In 2004, an outbreak of HIV/AIDS in Pakistan caused a skyrocketing number of cases in the country. As of 2020, there are an estimated 180,000 people living with HIV/AIDS in Pakistan. However, the vast majority of HIV-registered Pakistanis are receiving treatment and local organizations are making progress to expand treatment to the most vulnerable and stop the progression of the outbreak altogether.

The HIV Outbreak in Pakistan

The 2004 HIV outbreak in the country followed a pattern common in Asian countries, in which the disease grows exponentially within networks of people who inject drugs, before reaching a plateau. Once the disease reaches a plateau, the disease begins to spread to the general population.

About 38% of Pakistani people who inject drugs are HIV positive as of 2017. The common practice of sharing and reusing needles and other drug-injection equipment can explain this. Needles contaminated with HIV-positive blood easily spread the virus among communities struggling with substance use disorder in Pakistan.

There is also an interesting local phenomenon in Pakistan where injection drug users are not able to inject their own drugs. Instead, these individuals utilize “street injectors” who inject the drugs for them. The injectors use a method of injection known as double-pumping, in which blood goes into the needle. As payment for their services, after injecting the individual, injectors keep a portion of the drug solution mixed with blood. The injector then pools it for their own use or for sale to others.

The Spread of HIV Throughout Pakistan

Through practices like these, HIV became extremely prevalent within this highly marginalized group. Once the percentage of HIV-infected injection drug users plateaued, the virus spread throughout Pakistan through bridging populations — people in close proximity to those in the high-risk group, such as the spouses of men who inject drugs. A study published in 2021 in the Harm Reduction journal estimated that, in Pakistan, 8.5% of female spouses of men who inject drugs are HIV positive.

Another population key to the progression of the outbreak is truck drivers. Many truck drivers frequently engage in purchasing sex, which puts them at higher risk of contracting HIV. Due to their mobility across the country, truck drivers who contract HIV/AIDS in Pakistan present a risk of a far-reaching and fast spread of the virus.

Progress and Solutions

Identifying at-risk populations and HIV-positive individuals is an important part of stemming the tide of an outbreak. However, the organization Nai Zindagi believes that society should not blame or stigmatize these individuals, but should help them instead. The organization started in 1989 as a small residential drug treatment center in Lahore, Pakistan.

Over the years Nai Zindagi shifted to focusing on street-based people who inject drugs across the whole of Pakistan and came to have a reputation for working with these populations. In 1999, UNAIDS and United Nations Office on Drugs and Crime contracted Nai Zindagi to study “Hepatitis C and HIV among the growing numbers of street-based persons injecting drugs in Lahore.” Through the study, Nai Zindagi became aware of the increasing use of drugs via injections. At the time, the study noted no positive cases of HIV, but it was clear that HIV would spread rapidly once the first case came about within this group. This created a shift in the organization’s response to drug use, with a new emphasis on harm reduction, including reducing the spread of HIV.

Nai Zindagi’s Services

According to the Centers for Disease Control and Prevention, to address an HIV outbreak, a country must diagnose, treat, prevent and respond quickly to each case of the disease. Nai Zindagi provides services in each of these aspects, focusing on marginalized, impoverished people who use drugs and those close to them, such as spouses.

Nai Zindagi specializes in assisting street-based individuals, utilizing mobile treatment vans and testing machines to accommodate those who are experiencing homelessness in Pakistan. The organization provides testing services, counseling, treatment and referrals to clinics that specialize in HIV/AIDS in Pakistan.

It also provides outreach services and training to spread the word about dangerous behaviors such as the use of used or dirty needles. Nai Zindagi even provides syringe exchange services, with the aim of distributing clean needles to those most at risk of contracting HIV. Harm reduction services like these are clinically proven to reduce the risk of diseases spread through injectable drugs.

With the work of organizations like Nai Zindagi, those at risk of HIV are less likely to contract it and those living with HIV/AIDS in Pakistan will have access to treatment that lengthens and improves their lives.

– Grace Ramsey
Photo: Flickr