big studies pushing at the frontiers of HIV prevention

To build outreach, all major TV, radio and social media forms to be engaged through transmission of health guidelines on the subject of HIV, while engaging major MNCs (PHARMA companies) to create a clear advertisement strategy that can be implemented at earliest for broadcast media.

Engage high powered health checks within the governance system and limit mal-practice to seek out and take legal action against criminals pretending to be health care workers- be it doctors, nurses or higher management staff with political clout. No one is above the law.

The writer is a Director at a leading advocacy institute and a renowned radio based out of Karachi. He tweets as @zeeshan82445998. The views expressed in the article are the writer’s own and do not necessarily reflect the editorial policy of Global Village Space.