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PAKISTAN: Unsafe blood transfusions pose HIV, hepatitis risk
Receiving a blood transfussion in Pakistan can be risky
MULTAN, 13 March 2008 (IRIN) - In her second storey home in Multan, Punjab Province, Raheela Ahmed, aged 25, gasps for breath as she struggles up the stairs carrying her youngest child, Kulsoom. “I have been sick since she was born. I often feel weak and dizzy,” Raheela told IRIN.
A blood transfusion the mother-of-three received during the Caesarian section carried out to deliver her daughter is the reason for her illness. Raheela has been diagnosed with Hepatitis-C, a potentially fatal viral infection which affects the liver. Despite several courses of treatment with a variety of drugs she has not fully recovered.
She is not alone. According to estimates by experts at a seminar in Karachi in December 2007, 90 percent of the blood donated in Pakistan is provided by “commercial” or “non-voluntary” donors, who most often sell a pint of blood at prices ranging from US$5-10. Rarer blood groups attract higher prices.
While data is unavailable, these “commercial” donors are known to include drug users, who often sell blood to pay for their addiction.
The Joint UN Programme on HIV/AIDS (UNAIDS) says Pakistan, a country of some 160 million people, has one of the highest rates of drug use in the world – with about 450,000 drug users nationwide. Sixty-four percent of injecting drug users say they use non-sterile needles.
The World Health Organization (WHO) and UNAIDS has reported an HIV transmission rate of 10 percent among those injecting drugs.
Hepatitis infections are even more common among drug users. This is unsurprising given that 10-15 percent of Pakistanis, according to the Pakistan Medical Association, a professional body of doctors, are carriers of one of the hepatitis viruses.
Lack of blood screening
The lack of blood screening facilities adds to the hazards. According to UNAIDS, only 50 percent of the 1.5 million bags of blood transfused annually in Pakistan is screened.
From 2004 to 2006, at least 91 blood banks were closed down in Pakistan’s largest city, Karachi, in Sindh Province, after it was found they were not adhering to safe practices. Sindh Blood Transfusion Authority secretary Zahid Hussain Ansari said “78 of these were privately owned, and the others run by various NGOs [non-governmental organisations].”
The situation is feared to be worse in smaller towns across Pakistan, where virtually no screening or monitoring facilities are in place.
The lack of awareness also means patients and their families rarely ask questions about the treatment they are receiving or the safety of blood they may need to receive.
“We are now told the blood made me sick. I never knew this could happen and neither did my husband and mother,” said Raheela.
Reluctance by family members to donate blood, fearing “weakness”, aggravates the problem. Medical equipment re-used
The fact that medical equipment, including intravenous bags, syringes and other items, is frequently reused compounds the risks.
The existence of mafias based at hospitals, which facilitate the sale of used equipment, has been widely reported in the media and in reports by organisations such as the Human Rights Commission of Pakistan (HRCP).
Laws intended to curb this practice, however, remain poorly enforced.
UN estimates 85,000 living with HIV
Currently, UN and government estimates put the number of people living with HIV at around 85,000, while a far smaller number are reported, according to Pakistan’s National AIDS Control Programme, due to a lack of awareness and the stigma associated with the disease.
Despite a prevalence rate of 0.1 percent amongst the general population, the World Bank has reported that lack of awareness in Pakistan, and high risk factors including low condom use and unscreened use of blood make the situation fertile for AIDS to become a major health issue.
Whereas heterosexual contact accounts for 40 percent of reported cases, contact with blood or blood products, according to the Pakistan Red Crescent Society (PRCS), is responsible for 19 percent of such infections. Most cases go unreported.
“We have a high hepatitis infection rate. The mode of transmission of HIV is very similar to this disease, so the risks are immense,” said Shafiq Khan, a medical practitioner based in Multan.
People who need regular blood transfusions, including haemophiliacs, are among those most at risk.
However, the lack of safe blood, the limited screening facilities and the widespread practice of using blood provided by drug addicts and other high risk groups mean that anyone requiring blood is at risk. The growth in the number of people infected by HIV increases the dangers.