father, like son
of access to HIV/TB treatment leads to a high death toll among IDUs...
writes Aroosa Masroor
Thirty-year-old Fayyaz*, an injecting drug user who has HIV and TB is homeless.
"I live on the streets," he says "My brother and his wife refused to let me stay with them when they learnt I have been taking drugs. They feared I would pass on my habit to their young son."
Eight years ago, Fayyaz was a resident of Orangi, a low-income neighbourhood in Karachi. Today, he lives on Burns Road, where the highest number of injecting drug users (IDUs) from different parts of the city, are concentrated.
Majority of the IDUs who live on the streets inject drugs in groups. Lifestyle of IDUs makes them vulnerable to TB. Sharing of needles increases the risk of contracting HIV and, subsequently, tuberculosis (TB).
The highest risk, the least care
According to the second generation surveillance report on HIV/AIDS, 2006-07 in Pakistan IDUs is the highest risk group in the 12 cities selected for surveillance. The total number of IDUs, according to the research, was estimated at 31,000.
The highest percentage of IDUs (29%) was found in Karachi, at 808 spots. The prevalence of HIV among IDUs in Karachi during 2006-07 was estimated at 30.1 per cent. This was followed by Hyderabad (28.9%) and Larkana (16.5%). Lahore, Faisalabad, Gujranwala, Peshawar, Bannu, Hyderabad, Quetta, Sukkur, Multan and Sargodha are some other major cities of Pakistan where IDU populations are at high risk due to their sexual relationships and their living conditions.
Official statistics from Sindh Aids Control Programme (SACP) also reveal that from the reported 4,502 HIV positive cases, 1,700 belong to Karachi – most of them are IDUs.
According to SACP's research, HIV prevalence among IDUs in Karachi jumped from 0.4 per cent in January 2004 to 26 per cent in 2005, indicating a shift from 'low prevalence' to 'concentrated epidemic'.
A study carried out by the Marie Adelaide Rehabilitation Centre, located on Burns Road, further confirmed this.
However, despite the alarming statistics, it is mostly NGOs or doctors at private hospitals who perform the task of collecting blood samples, screening for HIV, providing counselling services and motivating IDUs to benefit from drug rehabilitation facilities.
Although there are approximately 60 TB-DOTS treatment centers in Karachi, access to health-care facilities remains unavailable to IDUs (who have TB) as they are often shunned by medical staff at state-run hospitals due to their appearance.
"There's no point in providing treatment to these addicts because they don't learn and will soon resume their habits," a medical attendant at the state-run Civil Hospital in Karachi, says.
Dr S. Ghulam Naqvi, Chest Specialist and Zonal TB Coordinator, Karachi TB Control Programme cites a number of reasons behind this disturbing trend.
IDUs are often neglected at state-run hospitals because of limited resources and burden of treating hundreds of patients on a daily basis. Further, IDUs do not comply with long-term treatment, he explains.
"The IDUs do not have proper homes or a family member assisting them during the treatment so it is hard to track their record and determine the success rate of treatment among IDUs," says Dr Naqvi adding that it is even difficult for private doctors to make them (patients) comply because they do not return after receiving short-term treatment. "The reason there is no exact official data on IDUs infected with TB/HIV is because most of them do not return for treatment after a few weeks."
Senior Physician Dr Naseem Salahuddin working at Indus Hospital Karachi, a private hospital accessible to the public free of charge, agreed. She is currently treating around 20 patients of HIV/TB co-infection.
"In the case of infectious diseases like TB, HIV and Hepatitis, it is compliance that matters," she says. "In the case of ARV treatment for HIV positive patients, IDUs is a category most difficult to deal with because we cannot begin treatment unless the patient has maintained complete abstinence through rehabilitation for a few years."
Malnutrition, a major problem
Dr Salahuddin added that malnutrition was another problematic factor that creates hindrance in treatment.
"A sufficient amount of calorie intake is required when the patient is taking HIV and TB drugs. The strong medicine can have a negative impact on the body if not taken with a proper diet."
It is ironic to note that even when medicines are being provided by the government, it is poverty and high food inflation that makes it difficult for patients to continue with their treatment.
Dr Ghulam Naqvi further informed that treatment for HIV and TB has recently started in three hospitals in Karachi, one of which is a government hospital. "So far only three patients have been diagnosed with co-infection, none of which are drug users," he informed.
However, Dr Saleem Azam, Director, Pakistan Society, an NGO working with IDUs in the Federal B Area and Gulshan-e-Iqbal – low and middle income localities of the city - offers a different opinion. He believes it is psychological counselling that IDUs need the most before they can begin any form of treatment. The government should focus on counselling than establishing more and more DOTS centers, he asserts.
