Behaviour
LETTER
The need for adolescent interventions in Pakistan for HIV/AIDS Pakistan has a population of 190 million and is the sixth most populous country in the world. It has a relatively low prevalence of HIV/AIDS, with estimates suggesting that up to 160 000 people are living with the condition.1 The National AIDS Control Programme (NACP) in collaboration with UNAIDS operates throughout the country in an effort to control the spread of HIV/AIDS. Pakistan is regarded as being at high risk for concentrated, widespread epidemics. Most cases of HIV are related to injecting drug use and sex work. However, increasing poverty coupled with easy access to injectable drugs is raising fears that HIV will spread to the adolescent population, noted to be a high risk group in Pakistan. However, even in this uncertain situation, there are no interventions in place to help prevent HIV/AIDS in adolescents. As sex education is not part of the school curriculum, even the 35% of those who do attend secondary school are misinformed about HIV/AIDS. Research studies have reported there is very little
138
knowledge of, and nonchalant attitudes towards, HIV/AIDS among school and university students. Across several studies, 23% of students had not heard of HIV/ AIDS, 56% incorrectly believed that mosquitoes could transmit HIV, and some respondents considered HIV/AIDS a disease of non-Muslims.2 As sexual health is a sensitive issue, it is rarely discussed and access to information is limited, creating a serious knowledge gap in developing teenagers. This lack of knowledge is thus likely to lead to careless decision making around risky sexual and non-sexual behaviours. Researchers who studied knowledge of and attitudes towards HIV/AIDS among adolescents in Pakistan have called for public health intervention programmes aimed at this subset of the population to augment existing preventative HIV/AIDS efforts. Worldwide, prevention programmes using the internet and text messaging to increase awareness among teenagers have reported positive results. In addition, peer-led interventions have also seen promising outcomes among youth in developing countries such as Uganda, China and India. NACP, UNAIDS and other organisations should shift their focus from the infective to the pre-infective population. Researchers must also design and implement interventions for adolescents if they
are to contain the spread of HIV/AIDS in the future. However, the most important task is to address the cultural and social norms of a patriarchal society where it is not acceptable to discuss HIV/AIDS. Hamza Nasir Dow University of Health Sciences, Karachi, Pakistan Correspondence to Hamza Nasir, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi 75500, Pakistan; [email protected] Correction notice This article has been corrected since it was published Online First. The abbreviation NARC was amended to NACP. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. To cite Nasir H. Sex Transm Infect 2014;90:138. Received 16 December 2013 Accepted 23 December 2013 Published Online First 15 January 2014 Sex Transm Infect 2014;90:138. doi:10.1136/sextrans-2013-051486
REFERENCES 1
2
UNAIDS Country Progress Report 2012: Pakistan (Global AIDS response). http://www.unaids.org/en/ dataanalysis/knowyourresponse/countryprogressreports/ 2012countries/ce_PK_Narrative_Report[1].pdf (accessed 12 Dec 2013). Raheel H, White F, Kadir MM, et al. Knowledge and beliefs of adolescents regarding sexually transmitted infections and HIV/AIDS in a rural district in Pakistan. J Pak Med Assoc 2007;57:8–11.
Saxton PJW, et al. Sex Transm Infect 2014;90:133–138. doi:10.1136/sextrans-2013-051160
LETTER
The need for adolescent interventions in Pakistan for HIV/AIDS Pakistan has a population of 190 million and is the sixth most populous country in the world. It has a relatively low prevalence of HIV/AIDS, with estimates suggesting that up to 160 000 people are living with the condition.1 The National AIDS Control Programme (NACP) in collaboration with UNAIDS operates throughout the country in an effort to control the spread of HIV/AIDS. Pakistan is regarded as being at high risk for concentrated, widespread epidemics. Most cases of HIV are related to injecting drug use and sex work. However, increasing poverty coupled with easy access to injectable drugs is raising fears that HIV will spread to the adolescent population, noted to be a high risk group in Pakistan. However, even in this uncertain situation, there are no interventions in place to help prevent HIV/AIDS in adolescents. As sex education is not part of the school curriculum, even the 35% of those who do attend secondary school are misinformed about HIV/AIDS. Research studies have reported there is very little
138
knowledge of, and nonchalant attitudes towards, HIV/AIDS among school and university students. Across several studies, 23% of students had not heard of HIV/ AIDS, 56% incorrectly believed that mosquitoes could transmit HIV, and some respondents considered HIV/AIDS a disease of non-Muslims.2 As sexual health is a sensitive issue, it is rarely discussed and access to information is limited, creating a serious knowledge gap in developing teenagers. This lack of knowledge is thus likely to lead to careless decision making around risky sexual and non-sexual behaviours. Researchers who studied knowledge of and attitudes towards HIV/AIDS among adolescents in Pakistan have called for public health intervention programmes aimed at this subset of the population to augment existing preventative HIV/AIDS efforts. Worldwide, prevention programmes using the internet and text messaging to increase awareness among teenagers have reported positive results. In addition, peer-led interventions have also seen promising outcomes among youth in developing countries such as Uganda, China and India. NACP, UNAIDS and other organisations should shift their focus from the infective to the pre-infective population. Researchers must also design and implement interventions for adolescents if they
are to contain the spread of HIV/AIDS in the future. However, the most important task is to address the cultural and social norms of a patriarchal society where it is not acceptable to discuss HIV/AIDS. Hamza Nasir Dow University of Health Sciences, Karachi, Pakistan Correspondence to Hamza Nasir, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi 75500, Pakistan; [email protected] Correction notice This article has been corrected since it was published Online First. The abbreviation NARC was amended to NACP. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. To cite Nasir H. Sex Transm Infect 2014;90:138. Received 16 December 2013 Accepted 23 December 2013 Published Online First 15 January 2014 Sex Transm Infect 2014;90:138. doi:10.1136/sextrans-2013-051486
REFERENCES 1
2
UNAIDS Country Progress Report 2012: Pakistan (Global AIDS response). http://www.unaids.org/en/ dataanalysis/knowyourresponse/countryprogressreports/ 2012countries/ce_PK_Narrative_Report[1].pdf (accessed 12 Dec 2013). Raheel H, White F, Kadir MM, et al. Knowledge and beliefs of adolescents regarding sexually transmitted infections and HIV/AIDS in a rural district in Pakistan. J Pak Med Assoc 2007;57:8–11.
Saxton PJW, et al. Sex Transm Infect 2014;90:133–138. doi:10.1136/sextrans-2013-051160
