Healthcare providers advised to promote HIV testing

Islamabad :Individuals who are exposed to or at risk of acquiring HIV may not seek HIV testing due to fear of maltreatment at the testing site or anticipating maltreatment in subsequent health services. Furthermore, people living with HIV (PLHIV) may choose to seek care in HIV services far from their residences, resulting in more challenges for their retention in care and treatment. A smile on the face of the care provider can bring a lot of change in care seeking behaviour and actually can change the lives of thousands living with HIV. When not stigmatised and not discriminated, the coverage of HIV treatment (ARVs) will reach everyone. It just needs a little change in thinking and behaviour.​
The Manager of the National AIDS Control Programme Dr. Baseer Khan Achakzai disseminated this message at an awareness seminar organised at the Pakistan Institute of Medical Sciences (PIMS) here Wednesday to motivate healthcare providers to work collectively towards addressing HIV-related stigma and discrimination and to devise joint recommendations for ending discrimination in healthcare setting.
Dr. Achakzai said, stigma and discrimination against PLHIV and those at increased risk of transmission is still unremitting in Pakistan. In addition to social rejection and exclusion, they often endure rejection and denial of care in healthcare settings; have reported dentists refusing to work on their teeth; surgeons refusing to do surgery; pregnant women being denied obstetric care; and breaches of the confidentiality and disclosure of their HIV status without their consent.
The experiences of PLHIV with healthcare may deprive them from seeking health services in general and from engaging with HIV care and treatment in particular. “In HIV response, it is the job of healthcare providers to encourage the HIV positive individuals for HIV test and treatment. PLHIV have reported discrimination while seeking the treatment, which affects the HIV response in Pakistan. HIV treatment is every individual’s basic right, so let’s facilitate patients’ adherence to the treatment,” Dr. Achakzai added.
WHO Representative in Pakistan Dr. Assai Ardakani said, “World AIDS Day reminds us of our commitment to end the HIV epidemic. It is an occasion to look back at our progress, retrieve lessons and move forward towards this goal. Today, we are better equipped than ever for moving forward. We have a wealth of evidence-based interventions and tools that enable us to broaden prevention options, simplify diagnosis, optimise treatment and above all save lives. All we need to do is to put these interventions and tools within the reach of people who need them.”
Dr. Assai said, progress has been witnessed in HIV surveillance, prevention, treatment and care. Between 2012 and 2016, the number of PLHIV receiving antiretroviral treatment increased steadily to more than double. “In spite of progress, however, the epidemic is still progressing. Pakistan features the lowest coverage of HIV prevention, diagnosis, treatment and care services among regional countries. Over, 85 per cent of PLHIV who need life-saving antiretroviral therapy do not receive it,” he flagged. He termed HIV testing as a critical step for accessing HIV treatment and care.
Unfortunately, Pakistan is facing a huge gap in diagnosis as only 3 out of 10 people living with HIV know their HIV status. Same is the case with treatment; just 7 percent of the estimated people living with HIV/AIDS are getting lifesaving ARVs. This low case identification and treatment is due to many reasons including limited availability of HIV testing and treatment services, inappropriate approaches to service delivery for people who are at risk of HIV, reluctance of healthcare providers to offer an HIV test to their clients, and stigma and discrimination. Additionally, testing the partners of people living with HIV has long been neglected or practiced in an unethical manner that deters people from testing.
WHO strongly advocates integration of HIV into other communicable diseases such as TB and Malaria thus ensuring services availability at all tiers of health systems. Today, with the advances in HIV testing and treatment technologies and the advent of highly sensitive and specific rapid HIV tests and simplified treatment, it has become simpler than ever. “With all these advances at hand, we have no choice but fulfilling our commitment to ending AIDS by 2030. HIV testing and counselling services should also be routinely offered to pregnant women, where mother-to-child transmission of HIV can be prevented. When we know our HIV status we can make better choices for living a healthy life. Test for HIV,” the speakers pointed out.
Country Director Dr. Mamadou L. Sakho said widespread HIV related stigma and discrimination in healthcare settings in Pakistan impedes access to services and impairs the accessibility to quality health service delivery. It also undermines highest attainable standard of health for all. There is a need to have concrete actions within healthcare settings so that more people can get themselves tested and adhere to treatment so that Pakistan can achieve three 90s and end AIDS by 2030, he state.
Senior Programme Officer in NACP Dr Quaid Saeed presented the results of the latest HIV surveillance survey carried out in 2016. The results of this survey show that HIV in Pakistan is concentrated in People Who Inject Drugs but this trend is now shifting with rising prevalence levels in Female Sex Workers and Transgenders. These are alarming figures since this disease is following the path of Asian Epidemic Modelling whereby infection from injecting drug users spread to sexual networks and then into the general population. He emphasised the need for implementation of prevention programmes to stop new infections and promotion of community-based testing to identify new HIV cases and link them to HIV treatment centers.
Ms. Fahmida from UNAIDS said stigma and discrimination in healthcare settings has many forms which include denial of healthcare services to key population and unjust behaviours to service provision, lack of respect, and behaviours that stop people living with HIV and AIDS and key populations from availing testing and treatment services. “UNAIDS and WHO call for concrete actions under the leadership of NACP to establish mechanisms within healthcare settings to address stigma faced by key populations,” she said.
Earlier on, Dr. Rizwan Qazi from PIMS welcomed the guests and gave a presentation on basic HIV facts and success stories of PIMS. The seminar ended with a question-answer session.