"Since IDUs have no family members, we use the 'peer education model' to raise awareness about infectious diseases and its consequences," he says. Fayyaz, on the other hand, says he wants to quit the drug habit but does not know how to seek help.
Despair leads to death
Besides HIV, most IDUs are also infected with Hepatitis B, Hepatitis C, and TB. The presence of these multiple viruses in a drug user's body ultimately results in his death.
Dr. Azam adds that the on-ground reality of most programmes is saddening. Not only do the relevant officials have limited experience in service delivery for high risk groups, there is also a lack of commitment on their part.
"There are no integrated programmes for TB/HIV," Dr Azam says. "An IDU, who cannot even afford two meals a day, cannot be expected to run around for one test after another."
Since there is no synergy between the two programmes, an IDU will first have to register as an HIV patient and then go through the entire procedure of registering as a TB patient for free medicine.
Moreover, after contracting the disease, it is difficult to convince drug users to take preventive measures. In most cases, they are reluctant to try because they have lost hope.
"Who would I want to live for?" asks Sajid, another IDU who tested positive for HIV recently. "It's not like my family would accept me now if I give up the habit and return to them."
Psychologists cite rising unemployment and political instability in the country as two of the main reasons behind the psychological stress that has resulted in the increasing number of drug users, including women who are hidden from public view. What is even more worrisome is the involvement of young people, mostly street children, who are gravitating towards substance abuse.
"The government needs to respond before it's too late since HIV can be prevented among IDUs," says Dr Saleem Shaikh, member of Bridge Consultants Foundation, an NGO promoting public health research in different parts of the Pakistan. Dr Shaikh is unhappy with the attention given to drug users in Pakistan's AIDS programmes.
The mortality rate among IDUs in Pakistan is the highest among vulnerable groups. Since many are abandoned by family once the habit kicks in, they end up having no family to care for them when they get ill.
"The Edhi morgue in Karachi receives 50 nameless bodies every day from different parts of the city," reveals Dr Azam.
"When buried, there is nothing inscribed on their tombstone either. They die the most unfortunate death."
Most of the time it is difficult to ascertain the cause of their death because IDUs are not registered in government-run TB or AIDS control programmes.
"Despite the fact that IDUs have been identified as the highest risk group, government projects are not focusing on this segment of the population," adds Dr Shaikh.
Dr Qamar Abbas of SACP, however, assures that the five-year World Bank AIDS control programme (2008-2013), launched in July 2008, will focus on high-risk population groups, including IDUs, sex workers and inmates.
But while they wait, IDUs continue their high risk behaviours as they become involved in sexual activity with peers, street-based female sex workers and beggars at night. Condoms are usually absent in these liaisons.
"We don't have the money to buy a condom," claims Fayyaz's friend, who accompanied him for the interview. He said he was familiar with the use of contraceptives to prevent transmission of the disease. When asked why he could not use the money he earns from begging and selling his blood, to buy a condom, he laughs, "I would rather spend that money on drugs."
*Names changed to protect identity
The article was first published in the August 5, 2008, issue of Panoscope - a daily conference newspaper produced at the XVII International AIDS Conference held from August 3-8, 2008.
Inland fishermen harassed by influentials using state force
In the first gathering of its kind in Sanghar town, about 500 fisherwomen hailing from different lake areas led a rally in the scorching heat to protest the illegal occupation of their waters by influential people who are allegedly backed by the local administration and law-enforcement agencies.
Reports reaching here said that three old fisherwomen fainted amidst vociferous sloganeering against the atrocities of landlords who have deployed private armed men to deprive fishermen of their catch. 'They have been assigned a legal contract of the waters,' they said.
The Chotiari Reservoir is spread over 65,000 acres (100 sq miles), and covers 60 small natural lakes which were the main source of earning for the local fishermen.
Majeed Mangrio, the president of Sustainable Development Foundation (SDF), a non-government organisation campaigning for the rights of fishermen, herdsmen and growers in the district, said that more than 11,000 families depending solely on fishing had been affected directly by the action of the contractors. There are 800 small boats engaged in the fishing activities in these waters.
Pakistan Fisherfolk Forum (PFF) Sanghar President Abdul Rehman Mallah said that after the notification issued by the former Sindh government, led by chief minister Arbab Ghulam Rahim, the contract system was abolished from all 1,200 water bodies in the province. However, the contractors in Sanghar district were influential, and continued their control over the waters. They threatened fishermen to 'surrender their catch or face action.'
Despite these threats and atrocities, the fisherfolk continued their struggle, he said, adding, however, seeing the strength of fishermen, the contractors offered notorious Qasim Zardari, who allegedly had the backing of PPP co-chairperson Asif Ali Zardari, to get major share and continued the disorder at the natural water bodies.
