Underreporting is rife due to the stigma attached to the virus, denial, inadequate surveillance and voluntary testing, as well as a lack of knowledge among the population, practitioners and policy-makers.

Studies among Pakistani truck drivers have found that one in three has never heard of condoms and 19 out of 20 who bought sex from women did not use condoms

“Pakistan’s HIV infection rate is comparable to South Africa fifteen years ago. Now is the time to deny the virus a firm foothold,” said World Vision Country Director, Sigurd Hanson.

According to the World Bank, heterosexual transmission accounts for about 63% of reported cases, exposure to infected blood or blood products for about 7%, male to male sex for about 5%, mother to child transmission for about 3% and injecting drug use for about 1%. The remaining 21% is unknown.

To date, the majority of infected cases are among males, with a female ratio of seven to one, a ratio that is expected in the early stages of an HIV epidemic.

Until very recently the majority of HIV infections and AIDS cases reported in Pakistan were among migrant Pakistani workers who had been deported from the Gulf States. However an HIV outbreak amongst Injecting Drug Users (IDUs) recently reported in a small town in Pakistan’s southern Sindh province has demonstrated the country’s vulnerability and need to act upon warnings of HIV/AIDS experts.

Studies among Pakistani truck drivers have found that one in three has never heard of condoms and 19 out of 20 who bought sex from women did not use condoms, according to UNAIDS. Behavioural and mapping studies in three large cities found a Commercial Sex Worker population of 100,000 with limited understanding of safe sexual practices. Furthermore, sex workers often lack the power to negotiate safe sex or seek treatment for Sexually Transmitted Infections.

Another serious contributor to increasing HIV infections is unsafe medical injection practices. Studies indicate that 94% of injections are administered with used injection equipment and the use of unsterilised needles in medical facilities is also widespread.

“Pakistan has a fleeting window of opportunity to pre-empt serious outbreaks by promoting prevention among high-risk groups including sex workers, injecting drug users, men who have sex with men, truck drivers and street children. At the same time we must also focus on the needs of young people and give them information about how to protect themselves,” said Hanson.

Another serious contributor to increasing HIV infections is unsafe medical injection practices.

Women and children are particularly vulnerable because of low literacy rates and their limited mobility that restricts access to information and preventive services. Large numbers of runaway children are forced into the sex trade to survive.

Country Director, Sigurd Hanson is in dialogue with the Coordinator for UNAIDS in Pakistan, who is urging World Vision and its partners to join other agencies who are addressing the HIV/AIDS problem in Pakistan and work together to implement a vigorous prevention programme, with a special focus on the North West Frontier and Punjab provinces.

Initially, the primary need is to build capacity on federal, provincial and local government levels, as well as among humanitarian organisations to implement a country-wide programme that addresses gender inequality, poor education and social disintegration that is both the cause and effect of dire poverty.

World Vision Pakistan is exploring ways to cooperate with local and international partners, including UNICEF and UNESCO and is seeking expressions of interest to fund a long-term comprehensive programme. World Vision believes that Pakistan can follow in the footsteps of other Asian countries such as Cambodia, where large-scale prevention progammes addressing the sexual transmission of HIV have seen significant reductions in high-risk behaviour and declining levels of new HIV and other sexually transmitted infections.