Pakistan’s shunned HIV victims fight pariah status

by Hasan Mansoor
KARACHI, Dec 1, 2011 (AFP) – Shunned by their families and society, Rubina and Iqbal are a Pakistani couple who have struggled for years to win their lives back and spread a message of respect for fellow victims of HIV/AIDS.
Rubina Naz, 33, one of 12 children born to a labourer, was diagnosed with HIV four years ago, a year after her drug-addicted husband passed away.
“I didn’t know what it was until I was tested positive. I was afflicted with this horrible disease by my first husband, who was an AIDS victim,” said Rubina.
They married when she was 16 years old and had two daughters and two sons together, but Rubina was unaware of her husband’s illness until she read his medical tests after his death and friends advised her to take her own.
Finding out she was HIV positive ruined her life.
“My in-laws threw me out and took my kids. Even most of my own family treated me like a sinner and stayed away when I was desperate to be helped. Those days were horrible,” she said.
Pakistan, the second-largest country in South Asia, stands a few steps behind India and Nepal in terms of the extent of the HIV epidemic.
The National AIDS Control Programme says Pakistan is a “low prevalence, high risk” country, with low rates of the virus across the general population but a high concentration among risk groups such as injecting drug users.
UN figures from 2009 show that there are an estimated 97,400 cases of HIV/AIDS in Pakistan.
Rubina’s meals were always served separately to the rest of her family, who were fearful of contracting the disease, but with her mother’s support she says she has overcome prejudice.
She now works as a kitchen assistant at charity Pakistan Society, dedicated to helping HIV positive people, which is where she met her new husband Mohammad Iqbal, 35, who is HIV positive and recovering from drug addiction.
Iqbal was a tailor in his teens when he was introduced to heroin by friends. He contracted the virus 10 years ago by sharing needles to inject the drug.
“My addiction shocked my parents, who both died early, then my brothers threw me out of home and I was forced to live on the streets,” he said.
A charity gave him the tests that led to his diagnosis. But it was another three years before he decided to get well.
“Continuous hatred towards me wore me out. I decided to live a meaningful life or end it. I opted to live and agreed to get rehabilitated,” he said.
Rubina and Iqbal found each other in the kitchen, which serves food to patients and visitors at the charity’s medical centre.
The charity also goes into communities to help drug addicts across the southern city of Karachi and the wider Sindh province, where it spreads the message that HIV victims can live a normal life and should not be cast out.
“Now I don’t hesitate to see myself in the mirror. I am regaining my lost respect in the world,” Iqbal said.
Rubina’s in-laws have agreed to allow her children to see her regularly and Iqbal’s brothers have permitted him to rejoin the family.
Anti-retroviral drugs that treat the illness are provided free of charge at state-run hospitals, clinics and health centres across Pakistan, meaning that those diagnosed have the chance of a relatively normal life.
So long as Rubina and Iqbal continue to take their daily medication and maintain a healthy lifestyle, Pakistan Society head Saleem Azam said their prognosis is good and their life expectancy should not be affected.
Azam said that women are the least documented victims.
The 2009 survey revealed that 15 percent of wives of injecting drug users in just one district, Larkana, where Pakistan’s political dynasty the Bhuttos have their ancestral seat, are HIV sufferers.
But Azam said the actual incidence may be much higher as many cases go undetected and there could be many women “who die of the disease without even knowing what happened to them.”
“In our male dominant society women have fewer choices to save themselves from their HIV positive husbands. The majority have not heard of the disease and if they do they cannot stop their husbands from afflicting them.”
Rubina and Iqbal have taught their families to respect HIV-positive people but say they will continue their quest to educate the rest.
“It is not over yet as the rest of society is still there to be educated,” said Rubina.

Ends

Pakistan sex workers on AIDS frontline

by Hasan Mansoor
A prostitute born and brought up in Karachi's Napier Road red-light district, Shumaila never heard about HIV and AIDS until recently. Today, she carries condoms but clients refuse to wear them.

"None of us were aware about the danger of AIDS looming over us for years but now we all know and can avoid it," said the tall 29-year-old who lives in a Victorian-style building in the heart of the neighbourhood.

Shumaila's awareness -- rare among Pakistan sex workers -- is thanks to the Gender and Reproductive Health Forum, a local charity that runs a UN-funded programme in Napier Road teaching prostitutes about the perils of HIV/AIDS.
"So far we have provided hundreds of thousands of condoms to sex workers in the last two years, which have saved them from being infected with the lethal virus," said Mirza Aleem Baig, who runs the forum.

Karachi, Pakistan's largest metropolis and one of the biggest Muslim cities in the world, has up to 100,000 female sex workers, according to data gathered by Pakistan Society, a local welfare organisation.

"This is 20 percent of their overall population in Pakistan. Lahore comes next with 75,000 sex workers," Saleem Azam, head of the charity, told AFP.

Prostitution may be illegal but it has prospered in an increasingly Islamised Pakistan, where an economic downturn and widening poverty have forced women and men onto the streets to meet the rising cost of living.

Shaheena, 38, is a home-based sex worker. She is a skilled paramedic but seldom finds a permanent job.

"So I opted to enter this business on the side," she told AFP, veiling her face to hide her identity.

"I have sibblings, cousins, nephews and nieces who don't know about my second profession. So I don't want to identify myself to embarass them.

"But it's a question of survival as none of my relatives support me with money. They are all too stretched themselves," she said.

Azam says more than 60 percent of Pakistan's prostitutes work from homes or ply the streets, while the elite serve wealthy clients from kothikhanas (houses or rooms) in plush neighbourhoods.

This year's annual UN report on AIDS said while the epidemic in Asia appears to be stable overall, HIV prevalence is increasing in some parts of the region, such as Bangladesh and Pakistan.

A survey published in the report said 60 percent of female sex workers and 45 percent of their male clients in Karachi and Lahore do not know that condoms can prevent transmission of HIV. [youtube=http://www.youtube.com/watch?v=Afp9PQNMM00]
Of those that do, few protect themselves. "The number of our clients who agree to wear a condom is very small. Female condoms are not available, which can save us more effectively," said Nasreen, another prostitute in Napier Road.

"I can't carry condoms in my purse on the street as we're vulnerable to the police and could be arrested if they find them," said Afshan, 29, who walks the city's busy streets looking for clients.

The most recent survey conducted by Pakistan's state-run National AIDS Control Programme (NACP) in 2006 said only 18 percent of sex workers reported always using condoms.

The UN report estimates that around 97,000 people, or 0.1 percent of the population, live with HIV in Pakistan. The government says only 5,000 people are infected.

NACP says the disease is spreading among high-risk groups, especially drug users, who mostly inject and use dirty needles, raising fears the virus could spread quickly from addicts to prostitutes.

In 2006, Pakistan said HIV/AIDS prevalence among female sex workers was around 0.02 percent, but independent bodies put it much higher.

"It is at least 15 percent," said Azam. "They are totally at the mercy of their clients. Most of their clients refuse to wear condoms," he said.

"In Pakistan, this business is illegal, thus there is no law to seriously tackle the issue and save precious lives. Yet a way-out is desperately needed on humanitarian grounds."

Baig said he had identified an HIV-positive sex worker a few months ago and tried to help her with treatment and a new job but she left because her colleagues considered her a blot on their business.

"Now, no one knows where she is and what she is doing," he said.