Brushing HIV/AIDS under the carpet

EVERY few years, HIV returns to the national conversation in Pakistan. There is outrage on television, emotional headlines, a few raids on clinics, promises of action and then silence. The cycle repeats itself so predictably that one almost wonders whether we are fighting the disease or simply performing concern for a few news cycles. For a long time, we convinced ourselves that Pakistan was following the so-called Asian epidemic model. The belief was comforting. HIV would remain confined to specific high risk populations and would not significantly enter the wider population. Unfortunately, reality has not cooperated with our theories. Cases are now emerging in different pockets of the country and among populations that were never expected to be at the center of the discussion. Larkana should have forced us to rethink everything. Then came Jalalpur Jattan, Sargodha, Dera Ghazi Khan, Taunsa, Turbat, Bannu and several other districts quietly reporting cases that rarely remain in the headlines for long. Each outbreak is treated like a separate incident. A few individuals are blamed, temporary outrage follows and then the country moves on as if the underlying conditions never existed in the first place. During my doctoral research on HIV in Pakistan, one uncomfortable conclusion became impossible to ignore. HIV in Pakistan is not simply a behavioral problem. It is a systems problem. The virus is spreading through the cracks of a fragile healthcare system that struggles to protect people from preventable harm. Unsafe injections, reused syringes, poor sterilization practices, unregulated blood transfusions, unsafe dental procedures and weak infection prevention measures continue to exist far more commonly than we would like to admit. We often speak about the healthcare system in Pakistan as if it is a single organized structure. It is not. It is a crowded marketplace of public hospitals, private clinics, informal practitioners, roadside injection providers, faith healers