HIV in injecting drug users of Quetta, Pakistan: Reporting another outbreak
Masoom Kassi, Bolan Medical College
11 March 2007
Dear Editor,
The city of Quetta, lying adjacent to the Afghanistan border, is amongst many cities of Pakistan plagued by injecting drug use, and the incidence is rising.(1) Its neighboring Baluchistan area of Iran, along with the where the northern areas of the country meet Afghanistan, have been described as the “Golden Crescent”, one of two major opium-producing areas.(2)
The presence of high-risk behaviors and little or no knowledge regarding HIV/AIDS in drug users of Quetta was previously identified by Zafar et al and now by Irene and Colleagues in this article.(3,4)We also studied the prevalence of HIV and other infections specifically in ‘street’ injecting drug users (IDUs) of the city.(5)
We were able to recruit 65 drug addicts, who were currently injecting drugs. The purpose of the study was explained and both verbal and written informed consent was obtained. 50 consented for serological testing. The sample represents a community of IDUs, most of who live and inject, near one of the major bridges of the city.
Testing by enzyme linked immunosorbant assay (ELISA) revealed 12 as positive for HIV. A Western Blot then subsequently confirmed these results, translating to a prevalence of 24% in the people screened.
This is alarming, a brewing epidemic. Similar outbreaks of HIV in drug users have been reported elsewhere in the country as well.(6) Quetta now represents another emerging pocket.
The situation is even graver because of prevalent high-risk behaviors, providing a fertile soil for the spread of the infection.
Much can be said on what needs to be done. But it’s about time that countries like Pakistan, where the prevalence is still lower than other countries, need to realize and effectively utilize this ‘window of opportunity’ when the infection is still limited to high-risk groups. Groups, like IDUs and sex workers, are the initial source of HIV infections, and targeted interventions can prevent epidemics from happening. Further neglect into the issue would allow the disease to establish its foothold in the country, with greater economic and social consequences in the future.(7)
We agree with Irene and Colleagues about interventions to target “site-specific populations” and would like to reaffirm that “programs to increase needle exchange, drug treatment and HIV and HCV awareness should be implemented immediately.”
Co-Authors: Pashtoon Murtaza Kasi, Abdul Malik Achakzai.
References:
(1) Baqi S, Kayani N, Khan JA. Epidemiology and clinical profile of HIV/AIDS in Pakistan. Trop Doct. 1999; 29(3): 144-8.
(2) Ghys PD, Bazant W, Monteiro MG et al. The epidemics of injecting drug use and HIV in Asia. AIDS. 2001; 15(Suppl 5): 91-9.
(3) Zafar T, Brahmbhatt H, Imam Get al. HIV knowledge and risk behaviors among Pakistani and Afghani drug users in Quetta, Pakistan. J Acquir Immune Defic Syndr. 2003; 32(4): 394-8.
(4) Kuo I, Ul-Hasan S, Galai N, Thomas DL, Zafar T, Ahmed MA, Strathdee SA. High HCV seroprevalence and HIV drug use risk behaviors among injection drug users in Pakistan. Harm Reduct J. 2006 Aug 16;3:26.
(5)Achakzai AM, Kassi M, Kasi PM. Seroprevalence of Hepatitis B, Hepatitis C and HIV viruses in injecting drug users of Quetta, Pakistan. Tropical Doctor 2007; 37:43-45.
(6)Shah SA, Altaf A, Mujeeb SA et al. An outbreak of HIV infection among injection drug users in a small town in Pakistan: potential for national implications [Letter]. Int J STD AIDS. 2004; 15(3):209.
(7)Ruxrungtham K, Brown T, Phanuphak P. HIV/AIDS in Asia. Lancet 2004; 364(9428): 69-82.
Competing interests
The authors declare that they have no competing interests.
High HCV seroprevalence of HCV infection in injecting drug users in Pakistan
Syed Abdul Mujeeb, AIDS Surveillance Center, Jinnah Postgraduate Medical Center, Karachi
22 January 2008
The authors rightly claim that this study provides a useful risk
profile of injecting drug users in Pakistan and it can be used to
develop tailored prevention programs for this high risk
populations. However, this study can be made more useful for
prevention program and similar future studies, if authors can
provide following information as well.
How duration of stay at drop in centre correlated with the seroprositivity
of HCV infection and how these results can be interpreted to make
more evidence based recommendations for drop in centre.
How this study made ethically more beneficial for study
participants who turn out hepatitis C positive and did not have
mean to get any treatment.
How awareness of hepatitis C infection was assessed in the study
population. The term hepatitis C infection is not commonly
understood and have a poor sensitivity and other local term that
can be used for hepatitis C infection have poor specificity.
