BUSINESS RESEARCH

MEHTODS

THE TREND OF PREVALENT HIV/AIDS IN THE YOUTH OF

PAKISTAN OVER THE LAST DECADE: CAUSES AND
EFFECTS

SUBMITTED BY

MUHAMMAD AMEER

HAMZA SHAIKH

(788)

SYED MUHAMMAD WAQAS

(785)

ARIF KHAN (

)
 ASHFAQ SHAH (

BBA-5

SUBMITTED TO

SIR HAMZA KHALIL

ACKNOWLEDGEMENTS

First of all we would like to thank ALMIGHTY ALLAH who has given us the courage
and wisdom to research and write a report on this sensitive topic. Secondly we would
like to thank Dr. MUNIR AFRIDI who guided us and gave us useful information in the
form of published material and took out time to give us a detailed interview in order to
complete our report. Hopefully this report will serve to its best. Last but not the least we
would like to thank our teacher MR.HAMZA KHALIL who instructed us on every step

2
about how to complete the report following a professional format. I hope this report
will provide a thorough knowledge about this increasing disease in KARACHI and will
be used further.

3
TABLE OF CONTENTS

Executive summary i, ii, iii

Problem 7

Introduction 7

• Need for research 7

• Background 8

Hypothesis 9

Research methodology 10

Research design 11

Secondary data 12

• Primary and secondary sources 12

• Proportion of data 12

Reported AIDS cases in Pakistan 13

• Area wise 14

• Age and gender wise 14

• No. Of AIDS cases 15

Estimated Number of Adults and Children 16

Primary data 17

• Tools applied 17

• Name and profile of the interviewee 18

Data is gotten by research 19-24

Testing of hypothesis 25

Recommendations 26

Conclusion 27

Bibliography 28

4
EXECUTIVE SUMMARY

Pakistan is one of the third world countries where the word literacy is pretty
rare. There is an intense need to make the people aware about the different aspects of
life as well as about different diseases, which can harm them and lead them to death.
The HIV/AIDS epidemic threatening many other countries has not yet hit Pakistan with
full force though the risk of transmission remains high.

The major difference between AIDS and HIV is that, HIV is the agent of the disease
whereas AIDS is the disease itself. There are two main types of HIV. HIV 1 and HIV 2.
Predominantly HIV 1 is the leading cause of AIDS in the world. The GP120, a part of
the HIV virus, attacks the CD4+ of the white blood cells of the human body and finds a
home in the nucleus of the cells and affects the immunity of the body. Once the HIV
virus enters the body it attacks the immunity system and if successful destroys the
defenses of the body thus making it vulnerable to innumerous diseases like T.B,
diarrhea, flu etc. This state when the body is incapable of defending itself against other
diseases is known as AIDS.

Research show AIDS is basically caused by the replication of HIV virus and Illiteracy is
the main reason for that. Therefore Acquired immunodeficiency syndrome (AIDS) is
increasing at a smooth rate for the last decade.

The first case of AIDS in Pakistan was reported in Karachi during 1986-1987, the
patient was a foreigner. According to official sources, there are currently 3073 including
332 full-blown AIDS cases reported till September 2005 in Pakistan. And the actual
number may be in 30 times of the actual registered number. WHO and UNAIDS
estimate that there are around 70,000 to 150,000 HIV and AIDS persons living in the
country. UN Aids report last year said that between 80,000 and 140,000 people were
infected - and the rate could spiral because of under-reporting of cases.An HIV-Aids
newsletter of the Ministry of Health put the total number of reported cases at 3,933, but
only about 618 of them were registered with nine treatment centres countrywide.

5 i
The HIV virus is not airborne it has to penetrate the human skin and the mucus
membrane in order to become active. It requires specific modes of transmittal which are
transfusion of infected blood, from infected mothers to her child and Unsafe sex.The
virus cannot be transferred through saliva since it cannot penetrate the mucus membrane
of the human body; therefore the disease is not contagious. Also it does not survive in
the body of mosquitoes and other such insects so it does not spread by their bite.
Heterosexual transmission accounts for the majority of reported cases (67%) Other
modes of transmission include: infection through contaminated blood and blood
products (18%), homo or bisexual sex (6%), injecting drug users (4%), and mother to
child transmission (1.3%), un khnown causes (3.7%) (Source: National AIDS Control
Programme).

