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									An update on HIV/AIDS and STDs in Pakistan: epidemiological trends over the last decade

Sharaf Ali Shah MBBS, Ashraf Memon MBBS, Omar Khan MD, Sten Vermund MD, Sibylle Kristensen PhD

Objectives:

HIV/AIDS situation in Pakistan.  This study describes HIV/AIDS situation in Pakistan with particularly focus on Sindh Province.  Risk and trends  National / Provincial response.


Background



Pakistan statistics in general
Total population (mid year, 2001): 140.5 million (Economic Survey, Finance Division 2000-2001)



Urban Population:

32.5% (Economic Survey, 2000-2001)

 

Annual population growth rate: 2.1% (Economic Survey, 2000- 2001) Maternal mortality rate (per 100,000 live births: 533 (National Institute of Population Studies GOP, 2001)

Background
 

Infant mortality rate
(per 1,000 live birth):

89.8 (Economic Survey, 2000-2001) 62.5 years (Economic Survey, 2000-2001) Male 56.5% Female 32.6% (Economic Survey, 2000-2001) 429 (Economic Survey, 2000-2001)

Life Expectancy at birth: Literacy rate: Per capita GNP (US$) UNDP Human Development



 

135 (of 174) countries ranking: UNDP Human Development Report 2000



Surface Area:

Km2 796,095 (Pakistan Statistical Yearbook 2001)

HIV/AIDS Situation in Pakistan
First AIDS Case 1986  Federal Committee on AIDS 1987  National AIDS Control Program 1988  Decentralization of National AIDS Control Program 1994-1995  National HIV/AIDS strategic plan 2000


HIV/AIDS Situation in Pakistan

Continued……



Safe Blood Transfusion Legislation Passed by Sindh Assembly 1997 Safe Blood Transfusion Ordinance by Federal Government of Pakistan 2002



Area Wise Distribution of HIV/AIDS
Sr # 01 02 03 04 05 Areas Federal Centers Punjab Sindh NWFP Balochistan HIV Positive 306 377 457 327 180 AIDS Cases 33 40 81 52 12 Total 339 417 538 379 192

Pakistan:

06

AJK Total

17 1664

04 222

21 1886

Pakistan: Year wise distribution of HIV/AIDS Cases
Year
1986
1987 1988 1989 1990 1991 1992 1993 1994

HIV Positive

AIDS Cases

Total

23
27 42 49 60 140 170 173 178

06
02 08 09 05 16 18 16 09

29
29 50 58 65 156 188 189 187

1995
1996 1997 1998

242
76 112 70

19
20 19 23

261
96 131 93

1999
2000 2001

72
115 115

17
15 20

89
130 135

Pakistan: Age wise distribution of AIDS Cases
Age
00-04 05-09

Male
02 02
--

Female
03
--

Total
05 02
--

%
2.25 0.9
--

10-14
15-19 20-24 25-29

---

01 05 56

01 06 60

0.45 2.702 27.02

01 04

30-34
35-39 40-44 45-49

28
23 30 23

10
06
---

38
29 30 23

17.12
13.06 13.51 10.36

50-54
55-59 60+ Unknown

13
06
--

--

13
07
--

5.86
3.15
--

01
--

07

01

08

3.6

Pakistan: AIDS Cases by Mode of Transmission
Mode of Transmission

AIDS

Percentage

Heterosexual
Men having sex with Men Blood/Blood products

Injecting drug use Mother to child
Other known (specify)

141 13 16 02 07
---

63.51 5.86 7.21 0.90 3.15
---

Multiple

Unknown

Total

43 222

19.37 100%

Pakistan: Sex wise distribution of AIDS Cases
Sex
Male Female

AIDS
196 26

Percentage
88.3 11.7

Total

222

100%

Pakistan: Age wise distribution of HIV positive cases
Age < 04 05-14 15-19 HIV 24 07 13 Percentage 1.44 0.42 0.78

