Dawn Editorial 1 December 2019

World AIDS Day

AS Pakistan braces for a potential HIV/AIDS outbreak for the second time this year, countries around the world are observing World AIDS Day today to acknowledge the role of communities in dealing with and controlling the spread of the deadly virus.
However, this day should be a sobering moment for the country’s health authorities who keep grappling with an increasing number of HIV/AIDS cases even in the midst of a global decline.
After a severe HIV outbreak in May in Ratodero, Sindh, where many of those infected were small children, a significant number of HIV-positive cases have emerged in about 20 Punjab districts. According to official documents, almost 320 suspected cases of HIV/AIDS surfaced in these districts including Attock, Lahore and Multan, in October alone. To add to the sudden upsurge in HIV-positive cases, internal rifts within the Punjab AIDS Control Programme have sparked a series of resignations. With four key officials gone, the programme may almost be on the verge of closure.
Despite the PACP crisis, the blame for the uptick in HIV cases must not be heaped on AIDS initiatives alone.
The problem is part of a larger malaise that ails Pakistan’s healthcare system. Social taboos, unqualified doctors and unsafe sexual and medical practices, including the reuse of syringes, sharing of needles by drug users, inadequate screening of blood donors, and contaminated surgical and dialysis equipment, have all contributed to Pakistan’s place among the 11 countries with the highest prevalence of HIV/AIDS.
As of 2018, there were more than 160,000 HIV-positive people in Pakistan, according to UNAIDS, while the number of AIDS-related deaths has increased by 369pc since 2010.
Popular narrative holds that drug users, male, female and transgender commercial sex workers and prisoners are most at risk of being infected. Also, a number of migrant workers, having acquired the virus because of risky sexual activity, infect their unsuspecting spouses upon their return.
However, the outbreaks in Sargodha (2018) and Ratodero have shown that unsafe medical practices are just as likely to infect the general population. In both places, the reason for the spread of virus was apparently the use of unsterilised equipment and infected syringes.
Unfortunately, a large number of people have limited access to healthcare services and are unaware of safe medical practices. Crucially, societal attitudes towards HIV/AIDS have complicated matters. Those infected are often shunned by society, and this prevents many others from seeking medical help or intervention for their symptoms.
The dilemma of our country’s approach to HIV/AIDS is especially apt for this year’s theme for World AIDS Day — ‘communities make the difference’. Today should be a moment of reckoning for our healthcare providers, who not only need to come up with an overhaul of the healthcare system but must also work to eliminate social taboos surrounding diseases such HIV/AIDS.


Iraq unrest

AFTER two months of unrest and violent confrontations between protesters and law enforcers in Iraq, Prime Minister Adil Abdul-Mahdi has tendered his resignation, which the Iraqi parliament will most likely decide on today. The move came after Grand Ayatollah Ali al-Sistani — one of the world’s leading Shia clerics — asked lawmakers in his Friday sermon to ‘reconsider’ their choice of supporting Mr Abdul-Mahdi, who had been in power for only a year, to prevent further bloodshed. The removal of the Iraqi prime minister has been one of the protesters’ central demands; however, demonstrations continued on Saturday, with people calling for an overhaul of the entire political system. Arguably, it is massive government corruption and a poor standard of living that have fuelled the protests. Despite Iraq being a major petrochemical producer, the proceeds of oil sales have failed to create a welfare state where citizens have access to basic services, health and education. Poor governance coupled with an equally precarious law and order situation — thanks largely to violence perpetrated by the Islamic State and other militant groups — have combined to put Iraq on the path of becoming a failed state. Demonstrators have also vented their anger at what they see as Iranian interference in Iraqi politics, torching Tehran’s consulates in Najaf and Karbala.
The fact is that after the American invasion of Iraq in 2003, Saddam Hussein’s brutal police state has been replaced by a corrupt system where cronyism and mismanagement are the order of the day. It can be argued that the US tried to create a ‘democracy’ in the Arab state in its own image, without understanding Iraq’s tribal, ethnic and religious complexities. True democracies are organic and evolve over time; experiments in statecraft implanted by external players often end up in a shambles, much as Iraq and Afghanistan have. As for Iran’s role, it is true that many of the Iraqi elite have deep ties with Tehran, while if it were not for Iran’s help, IS may have taken over Baghdad. Although Iraq’s demonstrators have every right to demand full sovereignty, care must be taken not to stoke the fires of Arab and Ajam, as such toxic ethno-nationalist rhetoric can easily spiral out of control. Iraq’s political system cannot be fixed in weeks, or even months. Nevertheless, urgent steps are needed to create a system that delivers in a just and democratic way.


Lesser humans?

TEN years ago, Pakistan made history with a landmark Supreme Court verdict that officially recognised a third gender. Then in May 2018, the National Assembly passed the historic Transgender Persons (Protection of Rights) Act. Under this law, individuals who do not fall into the male/female gender binary are guaranteed the right to self-identification, to have that identity recognised on all their legal documents, and to be safeguarded against discrimination. Further, the law guarantees the transgender community the same constitutional rights as any other citizen of the state, including “fundamental rights to inheritance, education, employment, vote, hold public office, health, assembly, and access to public spaces and property”. In the general elections that same year, several members of the transgender community participated as contestants.
But despite all these legal gains, the community continues to suffer horrific violence, often with little hope for justice: rape, kidnappings, sexual exploitation, violent attacks and murder. In one of the most recent instances, a transgender person was raped and tortured at gunpoint in Sahiwal in September. Almost exactly a year before that, another transwoman was found outside a taxi stand with burns on 80pc of her body in Sahiwal. She died on the way to a hospital in Lahore. There have even been instances where medical staff would not attend to a transgendered patient; a morgue would refuse to keep the body of a transperson; or a government contractor would not fulfil his duty of burying the body. A recent article published in this paper highlighted the trials and tribulations of a transgender beauty salon owner, but many others continue to have difficulty finding employment, and resort to begging at traffic signals. Then there are other forms of daily humiliation, where someone’s identity becomes the butt of a ‘joke’, or a snide remark. So while transgenders as a community may have equal rights on paper, they are still treated as second-class citizens and lesser human beings.


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