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Epidemiology

LETTER

Sindh, Pakistan: home to South-Asia’s first HIV law Over the last few years, Pakistan has become one of Asia’s fastest growing hubs for HIV transmission,1 due to the increase in the number of injection drug users (IDUs).2 According to a UNAIDs report, one in five IDUs in Pakistan are HIV positive,1 and have spread the disease further to other populations, especially sex workers.2 The highest and fastest number of reported HIV cases in the country has been reported in the Sindh province. In mid 2012, 213 new HIV cases were reported in Sindh in just 3 months—a 20% increase cases compared to beginning of the year.3 To counter and control this escalating silent epidemic, Sindh became the first territory in South Asia to enact the HIV/AIDS control, treatment and protection law in September 2013.4 This positive approach by the current Sindh government aims to act as an example and motivate other countries in the region, such India and Sri Lanka, to pass such laws as well.5 This ‘first of its kind’ law provides equal opportunities and equal standing to HIV positive people in all forums, especially healthcare, employment, education, and housing.5 In a country where social taboo dominates the HIV culture, failure to provide basic rights or to discriminate against any HIV positive individuals is

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now a crime, with severe punishments for the accused. There are also penalties for HIV positive individuals and negligent healthcare facilities that promote the risk and spread of HIV transmission among the general population. However, the most important aspect of the law is the formation of the six member Sindh Aids Commission.5 Comprising complete non-governmental employees, the commission has the task of advising the Sindh government regularly on all matters pertaining to the prevention and control of HIV and support for HIV positive individuals in the province, as well as managing HIV related projects. This will help strengthen the governmental stance in the Sindh Aids Control Program that has been showing signs of failure in curbing the HIV epidemic. Raising awareness about HIV, maintaining a regular HIV screening for sexual assault cases, children and prisoners, and making it compulsory for individuals to undergo HIV screening tests before marriage, are some of the minor benefits that serve to reinforce the already established guidelines of the Sindh Aids Control Program. One added essential benefit is the non-disclosure agreement between health workers and HIV individuals under treatment. While these provisions enacted in the law are definitely a big breakthrough for a small territory, implementation will be a tough task. In a country where official figures are understated due to social taboo, the law will have to overcome many challenges before it can demonstrate positive results.

Instituting the healthcare setup alone will provide a major boost. If successful, the law will be a great role model for other developing countries and will surely help curb the HIV epidemic in Sindh. Haris Riaz,1 Talha Riaz,1 Abdul Nafey Kazi2 1

Department of Medicine, Civil Hospital Karachi, Karachi, Pakistan Dow Medical College, Karachi, Pakistan

2

Correspondence to Abdul Nafey Kazi, Dow Medical College, 109/2, Popular Avenue, Phase 6, D.H.A, Karachi 75600, Pakistan; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. To cite Riaz H, Riaz T, Kazi AN. Sex Transm Infect 2014;90:54. Received 15 October 2013 Accepted 20 October 2013 Published Online First 11 November 2013 Sex Transm Infect 2014;90:54. doi:10.1136/sextrans-2013-051406

REFERENCES 1

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HIVAIDS: Pakistan has one of Asia’s Highest HIV prevalence rates. http://tribune.com.pk/story/240379/ hivaids-pakistan-has-one-of-asias-highest-hivprevalence-rates/ (accessed at 10 Oct 2013). Reza T, Melesse DY, Shafer LA, et al. Patterns and trends in Pakistan’s heterogeneous HIV epidemic. Sex Transm Infect 2013;89(Suppl 2):ii4–i10. Sindh reports 213 HIV, 10 AIDS cases in Sindh over three months. http://beta.dawn.com/news/740771/ 213-hiv-10-aids-cases-in-sindh-over-three-months (accessed at 10 Oct 2013). Law to control HIV/AIDS passed. http://www. dailytimes.com.pk/default.asp?page=2013\09\21 \story_21-9-2013_pg12_1 (accessed at 10 Oct 2013). Ordinance to help curb HIVAIDS promulgated. http:// beta.dawn.com/news/1013158/ordinance-to-helpcurb-hivaids-promulgated (accessed at 10 Oct 2013).

Fan W, et al. Sex Transm Infect 2014;90:52–54. doi:10.1136/sextrans-2013-051180

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Sindh, Pakistan: home to South-Asia's first HIV law Haris Riaz, Talha Riaz and Abdul Nafey Kazi Sex Transm Infect 2014 90: 54 originally published online November 11, 2013

doi: 10.1136/sextrans-2013-051406 Updated information and services can be found at: http://sti.bmj.com/content/90/1/54

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