PESHAWAR: To reach the Family Health Care Centre in Peshawar for treatment of HIV/Aids, Kulsoom Bibi has to travel 250 kilometer from Kurram Agency.

“With my ill-health, it is difficult to cover long distances and travel in public transport from Parachinar to Peshawar for the treatment,” said Bibi, who belongs to the town of Parachinar in Kurram Agency, one of the seven districts of the Federally Administered Tribal Area (FATA).

According to the Khyber Pakhtunkhwa Aids Control Program, there is no healthcare facility in the any of the seven agencies of FATA to treat patients with HIV/Aids.

Bibi currently resides in a rented home with her five children. She lost her husband to HIV/Aids two years ago.

Patients from the region have to travel to cities of Peshawar and Kohat in Khyber Pakhtunkhwa to receive treatment at Hayatabad Medical Complex Peshawar and Kohat District Headquarter Hospital.

Statistics made available by the KP Aids Control Program show that 485 cases of HIV/Aids were reported in FATA up to November 2016. Of these, 33 cases were reported in Bajaur Agency, 87 from Khyber Agency, 98 from Kurram Agency, 218 cases from Bannu, 34 from Mohmand Agency, 28 from Orakzai Agency, 72 from South Waziristan and 133 from North Waziristan.

Khwendo Kor, an organisation working for women rights in Khyber Pakhtunkhwa and Federally Administered Tribal Area (FATA), said that 55 workers from FATA were deported from Gulf countries due to being diagnosed with HIV infection.

According to the research study HIV Epidemic in Pakistan, migrant workers are predominantly low skilled rural men that travel either abroad or within the country for work and remain away from their families for months. The study says most are unprepared for the HIV exposures in large urban centers where they find work.

“Nearly all registered patients in HIV clinics in Pakistan are those who repatriated after acquiring HIV during their work abroad, mostly from the Middle East,” says the study. “Mandatory HIV testing is conducted at recruitment and repeatedly to renew work permits in the Middle East. Those who acquire HIV are quickly identified and deported – often without being told the reason for the deportation. The quick testing and retesting means that most are diagnosed and deported while suffering from acute HIV infection, when they are healthy and most likely to transmit the infection to their spouses and or sex partners.”

The report says that upon return, many marry or continue living risky sexual behaviours and infect their spouses and or sex partners. With nearly 2 million migrant workers currently in the Middle East (Bureau of Emigration, Pakistan), says the report, the potential number of individuals at risk of contracting HIV is huge. However, no national mechanism exists to enumerate or locate HIV positive repatriated workers.

“Except those from the city of Karachi, most are rural residents from NWFP, FATA and southern Punjab. The infections they transmit will likely lead to truncated epidemics (an epidemic that will likely not propagate further since their partners have limited or no further partners), since these HIV-positive patients will be infecting their spouses and their limited number of extramarital partners,” says the report.

Just as in FATA, HIV/Aids patients from the Provincially Administered Tribal Area (PATA) also lack healthcare facilities.

Asif Ali, who is a manager at the Association for Community Development (ACD) that works on HIV/Aids in the PATA region, said data of migrant workers deported from Gulf countries collected in 2016 showed 34 HIV/Aids patients in Swat, 25 in Bajaur Agency, 18 in Buner, 17 in Malakand Agency, 54 cases in Lower Dir, 21 in Upper Dir, 6 in Shangla and 1 in Chitral.

The KP Health Minister Shahram Taraki told media in December 2016 that there were an estimated 97,400 cases of HIV/Aids in Pakistan. Of these, around 16,000 HIV patients were registered with the National Aids Control Programme – with 2,584 registered in Hayatabad Medical Complex Peshawar and Kohat District Hospital and 485 in the Federally Administrated Tribal Areas. Of these, 235 HIV/Aids patients were foreigners, mostly Afghan refugees.

“Like other Asian countries Pakistan is also HIV epidemic, characterized by different risk factors,” says the report A Situational Analysis of HIV and AIDS in Pakistan. “Formerly Pakistan was considered to be a low prevalence country, but now it is in the group of “Countries in Transition” with a concentrated epidemic among high risk groups, where the AIDS problem is increasing since five years. The number of infected persons might be running in millions if proper screening is carried out,” the report indicated.

The report also pointed out behaviors conducive to the spread of HIV infection to young people. These are: curiosity about sex and drugs, negative peer pressure, and economic frustration in Pakistan. The report identified other factors, i.e., “Widespread poverty, significant power imbalances in men and women, labor migration, lack of any system to check the HIV positive reported persons, indiscriminate transfusion of unscreened blood, rising number of drug addicts and low condom use rates, are the serious risk factors that put the country in danger of facing a rapid spread of HIV/AIDS.”

Dr. Jawad Habib, Director Health FATA, told Truth Tracker that the authorities had proposed to UNICEF to help establish healthcare centers in the tribal areas for HIV/AIDS patients.

Habib pointed out several challenges for establishing HIV/AIDS centres in FATA. “We have not been successful in establishing the centers so far. The social taboos and cultural barriers are keeping us from taking up the issue. Sometimes HIV patients face problems from their own people and localities,” he maintained.

Bibi and other HIV/AIDS patients from FATA getting treated at Peshawar and Kohat may have to travel long distances to get treatment, said Habib, but that way they are not exposed to their communities back home.”

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