Frequency of risk factors for transmission of HIV/AIDS.
Background: Pakistan is considered a low prevalence but future high risk country for human immunodefi- ciency virus infection. The objective of this study was to find out the risk factors for transmission of HIV infection.
Material and Methods: This descriptive study was carried out from February 2008 to July 2011 at Anti Retroviral Centre, Kohat. All 65 HIV positive patients were interviewed after informed consent.
Results: A total of 65 patients suffering from HIV/AIDS were interviewed; 47(72%) males and 18(28%) fe- males. The mean age was 41 years. Five males and 3 females were unmarried; the rest 57 were married. Regarding education, 2 patients were having primary and one middle level education, the rest were unedu- cated. Regarding transmission, 40(61.54% had heterosexual transmission, 4(6.20%) were of mother to child transmission, one had history of dental procedure before contracting infection while 4 had a previous history of blood transfusion. No homosexual or transgender transmission was reported. Out of 40 heterosexual transmissions; 24 were from sex workers, 15 from husband to wife and one from wife to husband. Regarding addiction, 21(32.3%) using oral snuff addiction, 2(3.1%) hashish, 2(3.1%) smokers, 2(3.1%) were injection drug users and the rest had no addiction. Out of 65 cases, 57(87.7%) did not have history of sexually transmitted infections, whereas 8(12.3%) had no such history.
Conclusion: Heterosexuality is the most common mode of transmission and sex with a sex worker is the most common risk factor for HIV/AIDS transmission in our set-up, while mother to child and injectable drug abuse are the next common risk factor.
KEY WORDS: HIV, AIDS, Risk factors.
The first case of Acquired Immunodeficiency Syndrome (AIDS) in Pakistan was reported in 1987.1 Pakistan is considered a low prevalence but high risk country for Human Immunodeficiency Virus (HIV) infection.2 The epidemic stage can rapidly change, as has happened in other countries in the region, based on a number of vulnerabilities that also exist in Pakistan.
These include increasing levels of poverty combined with low levels of lit- eracy, especially in women, low levels of condom use for disease prevention, low levels of aware- ness among external migrants, and long-distance truck drivers known to engage in sexual practices that put them at risk of contracting HIV and sexu- ally transmitted infections (STIs); widespread in- dulgence in commercial sex with low levels of con- dom use, limited safety of blood transfusion, high prevalence of STIs with limited access to good- quality STI care, extensive use and reuse of sy- ringes without sterilization, including an increas- ing rate of needle-sharing among injecting drug users, and a large proportion of young people with low levels of knowledge about HIV transmis- Most HIV infections identified by AIDS Con- trol Program Pakistan are found among Pakistani workers deported from Gulf States and among for- eigners.4
The majority of people with HIV/AIDS appear to come from low income groups and un- aware about the disease. They may have acquired HIV as a result of lack of knowledge of the virus or safe sex.1 UNAIDS latest figures estimate the num- ber of cases bordering ninety six thousands.5
The objective of this study was to find out the risk factors for transmission of HIV infection in our set-up.
MATERIAL AND METHODS
This descriptive study carried out from Feb- ruary 2008 to July 2011 at Anti Retro Viral centre Kohat. The data was collected through a ques- tionnaire at Voluntary Counseling and Testing (VCT) room from referred patients. The source of deter- mination of transmission of disease was question- naire based. Patients were interviewed by the authors and an HIV counselor in the presence of an HIV nurse.
Rapid test using Immunochromatographic techniques (ICT) for HIV was done from two differ- ent sources and positive patients were referred for ELISA. Follow-up services were provided by the center. The approval was granted by Institutional Review Board for Bioethics (IRBB) of KUST insti- tute of medical sciences.
A total of 65 patients suffering from HIV/AIDS were interviewed; 47 (72%) were males and 18 (28%) females. The mean age was 41 years. Five males and 3 females were unmarried; the rest 57 patients were married. Regarding education, 2 patients were having primary education and one middle level education, the rest of the cases were uneducated.
Regarding transmission, 40 (61.54%) had het- erosexual transmission, 4 (6.20%) were of mother to child transmission (MTCT), one case had his- tory of dental procedure before contracting the infection while 4 cases had a previous history of blood transfusion. No homosexual or transgender transmission was reported.
