The battle against HIV is unlike any other, in fact a lot more grueling. This is one infection in which our objective is not just to provide treatment but also to ensure that the patient has the physical, psychological and social support to continue treatment. This is one disease in which the social taboo is still a major obstacle and facts are still distorted in everyone’s mind, which includes patients, healthcare workers and high-risk populations.
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The Stigma Attached To It:
According to National AIDS Control Program (NACP) of Pakistan, there are currently an estimated 0.15 million people living with AIDS in Pakistan, of whom only 25,220 people are registered with the NACP. Many patients don’t register due to the stigma of disease, but what is even more alarming is that a greater number of patients have never been tested for HIV and are completely unaware of their disease, their risk of transmission and its consequences.
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The disease is debilitating as the patient’s immune system is torn down by the virus. The patient is no longer able to defend itself from environmental pathogens and as a consequence, even the common flu can prove to be fatal.
Historically, AIDS was associated with rapid progression of disease resulting in death, but disease management has drastically improved since then. The new generation of medications called ARVs or Anti Retro Viral drugs slow down the progression of the disease and also reduce the risk of transmission. Therefore, HIV positive patients today can remain asymptomatic for years and have a better overall quality of life.
The NACP has been working steadily since 1986 and there are currently 33 HIV Centers across the country, which not only provide ARV drugs to patients but also provide counseling and post-exposure prophylaxis. Despite all these efforts, a little over 15,000 people in Pakistan are consistent with their treatment. Lack of compliance could be due to multiple factors including depression, social pressure or inability to follow up.
Four major factors need to be aligned with our goal, before we can make any progress :
1. Qualified Healthcare Professionals
The social stigma of HIV is not only rampant among the community, but also among healthcare workers. Many doctors and nurses, especially in rural areas, are unaware of the advances in diagnostic and therapeutic modalities, with regard to HIV.
2. Comprehensive Database of Patients
Treatment of AIDS is life-long and requires a commitment to the medications as well as to a regular clinical check-up which includes a physical examination as well as blood tests. In many cases, patients begin their therapy diligently but start slacking with time and end up missing medications and doctor appointments.
In such cases, it is essential for the clinical team to be able to track down the patient and counsel them of the hazards of non-compliance with therapy. Unfortunately, the database of HIV positive patients in Pakistan is rudimentary at best and data of many patients is incomplete due to loss to follow-up.
3. Advanced Technology in Relation to Diagnosis and Treatment
Guidelines on the diagnosis and treatment of AIDS has changed drastically in the past decade. In order to keep up with the trends, pharmaceutical companies and clinical laboratories should have the latest modalities as well as the expertise in advising and interpreting results.
4. Leadership and Governance
The last and most important factor, to be accounted for is Leadership’s commitment to this project and their accountability as well as that of all stake holders. From the federal to the provincial level, all healthcare institutions should collaborate with the NACP to ensure management of patients is in accordance with current clinical guidelines.
Governing bodies are also responsible for the financing of such large-scale projects and need to ensure the availability of free ARV medications for all patients at all times.
Our battle against AIDS is not against a virus, but towards a change in mindset, where AIDS is managed as a treatable viral disease and not something to hide or be ashamed of. Educating the community is the first and most important step we have to take as a nation to reduce the incidence, prevalence and mortality rate of this disease.
Reference : http://www.nacp.gov.pk
