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PAKISTAN: Dodging Drones and Bullets to Beat HIV

Ashfaq Yusufzai

PESHAWAR, Sep 8 2011 (IPS) - Having to contend with U.S. army drones and the crossfire between the Taliban and the Pakistani army, the residents of Pakistan’s tribal areas find access to treatment for HIV/AIDS harder than in most other parts of the world.

Currently, people living with HIV/AIDS (PLWHA) in the Federally Administered Tribal Areas (FATA) must cross the porous border into Afghanistan and take a circuitous route to Peshawar, capital of the Khyber Pakhtunkhwa province, to get timely anti-retroviral treatment (ART).

“I spent 200 dollars getting into Peshawar for treatment because of the difficult conditions created by militancy in the Kurram Agency where I live,” said Akbar Khan, 39, who was diagnosed with HIV infection in January last year. Kurram is one of the seven tribal agencies and six frontier regions that fall in Pakistan’s Federally Administered Tribal Areas (FATA), lying sandwiched between the provinces of Khyber Pakhtunkhwa and Balochistan, both of which also border Afghanistan.

Pakistan’s northwest became a sanctuary for Taliban and Al-Qaeda elements that poured over the border following the U.S.-led invasion of Afghanistan in 2001.

Khan made it to Peshawar travelling via Afghanistan to undergo tests to determine the right treatment dosage at the ART centre in Peshawar, capital of Khyber Pakhtunkhwa. “Most of the 44 HIV-infected patients in Kurram are unable to get to Peshawar because the roads leading to Peshawar are closed due to the militancy and they cannot afford to come via Afghanistan,” Khan told IPS. The Pakistan government, with financial and technical support from the World Health Organisation (WHO), had established a family care centre for providing free ART treatment to PLWHA in 2005.

So far, the centre has registered 531 patients, with 277 from FATA and 254 from Khyber Pakhtunkhwa. At the ART centre, Dr. Shahid Ali says patients from FATA find it extremely hard to travel to Peshawar and there are fears that many will die for lack of treatment.

“Many of the patients could die soon because continuous treatment is vital to prolong their lives. We had planned to provide ARV drugs to the patients at their doorsteps but escalating terrorist activity is standing in the way,” he told IPS. Things are no better in FATA’s North Waziristan Agency where there are 57 patients – 36 males, 16 females and five children – with only about a dozen now availing treatment at the ART centre. “FATA patients who can afford it have shifted to Peshawar or other safer places only to ensure they get treatment, while the majority are destined to die for want of treatment,” Shahid said.

The WHO’s Dr. Omar Ali says the government has been requested to facilitate access to FATA to provide treatment to the patients there, but there has been no response.

Ali says the number of PLWHA was increasing because of intravenous drug use, lack of screening facilities in the blood banks, use of unsterilised equipment by dentists and recycling of disposable syringes.

When the ART centre started functioning patients were unwilling to visit it because of the social stigma associated with HIV/AIDS, but such attitudes are gradually changing.

“With the passage of time, that situation changed and people are now coming to seek treatment because they know that ART can improve the quality of life,” said Ghufran Khan, an activist for the non-governmental organisation ‘AIDS PLUS’, which encourages PLWHA to seek treatment.

“Where we received 35 patients in 2005 and 136 in 2009, the numbers have risen to 531 this year, so far, which shows the increasing demand for treatment,” Ali said.

“Most of the patients in FATA are eager to visit the centre regularly because they see that those on treatment are alive and living normal lives,” said Muhammad Karim, 30, from Charsadda district in Khyber Pakhtunkhwa.

Karim is now hopeful of living productively and looking after his two kids, aged eight and three. He was deported from the United Arab Emirates after he tested positive for AIDS three years ago.

Imran Shah, another patient who managed to get to Peshawar from FATA’s South Waziristan Agency, said that he initially faced problems in the society.

“My brothers and sisters would not even talk with me for fear of contracting an incurable disease,” said Shah.

Now, he said, he has been receiving treatment at the centre and has also started working. “My family members are no longer afraid to interact with me because they are now sure that my disease is manageable,” he said.

WHO’s Ali said the centre has had to depend on drugs imported from India which are provided free of cost to people who turn up for treatment.

The Peshawar centre, which is staffed by doctors and nurses trained in India, provides ART, management of opportunistic infections, voluntary counselling and testing services and also acute care of HIV-related infections.

“We need to monitor treatment-related adverse effects and toxicities, and provide medical and psychological support in many of the cases,” he said.

Jamila Bibi, a staff nurse at the ART centre, said many women and children with HIV are facing a critical situation because they are denied access to treatment. “Quite a few contact us over telephone, but we cannot do anything for them unless the patients come to the centre.”

Most FATA patients are poor and illiterate and do not get the priority in care and treatment they deserve, she said. Last month, a girl Naseema died because of stoppage of ART, Bibi added.