December 5th, 2020
By Asra Haque
“I was sharing a cigarette with a friend, and when I told him that I have AIDs, he stopped smoking. He waited till the end of the conversation to ask me if he didn’t catch it from my cigarette!”
Ahmed narrates the little anecdote with a laugh. When he first found out that he was HIV positive, it took an incredible mental toll which was only mitigated with the aid of his friends and community support groups, especially among LGBT groups. It was not an easy road, but Ahmed was among the few to find a place in an otherwise ruthless society that refuses to acknowledge the needs of HIV patients. Emboldened by his experiences, he is now engaged in HIV awareness, trans rights, and human rights activism.
It was during the ongoing COVID-19 pandemic that he was diagnosed positive for the acquired immunodeficiency syndrome, also known as AIDS, a condition caused by the human immunodeficiency virus (HIV) which weakens one’s immune system so that the body is unable to fight infections and other illnesses. He is one among thousands of such patients that are continuing to multiply at a worryingly rapid pace.
According to the November 2020 report Implementation of the HIV – Prevention 2020 Road Map, the fourth annual progress report issued by the Global HIV Prevention Coalition, a collective of United Nations member states, donors, and civil society organizations to accelerate HIV prevention under the oversight of UNAIDS, found that the number of Pakistani adults (that is, anyone above 15 years in age) newly infected with HIV increased from 13,000 in 2010 to 23,000 in 2019, a whopping 74 percent increase. Worse still, amongst the only two of 23 Coalition focus countries found to have reported sharp increases in HIV infections, Pakistan fared the worst with its counterpart, the Republic of Angola, reporting a five percent increase in comparison.
The report determined that such dismal numbers for Pakistan are primarily due to low coverage of prevention and treatment services for key populations, which include the LGBT community, sex workers, and drug users. Moreover, the document found that HIV-related casualties were also on the incline in Pakistan, Afghanistan, and the Philippines. However, these findings only paint a small part of the picture.
“Treatment services for “normal” AIDS patients are already lacking, what are the chances that marginalized groups are able to get their hands on essential HIV drugs? They are already discriminated against, the odds are stacked against them,” Ahmed lamented. HIV facilities are only available at a scant number of government hospitals, and drugs are in limited supply, meaning a regrettably long, difficult, and disappointing process for patients.
He narrated an incident in which a woman from Abbottabad was turned away when she asked for two doses of an HIV drug for her son, who had contracted the virus via sharing a needle. “She was begging the front desk officers at the hospital to give her two boxes of the drug so it would at least last her son another month. She said she couldn’t possibly make so many trips to Lahore. But they turned her away, saying they could only supply one box per person.”
Hospitals are no safe spaces, where patients are often made to feel unwanted as if they are solely responsible for their suffering. An individual’s failings, however, are the responsibility of its society, he contends.
Pakistani society’s aggressive aversion to discussing the ‘taboo’ topic of sex and sexuality mean that most people are completely in the dark about how to practice safe, consensual sex. Moreover, pervading misconceptions that HIV is transmitted exclusively through intercourse and is a highly contagious disease, meaning that a patient faces ostracization for being a “sexual deviant” and a harbinger of death to all those around them.
It is not uncommon for an individual to delay or even forgo diagnosis in order to avoid the merciless ire of society. Worse still is when an HIV patient, unable to come to terms with their diagnosis precisely because of the popular rhetoric surrounding it, may resort to violence. This violence can be acted out upon the self via self-harm and in many extreme cases as suicide, or it can be acted out upon others. And when people already brimming with prejudice continue to shun and belittle those suffering from the immunodeficiency disease, it is only a matter of time that the most emotionally vulnerable among HIV patients are pushed to such an extent.
“Without counseling, if an individual is mentally not strong enough to accept their status as an HIV-positive patient, they may become vindictive. They say ‘I have AIDS, I got it from someone. So now I’ll give it to everyone else’,” Ahmed explained.
According to the numbers revealed by UNAIDS, there is a dire need for the Government of Pakistan to take more concrete, effective, and informed steps to prevent the further spread of HIV in the country. That means media campaigns that, rather than painting HIV as an incurable killer disease, dispel common myths to help destigmatize the disease and allow AIDS patients to live as accepted members of society.
Ahmed understands that it is important to also normalize and bring to the fore those communities and individuals that society does not want to acknowledge. Although society may pretend otherwise, sex work exists and is a very real part of not just culture but of the socio-economic ecosystem. Legalizing and thereby regularising sex work would make it easier to monitor the trade as well as bring it into the purview of affordable and quality healthcare provisions.
Moreover, harm reduction techniques such as counseling for drug users rather than strict punishment, and a concerted effort to create a concerned and supportive environment for users to accelerate their mental healing to reduce dependency on drugs are also an effective method to not just address the issue of rampant drug abuse in the country, but also limit AIDS transmissions through shared syringes.
Such ideas, however, may seem radical for such a conservative society, but they are not impossible without a deliberate movement to stamp out stigma.
“My family doesn’t know that I have AIDS,” Ahmed confided, wearing a sheepish smile. “If anyone finds out, then my sisters won’t be able to find suitors.”