Most reported cases are in the age group of 20-44 years, while males outnumbering
females by a ratio of 7-to-1. A joint study conducted recently by UN Aids and the Aga
Khan University in Karachi reported that 80% of known cases in Pakistan involved
people who had been deported from the Gulf States for having Aids. As mentioned
above most cases are seen in people who have been working abroad or visiting foreign
countries frequently. The workers are mostly related to middle and lower classes where
as those who only visit are from the upper or upper middle classes. So far, cases have
been reported from each socio class however the lower classes are found to be more
infected, the reason being their prolonged stays in the foreign countries for the sake of
jobs and the inability to keep their families with them as well as their ignorance
regarding AIDS.

The HIV and AIDS trends are changing in Pakistan and with recent data it shows that
the country has moved from a low prevalence to a concentrated epidemic stage. The
recent data compiled by the Government from the National RTI/STI study and the Pilot
study for HIV/AIDS Surveillance project by CIDA (HASP/NACP) suggest that upto
25% of the Injecting Drug Users (IDUs) in Karachi are infected with HIV.
ii

6
After conducting a thorough research on the topic “The trend of the prevalent HIV in
the youth of Pakistan over the last decade: causes and effects”, it can be concluded that
in the past ten years, even though the rate of HIV has been constant (that is, the rate
itself has shown a steady pattern) yet every year the number of cases of AIDS is
continuously increasing

This disease is mostly found in the young population, every year we loose a large
number of our precious youth. One other reason for the rapidly increasing rate of HIV is
the highly expensive life long treatment of AIDS, which the common man of Pakistan
cannot afford.

Even though the Government is constantly trying to control AIDS and large measures
have been taken to create awareness in our youth, yet our research reveals that in the
last decade the number of patients of AIDS has increased considerably, because of
which are we not only loosing the precious lives of our youth but our whole society is
also being adversely effected continuously and is being exposed to the threat of this
fatal disease “AIDS”.

iii

7
PROBLEM

The trend of prevalent HIV/AIDS in the youth of Pakistan over the last decade: causes
and effects

INTRODUCTION

NEED FOR RESEARCH:

Pakistan is one of those third world countries in which “awareness” of certain lethal
diseases is very minimal. People here are unaware of the fact that there is a disease
called AIDS, which is widespread and fatal. Due to this ignorance people are unable to
protect themselves.

Not knowing the consequences, the Small clinics do not use disposable syringes,
barbers use the same blade many times and people use-untested blood all promoting
aids and endangering our ignorant youth. Ignorant mothers are unable to protect
themselves and this leads to the birth of children who are the carriers of this disease and
further enhance the spread of AIDS. Keeping all this in view we believe that there is a
need of research on why and how the HIV rate in Pakistan has increased over the last
ten years. This research will be an attempt to create awareness in our youth to save their
precious lives.

8
BACKGROUND

The research is based on the topic of Aids, in order to find out the causes and effects of
the increasing HIV rate in the youth of Pakistan over the last ten years.
AIDS stands for Acquired Immunodeficiency (or Immune Deficiency) Syndrome. It
results from infection with a virus called HIV, which stands for Human
Immunodeficiency Virus. This virus infects key cells in the human body called CD4-
positive (CD4+) T cells. These cells are part of the body's immune system, which fights
infections and various cancers.
When HIV invades the body's CD4+ T cells, the damaged immune system loses its
ability to defend against diseases caused by bacteria, viruses, and other microscopic
organisms. A substantial decline in CD4+ T cells also leaves the body vulnerable to
certain cancers.
Unrecognized before 1981, its precise origin is unknown, but the most severely affected
part of the world is Africa. It is transmitted sexually; originally identified in the US
among homosexuals, it is now clear that it can be transmitted from man to man, man to
woman, woman to man and by an infected mother to her unborn child. It can be
transmitted by the transfusion of infected blood or by the use of infected needles, as
when needles are shared between intravenous drug abusers. It has a long incubation
period.
World Aids Day is commemorated around the globe on December 1 to evaluate
progress made in the battle against the epidemic and brings into focus the remaining
challenges. According to the UNAIDS, it will have killed 3.7 million people by the end
of this year, five million more have been infected with the deadly virus and 42 million
people, half of them women, are living with HIV/Aids. It was also mentioned that by
2007 the world will have to find about $15 billion a year to successfully treat and
combat Aids in low and middle income countries but actual numbers do not match from
the expected figure.

