GUJRAT, 2 December 2008 (IRIN) - An ongoing investigation into the large number of HIV cases in the small town of Jalalpur Jattan in Pakistan's northern Gujrat district, in Punjab Province, is expected to shed light on patterns of infection in the region and influence the future direction of the country's HIV policy.

In August, the New Light AIDS Control Society, a local non-governmental organisation, conducted random HIV tests of 342 people in the area; an alarming 90 were positive. The National AIDS Control Programme (NACP) and the US Centres for Disease Control are now carrying out a prevalence survey in Jalalpur Jattan which includes re-testing all of the people who tested positive in the last survey.

"The infection may have been brought by people returning from the Middle East and elsewhere," said Dr Munir Ahmed, Gujrat's executive district health officer, who speculated that the large number of migrant workers may have contributed to the high level of HIV.

Local behaviour patterns could also be a factor. "Gujrat is a district where medical practice by quacks is prevalent," said Dr Hassan Abbas Zaheer, programme manager at the Islamabad-based National AIDS Control Programme (NACP). "Injection safety standards are very poor and injection therapy is very popular."

Health care in Pakistan is overwhelmingly provided by private practitioners who promote the belief that receiving treatment via injection rather than oral medication is quicker and more effective.

Dr Arshad Pervaiz, a family practitioner in Gujrat, told IRIN/PlusNews that besides "quack" doctors reusing syringes, injecting drug use was on the rise in many small towns in Punjab Province, and awareness about HIV/AIDS was "still far too low."

NACP officials said the findings in Jalalpur Jattan confirmed the need to increase HIV awareness and ensure that the most vulnerable members of the population have access to HIV/AIDS information, treatment and care.

"We also have to use this opportunity to strengthen and promote safe injection and infection control practices for HIV, and Hepatitis B and C," Zaheer said at the launch of the prevalence survey.

The deep stigma attached to HIV and AIDS in Pakistan has contributed to the high levels of ignorance. Previous awareness campaigns have had a limited impact on public perceptions.

"I have heard about these cases [of HIV]. We don't know how many there are but we are very scared," said Muhammad Farooq, a labourer in Gujrat. Like many others in the area, he believes HIV can be contracted through casual contact with an infected person. "I wish we knew who these people were so we could stay away," he said.

The NACP acknowledged the need for more HIV education, especially as other districts in the Punjab have similar rates of migration and drug use to those in Gujrat.

"This means the rate in many places could be higher, even if cases have not yet been detected," said Pervaiz.

According to official figures from the NACP, there are only about 75,000 HIV-positive people in a population of 160 million, but UNAIDS has described Pakistan's epidemic as significantly under-reported.

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