Home >

Meth–related HIV/ AIDS epidemic

Rising incidence of HIV-AIDS in meth users in Pakistan is alarming

September 10, 2023


hirty-six-year-old Irfan Ahmed (name changed), a gay man, blames methamphetamine for all his sufferings – loss of employment, social isolation, a criminal record and, worst of all, his status as an HIV-positive person. Ahmed suspects that he became infected after engaging in sexual activities while under the influence of Ice, a street name for the highly addictive substance.

“Unprotected sex under the influence of methamphetamine is the biggest cause of the spread of HIV/ AIDS among same-sex partners in Islamabad,” says Ahmed. He says that many men who have sex with men are using methamphetamine for prolonged, uninhibited sexual pleasure in the twin cities of Islamabad and Rawalpindi.

However, the use of meth for sexual pleasure is not confined to the LGBTQ+ community; it is being used widely by transgender sex workers, female sex workers as well as heterosexual couples.

According to the 2022 Global HIV Statistics by UNAIDS, Pakistan has one of the fastest-growing HIV epidemics in the region, with an 84 percent increase in new infections since 2010. Over 222,000 people were estimated to be living with HIV (PLHIV) in 2022, compared to 66,000 in 2010.

Authorities say of the 56,268 people diagnosed with HIV in Pakistan till 2022, only 61 percent were taking anti-retroviral treatment (ART).

Data from the National Aids Control Programme shows that on average, 1,000 new HIV infections are being reported in Pakistan every month; around 50 people test positive for HIV in Islamabad and Rawalpindi.

Officials associated with the NACP believe that a large number of newly diagnosed HIV-positive people are young men in their 20s and 30s who identify as homosexual. Many of them say they have engaged in sexual activities while under the influence of drugs, especially methamphetamine.

Interviews with several methamphetamine users revealed that a vast majority of them were using the addictive methamphetamine during sex work.

A majority of the meth users said the drug helped them in sex work. Almost everybody said they had never cared for protection during the sex.

“Chemsex or sex under the influence of methamphetamine is often unprotected, leading to an increased risk of HIV infection”, says Ahmed. “Chemsex can be very addictive”, he adds.

Many in the Pakistani gay community use the Grindr app, banned by the Pakistan Telecommunication Authority, for networking through VPN as homosexuality remains illegal.

Shahzaib (name changed), a member of the LGBTQ+ community and resident of Islamabad, is also HIV positive. He says he believes that he contracted the infectious disease while having unprotected sex under the influence of methamphetamine – either in Australia or in Pakistan. “Dating apps not only help the gay community connect and find partners but also help them source methamphetamine,” Shahzaib says.

Methamphetamine is easily available on the streets across Pakistan and is being widely abused.

According to Shahzaib, who now works for an NGO that helps homosexual men get screened for HIV, “Those who test positive start ART, so that they can remain healthy,” he says.

Shahzaib adds, “a majority of the homosexual population is unaware of pre-exposure prophylaxis, which has been introduced recently by the AIDS control authorities. It is only available at select ART centres in the country.”

Interviews with several methamphetamine users revealed that a vast majority of them were using the addictive methamphetamine during sex work.

The situation is nearly as alarming for transgender sex workers, who not only use methamphetamine for sex work but also to lose weight and have a certain kind of figure.

“I’ve been using Ice for many years. I can’t work without it. Under the influence of this drug, nobody cares for prevention of diseases. Sex work is the only way of living apart from singing and begging on the streets for me and hundreds of others like me. I don’t particularly ask my clients to use a condom during intercourse”, says Chanda, a trans-woman from Rawalpindi.

Chanda says that a number of her colleagues have contracted HIV over the last few years. She blames Ice for the fast spread of the disease. “A majority of trans-people are neither aware of HIV nor care for protective measures,” she adds.

“When I ask my transgender colleagues to use protection, most of them say they don’t believe that such a disease exists. When I tell them that I am HIV positive, they ask why I am still healthy” Chanda says.

The situation is no different for female sex workers.

“Most of the clients of female sex workers use meth and other drugs. This makes it difficult for us to resist using meth,” says Aasma (name changed) an FSW from the Walled City, Lahore.

“Having sex with clients who use meth without using it ourselves is nearly impossible. Sex under the influence is always violent and unprotected. It frequently results in cuts and abrasions that raise the probability of transmission,“ she adds.

Aasma says that HIV is “spreading like fire” among female sex workers on account of unprotected sex under the influence of methamphetamine. She says most of them see no other option.

She says that when a person is high on Ice, they seldom care for protection. “Even the number of people she has sex with doesn’t seem to matter. The pain and mental agony take hold once you’re sober” Asama adds. She says she believes that HIV infections are spreading rapidly among the general population as well, primarily due to meth use.

Dr Quaid Saeed, formerly an HIV consultant to the Federal Ministry of Health and currently chief executive officer of the Islamabad Healthcare Regulatory Authority (IHRA), believes that the prevalence of HIV among homosexual men is currently highest in Pakistan. He says they are the largest high-risk population. He also says the use of methamphetamine among this community has reached alarming levels.

“As per Integrated Biological and Behavioural Survey (IBBS) conducted in 2006, the MSM population in Pakistan was 800,000. At the time, we knew that it was just the tip of the iceberg. Due to the social stigma, gay persons in Pakistan cannot come out. Some of them have wives and children as well as their male partners “, Dr Saeed says.

The doctor says that the HIV positivity rate is much higher among MSM and transgender sex workers today than the reported 5.5 percent in 2016. Dr Saeed says the use of methamphetamine is aggravating the epidemic.

“HIV transmission is directly proportional to the number of (sexual) encounters and number of partners and inversely proportional to the condom use. Gay men and transgender sex workers using meth often operate under circumstances where protection is not on their minds,” he says.

The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International