Addressing HIV/AIDS in primary care

Prevention and timely disease management are key to saving lives in HIV/ AIDS

Addressing HIV/AIDS in primary care


elonging to a class of retrovirus, the human immunodeficiency virus (HIV) affects the human body’s immune system. The untreated infection leads to AIDS (acquired immunodeficiency syndrome), and the affected individual is prone to developing opportunistic infections and cancers.

World AIDS Day is commemorated on December 1 every year. The aim is to offer support to those living with HIV and raise awareness to eliminate HIV infections. 38.4 million people around the world and 3.5 million people in South East Asia are living with HIV. It provides an opportunity for people worldwide to unite in the fight against the HIV, offer support for people living with HIV, and to remember those who have died from the diseases associated with AIDS.

Let’s have a quick glance at the HIV situation in our country. There have been three outbreaks so far. What lessons have we learnt in their aftermath? A public survey provided insights into the level of awareness in the masses, with comments like “we were not aware that needles/ syringes were the top cause of HIV spread in our country”. Some stated, “We are willing to help spread the word. Need material for the education of public”. A few asked, “Is the government doing anything regarding proper disposal of hospital waste?” Some expected government to take responsibility for preventing the spread; “government must ensure only safe needles/ syringes are available in the market.”

Preventable causes like contaminated blood or blood products, overuse and reuse of needles (injections/ drips), and unsterilised surgical/ dental instruments have been found to be the leading causes of the spread of this infection. These reflect badly on our health care system, which either lacks a well-functioning primary care setup or is poorly defined. Despite convincing evidence collected over the period, nationwide measures have not been taken to overcome the preventable causes.

Pakistan now has the most HIV infections after India and Nepal in South Asia. Despite the efforts by the national AIDS Control Programme, established in 1986-87, the HIV infection rate has increased significantly over the past few years.

High-risk injecting drug abuse and sexual behaviour, combined with low levels of HIV knowledge and prevention, and increasing spread of other sexually transmitted infections (STIs), indicates that HIV could spread rapidly to married couples and sex clients, which may result in a generalised epidemic.

The diagnosis of HIV presents complex physical and psychosocial issues that are not present with the diagnosis of other communicable diseases.

The diagnosis of HIV presents complex physical and psychosocial issues that are not present with the diagnosis of other communicable diseases.

Despite the advances in treatment, acceptance of HIV patients in the society has not improved; the HIV stigma still leads to discrimination. This is mainly due to lack of awareness and fear, which continues to have a forceful impact on people living with the disease.

People living with HIV/ AIDS are scared that they will be denied jobs or may get fired from jobs. They worry about getting evicted from their residences, ordered to limit contact with family, and discriminated against in other ways because of their illness. These fears act as barriers in diagnosis and seeking help for treatment. Unfortunately, healthcare personnel have also been known to stigmatise HIV patients and refuse to provide them the required care. At times family members and friends behave differently around and toward them; their attitudes change after finding out that their loved ones are infected with the virus.

Keeping in mind the present situation, let’s analyse how a primary care physician (family physician, general practitioner) can be of help.

Patients in primary care can present for the screening, including those with other sexually transmitted diseases, newly diagnosed cases of HIV, those on antiretroviral treatments and patients on rehabilitation (long-term) follow up. It is essential that key populations that are at a high risk for acquiring HIV – like sex workers, homosexual men, intravenous drug users and the transgender population – are identified and screened for sexually transmitted infections.

Along with increasing HIV testing and providing accessible care to those who test positive, the primary care team should also help reduce the stigma and discrimination within the health care system and the community. The major reasons for this stigma and discrimination are the lack of knowledge about the basic modes of HIV transmission, fear of its contagiousness, as well as being judgmental about the group of patients who are at high risk of HIV. HIV spread through the reuse of needles or syringes is a major threat to patients’ safety. Implementation of strategies to deal with quackery must be ensured by all provincial governments as this is a nationwide problem. The time to act is now.

Dr Hina Jawaid is an assistant professor in family medicine at the University of Health Sciences, Lahore

Dr Abdul Jalil Khan is an assistant professor in family medicine at Khyber Medical University, Peshawar

Addressing HIV/AIDS in primary care