AIDS-THE CASE SCENARIO IN PAKISTAN
Since the first case in 1987, the number of officially reported HIV positive persons and AIDS cases has grown to 1,787 with 207 AIDS and 1,580 HIV positive cases as of 31st March, 2001 among 2, 58, 662 million tests carried out since 1986 on the basis of four recommended categories for HIV antibody testing. The categories recommended by the WHO/UNAIDS include: (I) before transfusion of blood or tissue transplant (ii) Research and Surveillance (iii) Diagnosis and (iv) Volunteers.
Heterosexual transmission account the majority (37 percent) of reported HIV cases, with infection through contaminated blood or blood products the second most frequent mode of transmission (18percent). The remainder of reported HIV cases are linked to infection though injecting drug abuse (4%), homosexual or bisexual sex (6%) and mother to child transmission (1.3 %). Transmission modes for 35 % of the reported HIV cases are unknown or unreported. Based on existing data, an estimated 60,000 to 74,000 infected individuals may be present in Pakistan.
The story of Pakistans Government response to the HIV/AIDS crisis is one of good intentions thwarted by limited and varied political resolve and a scarcity of financial resources. In 1987, soon after the diagnosis of first HIV/AIDS cases in the Pakistan, the Ministry of Health established the Federal Committee on AIDS(FCA). Shortly afterwards, in 988, the National AIDS control program (NACP) based at National Institute of Health, Islamabad was launched.
In 1990, the first Government funded plan was developed for NACP and budgeted for three years at a cost of Rs. 20 million. Subsequently the program was expanded and made more programmatic through the approval of a PC-1 of Rs. 774.35 million for 1994-97. The required amount however, could not be made available to the program annually because of continual economic constraints and the duration of original PC-1 was extended to 2003.
In spite of all limitations, the NACP has played an important role in establishing provincial units, raising awareness about HIV/AIDS through variety of activities and launching AIDS and hepatitis B( a sexually transmitted disease) screening in public sector blood bank. A network of forty-six surveillance centers has been established from Gawadar to Sakardu. National guidelines on blood transfusion practice, clinical management and HIV testing and counseling have been developed. Over 8,000 health professionals have been trained through a number workshop. Although hampered by the scarcity of resources, research activities were also carried out to collect national data on HIV/AIDS. The first sero-prevalence study was conducted in 1996. Four studies of national importance are underway and will yield useful information by December 2001. These include (I) STI prevalence study (WHO sponsored) (ii) HIV Seroprevalence study (GoP sponsored (iii) External Review of the National AIDS control Program (GoP sponsored ) (Iv) Assessment of the knowledge, attitudes, and behavior (KAB) of people in response to AIDS awareness campaign (GoP sponsored)
In addition to the above mentioned achievements, the NACP with the collaboration of UNAIDS Pakistan has cared out an extensive strategic planning exercise, involving all stakeholders. The strategic planning framework is now being transformed to action plans and new PC-1s are being developed. Pakistan is the first country in Southeast Asia (SAARC) and WHOs eastern Mediterranean region that has gone through this exercise with a future vision.
International agencies particularly UNAIDS, WHO and World Bank have played a pivotal role in NACPs achievements through their technical and financial assistance for various ongoing projects.
The global burden of disease study predicted that AIDAS would rise to one of the top ten causes of mortality and disability by 2002 from 20th rank during the 1990s. Sandra Thurman, the top AIDS official in the Clinton administration, in an interview shortly before leaving the white house said, "people say that the more we learn about HIV, the more we realize we do not know a whole lot"
Although extensive research is ongoing to develop an effective and affordable drugs and vaccines, information, education and communication will remain the main prevention tools for yeas to come.
HIV/AIDS is a persistent global pandemic and will require a proportionate response to eliminate. It is the plague of our lifetimes and probably that of out childrens loves as well. Pakistan looks towards the international community for collaboration in the \successful implementation of its well-strategize future HIV control plans.
MINSITER UNFOLD NATIONAL HEALTH POLICY 2001
In Islamabad on June 2001, Dr. Abdul Malik Kasi, the Federal Minster for health presented the National Health Policy 2001 with a motto of "health for all"
The New healthy policy views health sector investment as part of governments poverty alleviation program and aims to protect people from hazardous diseases, promote public health and upgrade curative facilities. It also prioritizes primary and secondary sectors of health as opposed to tertiary care, which was the focus of earlier health plans.
The policy lays emphasis on preventive measures, upgrading curative care facilities through strategies of protecting people against hazardous diseases like tuberculosis, malaria, hepatitis and polio. Observed Dr., Kasi. The policy identified ten specific areas of reforms including: reducing widespread prevalence of communicable diseases, addressing inadequacies in primary and secondary health care services, removing professional and managerial deficiencies in the district health system, promoting greater gender equity, bridging basis nutrition gaps in the target population, correcting the urban bias in the health sector, introducing required regulation in private medical sector, creating mass awareness in the public health matters, effecting improvements in the drug sector and capacity-building for health policy monitoring.
The policy aims to increase immunization coverage to 80 percent by 2005 while full coverage would be achieved by 2010. Transmission of wild poliovirus should cease by the end of 2001 with WHO certification that polio has been eradicated from Pakistan by 2005.
Hepatits-B vaccine would be available in 70 percent of all districts by 2002 and 100 percent by 2003 proceeding 17.3 million dose annually over the next 5 years. Full directly observed treatment short course (DOTs) would be achieved in all districts of country by 2005 for tuberculosis treatment.
The Minister informed that 58,000 lady Health Workers under the health ministry and 13,000 Village-bases Family Planning Workers under the ministry of population welfare would be integrated from July 1 to create a cadre of 71,000 Family Health Workers under the national control for family planning and primary health care. This cadre would be increased to 100,000 by the year 2005.
The provinces would undertake improvement of district and tehsil hospitals under a phased approach. A minimum of six specialists in medicine, surgery, pediatric, gynecology, ENT and ophthalmology would be made available at these facilities.
The policy seeks to upgrade the standers of districts and tehsil hospitals and tehsil hospitals through provincial master plans. Under the plan, 25 district hospitals and 52 tehsil hospitals would be upgraded in Punjab; 11 district hospitals and 44 tehsil hospitals in Sindh; 19 district hospitals and 11 tehsil hospitals in NWFP; and three district hospitals and 30 tehsil hospitals in Balochistan.