9
HYPOTHESIS

There has been a significant rise in the HIV rate amongst the youth of Pakistan over the
last decade due to a number of reasons, adversely affecting the whole society.

10
RESEARCHMETHODOLOGY

The basic methodology that we are using here, for the purpose of commencing this
thorough and informative research is “Historical Research Method”.

Historical Research involves study; understanding and explanation of all relative past
events and happenings that can shed some light on the concerned topic from any and all
aspects. This is done to arrive at conclusions that help to explain present events or
anticipate future events.

Second hand data and processed information is being used here. The relative material
shall be deeply studied and discussed with authoritative figures so as to confirm the
findings and make all produced information best at quality.

11
RESEARCH DESIGN

1. IDENTIFICATION OF THE PROBLEM

What are the causes of the widely spreading HIV amongst the youth of Pakistan, which
is adversely affecting the whole society?

2. COLLECTION OF DATA

The data will be collected by interviews from doctors, medical magazines and from a
number of books and websites on the Internet.

3. ANALYSIS OF DATA

The data collected will be analyzed with the help of tabular analysis of the rate of HIV
within the last decade. Various charts and graphs will be used to represent the
quantitative results of the research. Other then that the data will be divided into various
sub topics to make a through analysis.

4. PRESENTATION

All the details of how the research took place and the findings of the result will be
complied into a report and a hard copy will be made, which will be available for further
study and reference.

12
SECONDARY DATA

AIDS was discovered in 1981. Since then scientists and doctors have been thriving to
find cures and causes of the disease, subsequently considerable research on the subject
has been conducted already. We being students found it more convenient and
informative to rely on secondary data. The data used comprises of published and
unpublished secondary data.

PRIMARY AND SECONDARY SOURCES

Information was picked from the March – issue of a monthly medical journal by the
name of “NABZ”.
This main source of information comprised the primary source of secondary data.
Various websites were also referred. These comprised secondary sources of secondary
data.

PROPORTION OF DATA

This report comprises mostly of secondary data because an extensive amount of

research has already been conducted, hence it was more appropriate and convenient to
utilize secondary data. Proportionally around 70% of the information has been gathered
from secondary data and the remaining portion consists of primary data. Apart from this
the necessary medical knowledge, financial facilities and resources that would have
been required for collecting primary data were not available to us therefore the focus
was more on secondary data.

13
AIDS CASES INPAKISTAN
REPORTED AREA WISE (TILL 30TH SEPTEMBER 2002)
S.NO AREA HIV+ AIDS PATIENTS TOTAL
1 FEDERAL CENTRES 334 37 371
2 PUNJAB 394 43 437
3 SINDH 490 84 574
4 NWFP 349 53 402
5 BALUCHISTAN 180 12 192
6 AZAD KASHMIR 18 4 22
TOTAL 1765 233 1998

REPORTED AGE AND GENDER WISE

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AGE MALE FEMALE TOTAL
00-04 02 03 05
05-09 02 - 02
10-14 - - -
15-19 01 - 01
20-24 05 01 06
25-29 57 04 61
30-34 28 11 39
35-39 24 06 30
40-44 33 - 33
45-49 24 - 24
50-54 13 02 15
55-59 06 01 07
60 OR MORE - - -
UNKNOWN 07 01 08
TOTAL 202 29 231

Pg 111 “NABZ”

15
 REPORTED AIDS CASES IN PAKISTAN
YEAR HIV AIDS CASES TOTAL
1993 173 16 189
1994 178 09 187
1995 242 19 261
1996 76 20 96
1997 112 19 131
1998 70 23 93
1999 72 17 89
2000 115 15 130
2001 115 20 135
2002 77 11 88
TOTAL 1741 233 1974

Pg 110 “NABZ”

16
Estimated Number of Adults and Children Living with HIV/AIDS, End of 2001*

Estimated number of Cases AIDS cases by mode of transmission,

with HIV/AIDS in Pakistan Pakistan, 2002

Adults and children 78,000

Adults (15-49) 76,000

Women (15-49) 16,000

Children (0-15) 2,200

Adult rate (%) 0.1

Estimated number of deaths

due to AIDS**

Deaths in 2001 4,500

Estimated number of
orphans***

Current living Orphans 25,000

*These estimates include all people with HIV infection, whether or not they have
developed symptoms of AIDS, alive at the end of 2001.