20-29 30-39 40-49 50> Unknown Total

359 504 294 43 420 1664

21.57 30.29 17.67 2.58 25.24 100%

Pakistan:Mode of Transmission of HIV Positive Cases
Mode of Transmission Heterosexual Men having sex with Men HIV 675 36 Percentage 40.56 2.16

Bisexual Blood/Blood products Injecting drug users Mother to Child Unknown Total

24 280 55 24 570 1664

1.44 16.83 3.31 1.44 34.25 100%

Pakistan: Sex wise distribution of HIV Positive cases
Sex
Male Female

HIV
1447 217

Percentage
87 13

Total

1664

100%



WHO/UNAIDS FORECAST MODEL ESTIMATES THE NUMBER TO BE APPROXIMATELY, 70,000 – 80,000

The HIV/AIDS situation in Sindh
   

Total Population: 40 million Total cases reported to date: 550 Asymptomatic HIV-positive: 455 Full-Blown AIDS (WHO criteria) 95 – Gender breakdown: 88.9% male 11.1% female

-Cases reported as of 31st March 2002

The HIV/AIDS situation in Sindh


Mode of transmission:
87% 2% 7% 4%

Heterosexual  Male-to-male sex  Infected blood & blood products  Maternal transmission


The HIV/AIDS situation in Sindh
Number of cases reported in 2000 36 Males 29 (80%) Females 07 (20%) Number of cases reported in 2001 37 Males 31 (84%) Females 06 (16%)





Results of HIV, Syphilis, Hepatitis C Seroprevalence surveys conducted in year 2001-2002
HIV
I/v Drug users 0% Female Sex Workers 0.28%

Syphilis
15% 21%

Hepatitis C Sample Size
85% 319 346

Hijras (Transsexual/ 0 Transvestites) Truckers 0
Prisoners 0.18%

31%
12% 11% 0.5%

-

414
300 535 2000

Antenatal Attendees 0

Risks and Trends
Younger Population: 63% of Pakistani Population is below 25 years.  Unsafe Sexual Practices  Low use of condoms and barrier methods  Low awareness regarding HIV transmission and low perception of risk


Risk and Trends
The prevalence of Hepatitis B and C in Pakistan is one of the highest in the region (Hepatitis C 2-6%) (Hepatitis B 4-10%) Among General Population  Unsafe Blood Transfusion Practices.  Source :

  

Commercial Family DonorVoluntary -

10-15% 80% 5-10%



Lack of Screening Both in Public and Private Sector

Risk and Trends
Unsafe Therapeutic Injection Practices  Irrational Use of Injections  Re-usage of Syringes  Recycling of Used Injection Equipment


National / Provincial Response Enhanced HIV/AIDS Control Program Support By World Bank


Multicultural approach involving Governmental agencies, NGOs, Private sector, Academic Institutions and Community Focusing on vulnerable sub-populations such as Female Sex Workers, Hijras, I/V Drug Users, Truckers, and Pakistanis working overseas (Gulf Countries)

National / Provincial Response
Continued……..


Delivery of comprehensive service package to vulnerable population including peer education programs, voluntary HIV counseling and testing and treatment of sexually transmitted infections. Behavior change community involving, print and electronic media Promotion of political commitment through advocacy.





References: our group’s papers on HIV/AIDS in Pakistan




 

Baqi S, Shah SA, Baig MA, Mujeeb SA, Memon A. Seroprevalence of HIV, HBV, and syphilis and associated risk behaviours in male transvestites (Hijras) in Karachi, Pakistan. Int J STD AIDS 1999 May;10(5):300-4. Ali S, Khanani R, Tarique W U, Shah S A. Understanding the HIV/AIDS context in Pakistan. Venereology1995; 8(3):160-3. Shah SA, Kristensen S, Khan O. HIV/AIDS in Pakistan. Tropical Doctor. 31(1): 59, Jan 2001 Khan OA, Hyder AA. Responses to an emerging threat: HIV/AIDS policy in Pakistan. Health Policy & Planning 2001; 16 (2): 214-8.


								
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