The activists allegedly said the PPP's leaders had personally taken action and transferred the district police officer (DPO), Dr Waliullah Dal, over his denial of taking action against fishermen and gave charge to Altaf Leghari being DPO, who belongs to Nawabshah, the home district of Zardaris. The new DPO has deployed police force near the lakes to take action against the fishermen in case deny giving catch to contractor. He has also asked concerned police officials of Chotiari and Mangali police stations to deal with fisherfolk "strictly".
This situation has created panic among the area activists, who themselves have been affiliated with PPP and faced difficulties to take the party flag up during the past government.
"After PPP came into power, we heaved a sigh of relief and thought we will get the rights back. However, the situation has become worse than before as PPP stalwarts themselves have come to kill us," Abdul Rehman Mallah said.
PFF spokesman Sami Memon giving the history of the struggle against the contract system said when the fishermen were struggling against the law-enforcement agency (Pakistan Rangers), they never thought that the society where they are demanding to live and do job peacefully was not the ideal one. However, despite receiving threats of dire consequences they continued the movement, mobilised the fishing community settled at all the 1200 water bodies of the province against the contract system.
The activists were put in lock ups and jails, women were beaten brutally at homes, children were barred from entering schools and youth were stopped to enter the water bodies. However, they being committed with the cause of serving the community people and protecting their rights continued fight. At last the government realized the strength of power and announced withdrawal by the certain agency, which allegedly occupied water near Zero Point, Badin Coast and was authorized to awarding annual contracts to willing parties.
This success gives the most marginalized fishing community nothing but courage to turn their dream true with the effective struggle. The government despite its claims did nothing in the favour of the community. The visible thing was that the area influential remained dominated over the water bodies, depriving poor workers of their catch by hook or by crook.
PFF Chairperson Muhammad Ali Shah allegedly said all the powerful authorities and government agencies are together pressurising fishermen everywhere to leave their waters, depriving them of their rights of living. Shah said they think it is a part of their struggle they launched lomg ago against the law-enforcement agency (Rangers).
Now, he alleges, a notorious Qasim Zardari and his aides have occupied Chotiary dam, depriving the local fishermen of their source of living with the backing of PPP government.
This unimaginable move by a PPP influential has alerted all inland fishermen, who are the natural custodians of water bodies scattered in the entire province to come forward again for seeking their rights they have been ensured by the country's Constitution, he added.
Shah's Continental in Karachi
By: Zahid Rahman
The last king of Afghanistan Muhammad Zahir Shah is no more, however, his legacy remains alive on the streets of Karachi. By maintaining and driving King Shah's Lincoln Continental Cabriolet in Karachi for the past 14 years, Mohsin Ikram ensures Afghanistan's gift to Pakistan is always up and running.
Made in 1947, the off-white Lincoln Cabriolet arrived in Karachi immediately after Afghanistan set up its Embassy in Pakistan. The car is said to have been a gift from the King to Shah Wali Khan, the ambassador of Afghanistan to Pakistan at the time and the first cousin of the Shah.
Believed to be the first car to arrive in Pakistan from abroad, the Lincoln used to bear a number plate reading '1'.
The car which remained in the use of the Afghanistan embassy for five years was later sold to private collectors. The present owner, Mohsin Ikram, President, Vintage and Classic Car Club of Pakistan (VCCP), identifies Sikander Ali Shah, Director Finance at Ali Autos, as the first ever Karachiite to have bought this car.
Since then the royal Lincoln has been driven by various people for different purposes, from personal use to official businesses. Meanwhile, it has also been used to present a softer image of Karachi, says Ikram referring to the rallies and events arranged by the club to promote the motor heritage of Pakistan.
Therefore, in an effort to preserve heritage, Ikram bought the 1947 Lincoln Cabriolet for 0.25 million rupees. Talking about the restoration of the car, Ikram explains that the car was, "only a piece of junk" when he bought it.
Ikram recalls that the car was nothing but rusted steel and he had to spend thousands on its restoration. However, since it is "Heritage on wheels" the car is worth millions if it is maintained well, says Ikram.
Designed by the U.S based Ford Motor Company in 1940 for the personal use of company's President, Edsal Ford, Lincoln Cabriolet cars are deemed classic by the Classic Car Club of America and are regarded as the automotive design of the century. The car is believed to have been designed exclusively on the demand of the president for a "continental car for himself."
Given its unique design and the sleeker and stylish look as opposed to the then heavy styled cars, Lincoln Cabriolet was soon in demand and made available for public in 1941. However, the car was rare and was produced in limited numbers.
"The 1947 version alone had only 400 models," tells Ikram adding that Lincoln Cabriolet was regarded as prestigious and deemed as a status symbol in those days.
Even today, this make of Lincoln Cabriolet is not easily found. "In the sub continent alone," says Ikram "there are only two 1947 Lincoln Cabriolets," adding that besides the one in Pakistan, the other one is owned by some Maharaja in India as it still symbolizes status.
