World AIDS Day: Rising from the ashes
Inpaper Magazine
By Huma Khawar
Shafqat Nisa’s first source of information regarding HIV was Nazeer Masih, President New Light AIDS Control Society, a non governmental organisation working for People Living with HIV. “He told me that he himself was HIV positive and one of the first to have declared his HIV status in Pakistan. Before that I thought my husband was the only one suffering from the infection,” says Nisa, Coordinator of the Rawalpindi branch of the NGO.
Working with people living with HIV and AIDS for over a decade, Nisa, 42, sees a remarkable change in people’s attitudes over the years. “When my husband returned to Pakistan after becoming HIV positive, I had no idea about the infection except through some strange television advertisements which made it seem like something terribly bad.”
“At that time when we visited the hospital, people gathered around us as if to see the eighth wonder of the world — including doctors,” she narrates her story of the stigma associated with the infection.
Masih, identifying the potential in Shafqat asked her to look for more HIV positive people, especially women. Although she thought it an ‘impossible task’, deriving support from Masih and his wife, she felt “if this sharing can help me so much I need to help other people out there still in hiding, not being able to find a soul to cry with.”
When her husband died in 2002, she was already working for the organisation.
The global HIV pandemic involves a significant proportion of children, with most paediatric HIV infections acquired through mother-to-child transmission during pregnancy, child-birth or breast-feeding. An increasing number of women and children infected with HIV are being reported in Pakistan. According to the UNAIDS estimates, out of the 96,000 people living with HIV in Pakistan, 27,000 are women of child-bearing age.
Gradually women started contacting Shafqat; even doctors referred patients. Today she has 70 HIV positive people registered. “When an HIV positive woman becomes pregnant, she knows she has to contact us as soon as possible. After a counselling session we take her to the lady doctor at the Treatment Centre at the hospital for further counselling.” Many women today, thanks to the timely referral by Nisa, have been able to give birth to HIV free child.
As I sit talking to Nisa in her office, Jamila, an outreach worker brings me tea and biscuits. Jamila’s husband tested HIV positive while working at a restaurant in London. “It was the hospital people who called my father-in-law and asked him to get me tested. The two tests, Rapid test at Pakistan Institute of Medical Science (PIMS) and Eliza at National Institute of Health, (NIH) Islamabad, both confirmed my HIV positive status. At that time I was seven months pregnant.”
Jamila, now 26, delivered her first baby boy in 2007. “I met the doctor at PIMS who gave me medicines so that my child is HIV negative. When the baby was born, they conducted two tests; both were negative. Alhamdolillah”, she adds.
Soon we are joined by another HIV positive woman Rasheeda, 23, carrying a six-week-old baby, her fifth child. “My husband is an Injecting Drug User and bed ridden for the past one and a half years. I have received ARVs during my last two deliveries and both my children have been tested HIV negative.”
“Initially breast feeding by HIV positive mother was considered a big risk for the baby and the mother was strictly forbidden to breastfeed. But now this has changed.” Nisa shares her concern of how difficult it is to convince these women on the changing global research every day.
“Deprived of mother’s milk the baby suffers from low weight, slow growth and ill health, besides diarrhoea and pneumonia”, explains Dr Shazra Abbas, health officer at UNICEF Pakistan.
According to the WHO Guidelines on HIV and Infant Feeding 2010, ‘Evidence has been reported that antiretroviral (ARV) interventions to either HIV infected mother or HIV exposed infant can significantly reduce the risk of post-natal transmission of HIV through breastfeeding.’ The recommendation, that replacement feeding should not be used unless it is Acceptable Feasible Affordable Sustainable and Safe (AFASS) remains.
Although the official figure of People Living with HIV is around 5,000, we see an increase of around 35 to 40 new patients every month at our Treatment Centres all over the country,” says Dr Naveeda Shabbir, of National AIDS Control Programme, (NACP) Ministry of Health.
“Most of the HIV cases in Pakistani women according to Dr Shabbir, show the infection acquired through the risk behaviours of their husbands. Most women are wives of migrant workers or IDUs. “Our women have ‘one of the highest maternal mortality rates in the world and lowest access to reproductive health services. These factors combined with poverty, illiteracy and lack of decision making make them vulnerable to HIV and AIDS,” adds Dr Shabbir.
(World AIDS Day is observed on December 1)