**Estimated number of adults and children who died of AIDS during 2001

***Estimated number of children who have lost their mother or father or both parents
to AIDS and who were alive and under age 15 at the end of 2001.

Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Infections 2002

Update (Pakistan), UNAIDS/UNICEF/WHO.

17
 PRIMARY DATA

The necessary medical knowledge, financial facilities and resources that would have
been required for the collection of primary data were not available to us therefore the
focus was more on secondary data. However we were still able to collect a considerable
amount of primary data that has been explained as follows.

TOOLS APPLIED:

Out of the three tools of primary data collection that are:

• Interviews
• Observations (participative and non-participative)

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NAME AND PROFILE OF THE INTERVIEWEE

NAME: MUNIR AFRIDI

OFFERING SERVICE IN:

NATIONAL MEDICAL CENTER

ACADEMIC PROFILE

MBBS L.M.C Ayub medical collage ABOTTABAD

Experience period: 7 years

Contact # 0333-2347904

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DATAISGOTTENBYRESEARCH

DIFFERENCE BETWEEN AIDS AND HIV

The major difference between AIDS and HIV is that, HIV is the agent of the disease
whereas AIDS is the disease itself. There are two main types of HIV
• HIV 1
• HIV 2

Predominantly HIV 1 is the leading cause of AIDS in the world. The GP120, a part of
the HIV virus, attacks the CD4+ of the white blood cells of the human body and finds a
home in the nucleus of the cells and affects the immunity of the body.

The HIV virus is formed of a lipid covering that is very sensitive and can be easily
destroyed by the stomach enzymes, sunlight, and heat. However if the following three
conditions are present the virus can develop into a disease:

1. Source of HIV
2. Susceptibility of the infected
3. Right mode of transmittal

Once the HIV virus enters the body it attacks the immunity system and if successful
destroys the defenses of the body thus making it vulnerable to innumerous diseases like
T.B, diarrhea, flu etc. This state when the body is incapable of defending itself against
other diseases is known as AIDS.

20
WHAT IS DEVELOPMENT OF AIDS?

Any agent that enters the body is known as a “FOREIGN BODY”. To control or
neutralize the foreign bodies anti bodies are developed, which usually destroy them in
90% of the diseases. However in diseases like HIV where the replication of virus is very
rapid the production of the antibodies cannot compete with them. Hence the virus takes
charge over the antibodies and develops into the disease. Every body responds to the
disease differently depending upon the count of their white blood cells.

In the case of HIV, some people are not able resist the disease for more than 6 months
while as others remain unaffected for as long as 14 or 15 years. During this span of
development of HIV into AIDS, the infected is known as “HIV carrier”. This is the state
when the person himself dose not have the disease but has the capability of transmitting
it into others. This variation of resistance to the disease depends upon the environmental
condition that the infected has around him. People with AIDS often suffer infections of
the lungs, intestinal tract, brain, eyes and other organs, as well as debilitating weight
loss, diarrhea, neurologic conditions and cancers such as Kaposi's sarcoma and certain
types of lymphomas.

HOW MANY HAVE BEEN EFFECTED BY HIV/AIDS?

According to official sources, there are currently 3073 including 332 full-blown AIDS
cases reported till September 2005 in Pakistan. And the actual number may be in 30
times of the actual registered number.

WHO and UNAIDS estimate that there are around 70,000 to 150,000 HIV and AIDS
persons living in the country

UN Aids report last year said that between 80,000 and 140,000 people were infected -
and the rate could spiral because of under-reporting of cases.

21
 An HIV-Aids newsletter of the Ministry of Health put the total number of reported
cases at 3,933, but only about 618 of them were registered with nine treatment centres
countrywide.

