Pakistan needs to speed up its human immunodeficiency virus control strategy to achieve targets in fast-track acquired immune deficiency syndrome response

Abstract

In last fifteen years remarkable success in the fight against human immunodeficiency virus (HIV) is achieved globally. The number of HIV infections has decreased and the number of people on antiretroviral therapy is increased. This all is possible by strong political commitments and heavy investments in the fight against HIV. Pakistan is among few Asian countries in which HIV cases are increasing year by year since 1990. There are 94000 cases of HIV in Pakistan and only 14000 are registered with government. The main source of HIV infection in Pakistan is the use of contaminated injection equipment among people who inject drugs (PWID). The overall prevalence of HIV among PWID in Pakistan is 27.2%. There are five cities in Pakistan in which HIV prevalence is above 40% in PWIDs. In June 2016, United Nations political declaration on acquired immune deficiency syndrome (AIDS) provided a global mandate to fast-track the AIDS response over the next five years to achieve the targets in Sustainable Development Goals. To achieve the targets in fast-track AIDS response, the global leaders showed strong commitments to invest $ 26 billion per year by 2020. Pakistan needs to speed up its HIV control program. There is a dire need to locate all HIV positive people and enroll them in the treatment program. Pakistan also needs to calculate exact number of people living with HIV, increase HIV treatment centers and increase HIV awareness. Recently, Global Fund invested handsome money in the fight against HIV. Let’s hope the country will have effective HIV control strategy to achieve the HIV elimination target by 2030.

Key Words: Human immunodeficiency virus; People who inject drugs; Fast-track; Antiretroviral therapy

Core tip: Human immunodeficiency virus (HIV) cases are increasing day by day in Pakistan. Currently, the prevalence of HIV is less than 0.1% in general population while the scenario is totally different in people who inject drugs, having prevalence of 27.2%. Approximately 15% of HIV positive cases are enrolled with government for treatment. United Nations political declaration on acquired immune deficiency syndrome (AIDS) provided a global mandate to fast-track the AIDS response over the next five years to achieve the targets in Sustainable Development Goals. Pakistan needs to speed up its HIV treatment program to achieve the targets in fast-track AIDS response.

TO THE EDITOR

Fifteen years ago acquired immune deficiency syndrome (AIDS) epidemic was affecting families, communities and entire nations. The epidemic united the global community and the efforts were initiated to decrease the AIDS death toll and increase human immunodeficiency virus (HIV) drugs accessibility. Millennium development goal (MDG) six played a key role in the success against AIDS epidemic[1].

From the year 2000, the number of new HIV infections around the globe has decreased from 3.1 million to 2.0 million and the number of HIV-positive people on antiretroviral therapy has increased from 1 million to 15 million. Similarly, the AIDS-related deaths decrease from 2.0 million to 1.2 million. All this is possible by the inclusion in the MDGs and increase in AIDS funding from $4.9 billion to $21.7 billion[1]. The AIDS epidemic is halted and reversed. If the efforts are stopped here the AIDS linked morbidity and mortality will again start growing.

Pakistan is among few countries in Asia in which new HIV cases are increasing year by year since 1990. There are 94000 cases of HIV in Pakistan and only 14000 are registered with government[1]. The government has no idea where are the rest of 80000 HIV cases.

The government is expected to complete the Integrated Biological and Behavioral Surveillance survey in 2016; the survey will determine the actual number of people living with HIV in Pakistan including sex workers and drug addicts.

Currently, there are 21 HIV treatment centers and 20 community-based care and support centers for HIV patients across the country. The government is planning to increase the treatment centers from 21 to 25 till 2017.

The main source of HIV infection in Pakistan is the use of contaminated injection equipment among people who inject drugs (PWID). The overall prevalence of HIV among PWID in Pakistan is 27.2%[1]. There are five cities in Pakistan in which HIV prevalence is above 40% in PWIDs. These cities include Sargodha (40.6%), Karachi (42.2%), Gujrat (46.2%), D.G. Khan (49.6%) and Faisalabad (52.5%)[2]. HIV positive PWIDs are also transmitting HIV infection to their spouses.

Pakistan shares a long porous border with Afghanistan, the leading producer of Opium. Approximately 40% of Afghan Opium is transported and sold through trafficking routes passing from major cities of Pakistan. There is an increase in shift from inhalator to injectable drugs during the last few years. In Pakistan 430000 injecting drug users are present and 70% of them are sharing needles[3].

In June 2016, United Nations political declaration on AIDS provided a global mandate to fast-track the AIDS response over the next five years to achieve the targets in Sustainable Development Goals. The declaration calls on countries to reduce new HIV infections to 500K, reduce AIDS related deaths to 500K and eliminate HIV related Stigma and discrimination by 2020[4].

The political declaration also stresses that the 90% of people living with HIV should know their positive disease status, 90% of HIV positive people who know their status have access to HIV treatment and 90% of HIV positive people getting treatment have suppressed viral load by 2020[4].

The global leaders also pledge to provide HIV prevention to both general and high risk populations, including people who inject drugs, sex workers and prisoners. The targets also include a 95% reduction in new HIV infections among children in next five years. To achieve the targets in fast-track AIDS response, the global leaders showed strong commitments to invest $ 26 billion per year by 2020[4].

In order to achieve the targets in the Fast-Track AIDs response, Pakistan needs to speed up its HIV control program. There is a dire need to locate all HIV positive people and enroll them in the treatment program. The PWIDs needs special attention, they are bridging the epidemic between other key populations including sex workers. All the PWIDs should be provided with enough syringes so that they avoid sharing the syringe. The mother to child transmission also needs special attention. Currently, 3% of HIV positive pregnant women are taking antiretroviral therapy[1]. Thailand is the only country in the Asia who halted the mother to child transmission of HIV by covering all the HIV positive pregnant women into effective HIV treatment program.

Pakistan needs to calculate the exact number of people living with HIV. The HIV awareness program also needs attention. There is hardly any HIV awareness program on electronic, print and social media. There is a need to increase the HIV treatment centers in the country; only 21 HIV treatment centers are not enough to cover a population of 180 million people. There is a need to increase HIV screening so that the 90% of HIV positive people know about their positive disease condition and enroll 90% of HIV positive people in the treatment program.

It was also observed that the slower HIV program in Pakistan was due to lack of the financial resources. Recently, Global Fund invested handsome money in the fight against HIV. Let’s hope that the Pakistan will have effective HIV control strategy by the recent investments and we will be able to achieve the targets in the Fast-Track AIDS response which will eventually lead to HIV elimination by 2030.