Out of 40 heterosexual transmissions; 24 were from sex workers, 15 from husband to wife and one from wife to husband.
Regarding addiction, 21 (32.3%) gave his- tory of oral snuff addiction, 2 (3.1%) history of hashish, 2 (3.1%) smokers, 2 (3.1%) were injec- tion drug users (IDU) and the rest had no addic- tion.
Out of 65 cases, 57 (87.7%) did not have history of STIs, whereas 8 (12.3%) had history of STI. (Figure 1)
The patterns of HIV transmission in Pakistan are similar in many ways to other parts of Asia. The virus traverses the barrier from high-risk com- munities to the mainstream population. Once this transmission jump has occurred, the increase in HIV incidence is swift and uncontrollable. Along a similar pattern, India experienced an explosive spread of HIV/AIDS in the early 90s.6
An important factor that has emerged in the HIV epidemic in Pakistan relates to migrants work- ing abroad who become infected either through sex or blood transfusion and are consequently re- patriated due to their HIV status.7 More than two million Pakistani workers work in oil rich Arab countries and the majority cannot migrate with their families due to limited income or prohibitive im- migration policies of the host country. Pakistani nationals working abroad in the oil-rich Gulf States are usually of low socioeconomic status and sexu- ally active young men aged 20-40 years.8,9 While abroad, these men are likely to have unprotected sex with multiple partners, usually sex-workers, and sometimes with other men. Commercial sex work- ers in the Gulf States are typically short-term resi- dents with a temporary tourist visa. No HIV testing is conducted on short-term visitors to the Gulf States who do not require a work permit.8,10
Con- dom use or other barrier methods are rarely used by Pakistani nationals thereby increasing their chances for infection.11 Having no knowledge of the disease, these poor fellows get infected and are deported without providing safety measures for prevention of infection transmission. Their wives acquire infection through them.4
Mujeeb and Hashmi12 reported that during 1986-87, 1363 subjects were screened for HIV infection in Karachi, 2 were confirmed positive by Western Blot. These two were married females who had received multiple transfusions and denied other risk factors.
Khanani et al13 reported another 3 confirmed cases of HIV infection in a group of 413 screened individuals from Karachi in 1990. Two were foreign nationals of Tanzania and Uganda and the third was a Pakistani national residing in Saudi Arabia who had received multiple transfusions following a car accident in 1981.
In 1992 Kayani et al14 screened 47,766 serum samples. The noteworthy point in their study was none of the confirmed HIV positive patients represented indigenous case of AIDS in Pakistan. The largest group of positive patients was repre- sented by foreigners /expatriates, individuals with frequent travel history and recipients of multiple transfusions.
The presence of a pre-existing STIs increases the risk of HIV transmission by sexual intercourse. The most common means of HIV transmission now, is heterosexual contact and if left unchecked will continue to be the main means of spread in Asia. Low prevalence of STIs in our study group may be due to the fact that our people do not notify STIs because of social constraints.
The other important mode of transmission is blood transfusion. The requirements for a safe transfusion include organized infrastructure, a con- tinuous supply of electricity, well-educated pro- fessionals and readily available supplies of expen- sive equipment and reagents, resources that are all typically in short supply in developing coun- tries.15 In United States where every blood unit is screened, the statistical incidence of transfusion associated AIDS is estimated to be 1 in 1,25000 blood donations16 Blood transfusion without proper screening is a common practice in Paki- stan. 15 Blood donations by HIV seropositive donors is also a problem because of illegal professional blood system which exists and most of the professional blood donors are drug abusers.17
Mother to child transmission is statistically important in our results. Majority of the deliveries in rural areas are carried out by nurses and Lady Health Visitors who do not have the knowledge of the disease. In addition to being ignorant of modes of transmission of HIV, they also have lack of ac- cess to proper medical services. This results in reuse of contaminated syringes and instruments thereby increasing the spread of blood borne in- fections in the community.
One interesting case, among the group of unknown causes of HIV transmission, was a Shia Muslim with cut marks on his back. During Moharam, they share chains having small blades for mourning, and acquire the infection without having knowledge of it. One case reported razor sharing with roommates during his stay at Saudi Arabia for job. One patient reported having dental procedure in the past.
