The AIDS challenge

How well is Pakistan doing in its fight against AIDS? On World Aids Day last week, President Arif Alvi promised that the government would eliminate the disease from the country. This promise has been repeated by previous governments as well, but compared to the lofty promises, actual performance has been dismal. There are over 150,000 AIDS patients in Pakistan, with the number of HIV infections on the rise. Pakistan is understood to have reached a threshold level, and the country is facing a concentrated epidemic. In contrast, the performance of the National AIDS Control Program remains exceptionally poor. One example is the Punjab AIDS Control Program (PACP), which remains riddled with organisational inefficiencies. The numbers are embarrassing. In 2017-18, it could only provide three percent of targeted sex workers with preventive services. It serviced only 1,500 sex workers out of a target of 50,000. Similarly, no strategy was evolved and no initiatives taken to identify and focus on the most vulnerable sections of the population, which include drug users, truck drivers and transgender persons. Moreover, the state of financial transparency is also worrying, as the PACP spent 90 percent of its allocated funds in achieving less than five percent of its targets.

Effectively, the numbers are poor enough to suggest that the national program to combat AIDS is a major failure. We talk a good talk, but there is no action on the ground. Parliament is set to present a bill on the prevention of AIDS, but it sounds like another redundant piece of legislation. What is the use of a separate law to treat a single disease? The point instead is to create effective AIDS prevention programmes, rather than focusing on unnecessary law-making.

The real question is how to improve the performance of the AIDS prevention programmes. Some experts have pointed out the need for major structural reforms, or transferring the anti-AIDS programme to a specialised area of the health department. But is there is a will to do so?. One could claim that such fears are overblown – but the reality is that the official numbers of people infected with AIDS in Pakistan are underreported. Cultural taboos have a major part to play as many of those infected remain undiagnosed. The new government has not prioritised tackling this grave menace, which requires a thorough and multi-pronged approach that deals with the provision of medical services along with an awareness campaign to address cultural taboos that surround the spread of the HIV virus. Pakistan barely has an infrastructure to deal with AIDS. If Punjab, often considered ahead of other provinces in social sectors, is doing so poorly, one can only imagine how the rest are doing. Concrete promises will need to be made and kept to stop the spread of AIDS in Pakistan.