A novel prevention method is to be introduced in country
The HIV pandemic has affected around 38 million people across the globe. In many countries the number of new infections is now declining, but cases continue to rise in Pakistan.
An estimated 190,000 people here are living with the HIV virus. In the midst of COVID-19, it’s easy to forget this pandemic though it has been with us since 1970.
The outbreak of Ratodero in 2019 in Pakistan highlighted how important it was to educate people about preventive methods to stop the spread of the virus.
With that in mind, a new method of HIV prevention is about to be introduced soon in the country.
“We are working on launching PrEP in Pakistan soon,” UNAIDS Country Office Director for Pakistan and Afghanistan Dr Maria Elena Borromeo, tells SAMAA Digital.
PrEP, which stands for pre-exposure prophylaxis, is a method for HIV prevention that is now being used increasingly around the world.
It targets people who don’t have HIV infection but have a high chance of contracting it. Those key populations in Pakistan include people who inject drugs, men who have sex with men, transgender people, and male and female sex workers.
Antiviral drugs tenofovir and emtricitabine, available as a single pill, need to be taken daily. This combination reduces the incidence of HIV as well as the rates of transmission of the virus.
PrEP has shown to work. It reduces the risk of getting HIV from sex by about 99% when taken as prescribed, according to the US Centres for Disease Control and Prevention.
“Although there is less information about how effective PrEP is among people who inject drugs, we do know that PrEP reduces the risk of getting HIV by at least 74%,” CDC guidelines add.
PrEP is considered safe. A few side effects such as diarrhea, nausea, headache, fatigue, and stomach pain have been reported in some people, but they don’t last long. It can also be used by pregnant and breastfeeding women.
Pre-exposure prophylaxis therapy can only be started if prescribed by a doctor. It is not used in the general population but for those people most at risk of contracting HIV.
If anyone feels they have already been exposed to HIV, they need to consider post-exposure prophylaxis (PEP), not PrEP.
An HIV test is mandatory before beginning PrEP to rule out HIV, as this drug regimen is only given to HIV-negative people. CDC says while on PrEP, you need to visit your doctor every three months. If the side effects become unbearable or one’s lifestyle changes so they’re no longer at risk of exposure they can stop the treatment.
Along with working on new preventive methods, the government is also ramping up the country’s HIV programme.
The Deputy National Coordinator Common Management Unit AIDS Dr Ayesha Isani said this during a media training workshop on the HIV response.
The plan is to ensure “universal health coverage for HIV prevention and referral to treatment at both community level and primary health care centres” said the AIDS national coordinator.
There are 49 antiretroviral therapy (ART) centres in the country which will be increased to 102.
Seventeen community based organisations (CBO) are working on ground to support the HIV response; the government aims to bring this number to 52.
When key populations are counselled about HIV by their own community members, they are more comfortable, said Dr Isani.
CBOs work on creating awareness about HIV prevention and treatment to bring about behavior change in the community. They educate the key populations about sexually transmitted infection (STI) symptoms and use of condoms. Counselling of families is also done through this method.
The impact of these interventions is gauged through the Integrated Behavioral and Biological Survey (IBBS). The last one was carried out between 2016 and 2017 and a sixth IBBS is due.
Only 44,758 of the estimated 0.19 million with HIV know their status. Around 54% of them, 24,362, are on ART.
There have been 6,800 AIDS-related deaths, which is concerning, says Dr Isani.
The government intends to reduce HIV-related stigma and discrimination, which is one of the biggest barriers to diagnosis and treatment.
Like every other health programme, the provision of HIV services was adversely affected by the COVID-19 pandemic. Though progress was stalled, there was no disruption in treatment services, said Dr Isani.
“We started multi-month dispensing which helped greatly.”
This meant that medicines were dispensed every three months instead of monthly. Courier services were used to dispatch medicines and food supply. Healthcare staff was trained through virtual sessions.
“Now that the COVID-19 vaccine is here, we need to gear up our act and head out again,” said Dr Isani.