Once Bill Gates said, “AIDS itself is subject to incredible
stigma.” The Sixty-ninth World Health Assembly endorsed a new Global Health
Sector Strategy on HIV for 2016-2021. The strategy includes 5 strategic
directions that guide priority actions by countries and by WHO over the next six
years.
The strategic directions include:Information for focused action, Interventions
for impact (covering the range of services needed), Delivering for equity
(covering the populations in need of services), Financing for sustainability,
Innovation for acceleration (looking towards the future).
WHO is a cosponsor of the Joint United Nations Programme on AIDS (UNAIDS).
Within UNAIDS, WHO leads activities on HIV treatment and care, HIV and
tuberculosis co-infection, and jointly coordinates with UNICEF the work on the
elimination of mother-to-child transmission of HIV.
The strategy builds on the extraordinary public health achievements made in the
global HIV response since WHO launched the Special Programme on AIDS in 1986. It
continues the momentum generated by the Millennium Development Goals and the
universal access commitments.
The recent surge in detection of HIV-positive cases in just one taluka of
Larkana district has painted a bleak picture of the existing healthcare system
in Sindh, where a number of bodies exist to fight HIV and other diseases but the
situation has turned alarming.
Larkana is considered to be the political capital of the ruling Pakistan Peoples
Party (PPP) and increasing number of such ailments indeed reflects poorly as far
as its tall claims of good governance are concerned. This situation calls for a
thorough audit of the healthcare system and related aspects.
The conditions at the primary and secondary level of health facilities are
enough to make one worry.
Just a couple of years ago, close to 100 people, out of 13,600 measles patients,
died in seven districts of upper Sindh after the Expanded Programme of
Immunisation (EPI) had failed to achieve required vaccination coverage and dying
children in Thar is another tragedy.Recent screening of 21,375 people for HIV,
681 found infected and 537 of these are children.
Without immediate and proper attention, the HIV emergence can develop into
full-blown cases of AIDS.
Also, quackery apparently is the leading cause behind the current outbreak of
HIV-positive cases in Larkana, as quacks reused syringes for patients.
If community screening is carried out elsewhere, as carried out in villages of
Hyderabad district by Peoples Primary Healthcare Initiative (PPHI), it would end
up in more HIV cases.
Sindh Health Minister Dr AzraPechuho disclosed that Hyderabad district was
another high-risk area for HIV/AIDS in Sindh. Initially, Sindh’s AIDS Control
Programme manager Dr SikandarMemon had claimed 10,000 HIV cases were there in
Sindh.
In Larkana, a doctor, who himself tested positive for HIV during screening, has
been arrested. He was accused by the Larkana deputy commissioner “of infecting
15 children” but health services director general Dr MasoodSolangi disputed the
DC’s statement and termed the doctor “insane”thoughDIG Police rejected the
claim.
But, There is no explanation whether the 15 children were infected by him.
Bodies like the Sindh Blood Transfusion Authority (SBTA), Sindh Healthcare
Commission (SHCC) and the AIDS Control Programme apparently work in isolation.
Whereas they need to expand the scope of screening to other districts.
The SBTA’s task is to curb unsafe blood transfusion through unregistered blood
banks. However, over the last several years it failed to make its presence felt
effectively until it was headed by Dr Zahid Ansari. The authority had even
declined to run German-funded blood centres in Sindh.
Now, Dr Dur-e-Naz Jamal as its new head, visited Larkana against the backdrop of
HIV-positive cases and got some unregulated facilities closed.
The AIDS Control Programme has not been able to reduce HIV burden and it is not
sharing correct statistics of the disease that may otherwise enable government
to combat AIDS, lest it attains epidemic proportions in other parts of Sindh,
too.
Reports said that the World Health Organisation (WHO)-recommended kits for blood
screening were not used even at the privatised health facilities.
“No third-party evaluation is done in respect of the BHUs so far run by the PPHI
to see what qualitative change it had brought about. While services were being
privatised, the much-talked about change in the delivery of qualitative
healthcare still remained a distant dream.
Meanwhile, Prime Minister's Special Assistant on Health Dr.Zafar Mirza said, a
ten-member team of experts from World Health Organization will visit Pakistan
soon to ascertain causes of spreading HIV virus in Larkana region of Sindh.
HIV continues to be a major global public health issue, having claimed more than
35 million lives so far. In 2017, 940 000 people died from HIV-related causes
globally.
A major factor that must be accounted for in the overall HIV transmission
scenario is the rampant use of therapeutic injections, often with non-sterile
injection equipment. There are an estimated 800 million therapeutic injections
given annually in Pakistan or approximately 4.5 per capita. This is among the
highest in the World. This has led to the prevalence of Hepatitis C infection.
HIV can be suppressed by combination ART consisting of 3 or more ARV drugs. In
2016, WHO released the second edition of the Consolidated guidelines on the use
of antiretroviral drugs for treating and preventing HIV infection. By mid-2018,
163 countries already have adopted this recommendation, which covers 98% of all
PLHIV globally.
Expanding access to treatment is at the heart of a set of targets for 2020 which
aim to bring the world on track to end the AIDS epidemic by 2030.
Ending the AIDS epidemic will require rapid acceleration of the response over
the next five years and this can only be achieved through renewed political
commitment, additional resources, and technical and programmatic innovations.
It will guide efforts to accelerate and focus HIV prevention, enable people to
know their HIV status, provide antiretroviral therapy and comprehensive
long-term care to all people living with HIV, and challenge pervasive
HIV-related stigmatization and discrimination.