Steps taken right now will go a long way in battling HIV/AIDS. But in order to bring and sus- tain change on the ground, the government needs to extend its full support and participation.
Heterosexuality is the most common mode of transmission and sex with a sex worker is the most common risk factor for HIV/AIDS transmis- sion in our set-up, while mother to child and in- jectable drug abuse are the next common risk fac- tor.
Acknowledgements: We are thankful to HIV nurse Shehla Gul, counselor Shaheen Kauser and Waqat Shah who helped us in conducting the interviews in a congenial atmosphere.
1. 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.
2. Ali S, Khanani R, Tariq W, Shah SA. Understand- ing the HIV/AIDS Context in Pakistan. Venereol- ogy 1995; 8:160-3.
3. Prepared for USAID by TvT Global Health and Development Strategies/Social and Scientific Sys- tems, Inc., under The Synergy Project. For more information, see http://www.usaid.gov/ our_work/global_health/aids or http:// www.synergyaids.com
4. Shah SA, Khan OA, Kristensen S, Vermund SH. HIV-infected workers deported from the Gulf States: impact on Southern Pakistan. Interna- tional Journal of STD and AIDS 1999;10:812-4.
5. Zuberi SJ. An overview of HBV/HCV in Paki- stan. J Med Res 1998;37:I2.
6. Rai MA, Rajabali A, Khan MN, Khan MA, Ali SH. Educating the power: HIV/AIDS and parliamen- tarians of Pakistan. Published online: 16 Sep- tember 2009. Health Research Policy and Systems 2009, 7:20 doi:10.1186/1478-4505-7-20.
7. Mujeeb SA, Kayani N, Khursheed M. HIV/AIDS in Pakistan care caring.1999; 7:31.
8. Kandela P. Gulf States test foreigners for AIDS. BMJ 1994;308:617.
9. Ali S, Bukhari HA. Development of appropriate interventions to check the spread of HIV/AIDS among frequent travelers (abstract no. Pub.D.1439). Int Conf AIDS 1996;11:506.
10. Kandela P. Arab Nations: attitudes to AIDS. Lan- cet 1993;341:884-5.
11. Hyder AA. Khan OA, Shah SA, Memon MA, Khanani MR, Ali S. Subnational response in HIV/ AIDS: a case study in AIDS prevention and con- trol from Sindh province, Pakistan. Public Health 1999; 113:39-43.
12. Mujeeb SA and Hashmi MRA. A study of HIV antibody in sera of blood donors and people at risk. J Pak Med Assoc 1988;38-221-2.
13. Khanani RM, Hafeez A, Rab SM, Rasheed S. AIDS and HIV associated disorders in Karachi. J Pak Med Assoc 1990;40:82-5.
14. Kayani N, Sheikh A, Khan A, Mithani C, Khurshid M. A View of HIV - Infection in Karachi. Journal of the Pakistan Medical Association 1994;44:8.
15. Luby S, Khanani R, Zia M, Vellani Z, Ali A, Qureshi AH, et al. Evaluation of blood bank prac- tices in Karachi, Pakistan, and the government's response. Vol. 56, No. 1 (Suppl. 1), January 2006.
16. Bove JR. Transfusion associated hepatitis and AIDS. What is the risk? N Eng J Med 1987; 317:242-5.
17. Mujeeb SA Khanani RM, Khursheed T, et, al. Prevalence of HIV infection among blood do- nors. J Pak Med Assoc 1991:41:253-4.
KUST Institute of Medical Sciences, Kohat University of Science and Technology Kohat, Pakistan, Corresponding Author: Nafisa Batool Tahir Assistant Professor Medicine KUST Institute of Medical Sciences, Kohat University of Science and Technology Kohat, Pakistan, E-mail: firstname.lastname@example.org
|Printer friendly Cite/link Email Feedback|
|Author:||Tahir, Nafisa Batool; Tahir ud Din, Qazi; Noor, Irshad|
|Publication:||Gomal Journal of Medical Sciences|
|Article Type:||Clinical report|
|Date:||Dec 31, 2011|
|Previous Article:||Architectural changes of liver in response to alcohol.|
|Next Article:||Assessment of children with rickets at Saidu Teaching Hospital Swat.|