With its elongated bonnet, spacious leather seats and convertible power top and windows, the white royal car is still prestigious and breathtakingly beautiful. Ikram adds that he has to spend a lot of time and money to maintain the Lincoln.
On special orders he has to order the 6 volt battery for the car which is no longer in use, Ikram has also employed a full time technician for the car's maintenance.
"Classic cars like the 1947 Lincoln Cabriolet V12" explains Ikram "reflect an era.," therefore he adds that they should be preserved . Ikram says that he will never sell the royal car wand will keep will later pass it on to his children, so that Pakistan can have the honour of being home to a vintage car of this sort.
We don't need no education, we don't need no thought control
By Gibran Ashraf
Every once in a blue moon comes a group of people who just lift your heart. Ijaz Anees's pianist sons Ahsan, Usman and Asad have enthralled audiences in Pakistan and abroad with their magical play. Recently, Kolachi caught up with them to get an insight on the next trick they were going to pull out of the hat.
Usman and Asad caught the public eye some time back when they held public performances. Usman, who is only 16, left audiences gaping in amazement at how the youngster was able to play greats such as Bach and Beethoven with utmost ease.
Prof. Anees reveals the secret to the ceremonious success of his children in the relatively frowned upon world of western classical music.
"When I realised that the conventional education one finds in schools, is worth nothing and just part of a rat race for a piece of card board what others would call a "degree", I pulled all my four children out of school and taught them at home". He then became their tutor and instructor of music and painting.
An electrical engineer by profession, Prof. Anees belonged to Lahore and came to Steel Town as an employee at the Pakistan Steel Mills in the early 80's. However, he left the job in 1992, visited Russia and found music. He brought back a plethora of music records and books.
Giving piano lessons and repairing pianos to make a living and support his burgeoning artistic family, he raised no Einsteins, but rather musicians and artists of world class nature.
The most recent feather in their cap came in Germany where Usman, on the invitation of the Ambassador of Pakistan in Germany, played at the Mendelssohn-Remise in Berlin among a company of German musicians, playing to a German audience. He was lauded for his skill at excelling in an art that is traditionally European.
In all this, says Prof Anees, his role has been that of a guide who provided the basic training and resources to his children that they needed to launch themselves. "I realised that the age when children should be learning skill and craft, they are stuck in schools being taught like monkeys, so I took them out and gave them something that would last with them a lifetime."
His expressions may seem lyrical but the premise of Prof Anees's belief in built on the following argument: "As far as conventional education is concerned, that is very easy and requires little effort to accomplish. In fact, when I decided to prepare my son for his intermediate exams, I found that the entire course required just one year of preparation. So, I ask, why do we waste our money and twelve years by sending our children to school when they could easily utilise that time for some thing constructive," reflects Prof Anees.
However, it is not only the piano in which they excel. Though Usman made his public debut for recitals in 1999, he and the rest of his siblings are yet to exhibit their art work. Many of their paintings and sculptures are reproductions of famous works of Michelangelo and other great artists, but to execute them to perfection is a skill indeed. "I am trying to understand colours and tonalities of my work," says Usman.
Though they may possess the skills to replicate, they are still learning to create their own pieces. Usman has managed to create his own compositions with a Fantasia in D major, another Fantasia in G minor, a Waltz in B-flat major, a Piano Sonata in C major and a Piano piece in A major. He intends to eventually write his own symphony.
Although he has played duets with both his brothers, Ahsan and Asad separately, he is relishing an opportunity for a triad play.
Since the market for classical music in Pakistan is very limited with at best three to four shows a year, of which majority of them are recitals at private functions, much of their audience is comprises foreign diplomats who wish to hear some thing from their region. The main hosts in this venture usually are the Consul Generals of France, Germany and the High Commissioner of England.
The dearth of listeners and hence players have also poured iced water on the hopes of Prof Anees to create a local orchestra of international repute. However, his quest turned barren as there are no good quality musicians in the country. "At best there will be one or two flautists, a couple of violinists, a drummer, what about the rest?" he questions. He then decided to form a group with abandoned children, but with no support from the concerned departments, he gave up the idea.
Asked about the overall interest of the public in learning western classical music, he replied "no one is seriously interested in training their children. At best they send them for a two-month summer break to keep the children preoccupied or to satisfy desires or some cultural requirements. Almost all treat it as a hobby, even those teaching in places like NAPA and Indus Valley".
"The fact of the matter is that these things can not be acquired, if you do not have the talent for it. And if the flame is not ignited from a young age, it fades away" he says categorically.
Not many would however agree with the method of Prof Anees. He himself admits that considering the fast pace of life today, it may not be the best option for parents.