Harm Reduction Journal
HIV in injecting drug users of Quetta, Pakistan: Reporting another outbreak
11 March 2007
Dear Editor,
The city of Quetta, lying adjacent to the Afghanistan border, is amongst many cities of Pakistan plagued by injecting drug use, and the incidence is rising.(1) Its neighboring Baluchistan area of Iran, along with the where the northern areas of the country meet Afghanistan, have been described as the “Golden Crescent”, one of two major opium-producing areas.(2)
The presence of high-risk behaviors and little or no knowledge regarding HIV/AIDS in drug users of Quetta was previously identified by Zafar et al and now by Irene and Colleagues in this article.(3,4)We also studied the prevalence of HIV and other infections specifically in ‘street’ injecting drug users (IDUs) of the city.(5)
We were able to recruit 65 drug addicts, who were currently injecting drugs. The purpose of the study was explained and both verbal and written informed consent was obtained. 50 consented for serological testing. The sample represents a community of IDUs, most of who live and inject, near one of the major bridges of the city.
Testing by enzyme linked immunosorbant assay (ELISA) revealed 12 as positive for HIV. A Western Blot then subsequently confirmed these results, translating to a prevalence of 24% in the people screened.
This is alarming, a brewing epidemic. Similar outbreaks of HIV in drug users have been reported elsewhere in the country as well.(6) Quetta now represents another emerging pocket.
The situation is even graver because of prevalent high-risk behaviors, providing a fertile soil for the spread of the infection.
Much can be said on what needs to be done. But it’s about time that countries like Pakistan, where the prevalence is still lower than other countries, need to realize and effectively utilize this ‘window of opportunity’ when the infection is still limited to high-risk groups. Groups, like IDUs and sex workers, are the initial source of HIV infections, and targeted interventions can prevent epidemics from happening. Further neglect into the issue would allow the disease to establish its foothold in the country, with greater economic and social consequences in the future.(7)
We agree with Irene and Colleagues about interventions to target “site-specific populations” and would like to reaffirm that “programs to increase needle exchange, drug treatment and HIV and HCV awareness should be implemented immediately.”
Co-Authors: Pashtoon Murtaza Kasi, Abdul Malik Achakzai.
References:
(1) Baqi S, Kayani N, Khan JA. Epidemiology and clinical profile of HIV/AIDS in Pakistan. Trop Doct. 1999; 29(3): 144-8.
(2) Ghys PD, Bazant W, Monteiro MG et al. The epidemics of injecting drug use and HIV in Asia. AIDS. 2001; 15(Suppl 5): 91-9.
(3) Zafar T, Brahmbhatt H, Imam Get al. HIV knowledge and risk behaviors among Pakistani and Afghani drug users in Quetta, Pakistan. J Acquir Immune Defic Syndr. 2003; 32(4): 394-8.
(4) Kuo I, Ul-Hasan S, Galai N, Thomas DL, Zafar T, Ahmed MA, Strathdee SA. High HCV seroprevalence and HIV drug use risk behaviors among injection drug users in Pakistan. Harm Reduct J. 2006 Aug 16;3:26.
(5)Achakzai AM, Kassi M, Kasi PM. Seroprevalence of Hepatitis B, Hepatitis C and HIV viruses in injecting drug users of Quetta, Pakistan. Tropical Doctor 2007; 37:43-45.
(6)Shah SA, Altaf A, Mujeeb SA et al. An outbreak of HIV infection among injection drug users in a small town in Pakistan: potential for national implications [Letter]. Int J STD AIDS. 2004; 15(3):209.
(7)Ruxrungtham K, Brown T, Phanuphak P. HIV/AIDS in Asia. Lancet 2004; 364(9428): 69-82.
Competing interests
The authors declare that they have no competing interests.
High HCV seroprevalence of HCV infection in injecting drug users in Pakistan
22 January 2008
The authors rightly claim that this study provides a useful risk
profile of injecting drug users in Pakistan and it can be used to
develop tailored prevention programs for this high risk
populations. However, this study can be made more useful for
prevention program and similar future studies, if authors can
provide following information as well.
How duration of stay at drop in centre correlated with the seroprositivity
of HCV infection and how these results can be interpreted to make
more evidence based recommendations for drop in centre.
How this study made ethically more beneficial for study
participants who turn out hepatitis C positive and did not have
mean to get any treatment.
How awareness of hepatitis C infection was assessed in the study
population. The term hepatitis C infection is not commonly
understood and have a poor sensitivity and other local term that
can be used for hepatitis C infection have poor specificity.
Competing interests
None declared