WHAT ARE MAIN CAUSES OF AIDS?

The HIV virus is not airborne it has to penetrate the human skin and the mucus
membrane in order to become active. It requires specific modes of transmittal which
are:
• Transfusion of infected blood
• From infected mother to her child
• Unsafe sex

The virus cannot be transferred through saliva since it cannot penetrate the
mucus membrane of the human body; therefore the disease is not contagious. Also it
does not survive in the body of mosquitoes and other such insects so it does not spread
by their bite.

Research show:
• Heterosexual transmission accounts for the majority of reported cases (67%)

• Other modes of transmission include: infection through contaminated blood and blood
products (18%),

• Homo or bisexual sex (6%),

• Injecting drug users (4%),

• Mother to child transmission (1.3%)

(Source: National AIDS Control Programme)

22
MOST INFECTED AGE GROUPS AND CLASS

Most reported cases are in the age group of 20-44 years, while males outnumbering
females by a ratio of 7-to-1. A joint study conducted recently by UN Aids and the Aga
Khan University in Karachi reported that 80% of known cases in Pakistan involved
people who had been deported from the Gulf States for having Aids.

As mentioned above most cases are seen in people who have been working abroad or
visiting foreign countries frequently. The workers are mostly related to middle and
lower classes where as those who only visit are from the upper or upper middle classes.
So far, cases have been reported from each socio class however the lower classes are
found to be more infected, the reason being their prolonged stays in the foreign
countries for the sake of jobs and the inability to keep their families with them as well
as their ignorance regarding AIDS.

WHO IS MOST INFECTED GENDER?

The disease is more prominent in people, who have been working abroad.
Majority of this population comprises of men, and therefore the most infected gender is
the male population. It has been observed that it is then transmitted from the male
members of the family to their spouses and eventually the whole family. In 1990, the
first overseas Pakistani case was recorded, later in 1995 the local cases mostly
comprising of the families of the overseas workers, were recorded. In the beginning, the
man to woman ratio of HIV infected people was 13:1 but now that the wives of these
overseas Pakistanis are being infected, the ratio had dropped down to 7:1 and is still
dropping.

23
TREND OF HIV RATE IN THE PAST DECADE

The HIV and AIDS trends are changing in Pakistan and with recent data it shows that
the country has moved from a low prevalence to a concentrated epidemic stage. The
recent data compiled by the Government from the National RTI/STI study and the Pilot
study for HIV/AIDS Surveillance project by CIDA (HASP/NACP) suggest that upto
25% of the Injecting Drug Users (IDUs) in Karachi are infected with HIV.

HOW IS TREATMENT FOR HIV/AIDS?

The anti bodies created by the body in response to the HIV virus are used as the
detecting agents. This test is known as the anti-body test, which is used for the
diagnosis of the disease. Later, when the presence of the HIV virus is confirmed, two
was of monitoring the patient are used:

• Firstly, the count of the CD4 cells is monitored. A healthy, uninfected person
usually has 800 to 1,200 CD4+ T cells per cubic millimeter (mm3) of blood. This
count starts to drop when the virus attacks the body.
• Secondly, the number of HIV viruses is monitored. As the number increases the
body immunity goes down making the patient more vulnerable to AIDS.

No specific cure for AIDS exists, however as different diseases develop due to loss of
immunity, they are treated accordingly. One medication for fighting the development of
the HIV virus is known as HAART. HAART stands for High Active Anti Retroviral
Therapy .it is a life long treatment that requires an expenditure of 40000-50000 Rs per
month. Therefore, the doctor ensures whether the patient can bear the expense
throughout his/her lifetime. They do not treat every patient. The reason being that once
this medication has been taken by a patient it cannot be discontinued as the HIV virus
will develop an immunity towards the medication, hence making it indestructible. Later,
when this particular spreads it would be incurable.

24
CONTROL FOR AIDS

The government has started various projects to control and prevent AIDS. The most
prominent ones are:

• The national AIDS control Islamabad

• Subai (provincial) AIDS control
• Services center Karachi

A part from these several others small centers and NGOs operates privately. The main
objective of these projects is:

• To prevent and to create awareness by the use of media, seminars and

workshops. This is the most important objective as a majority of Pakistani population
is highly illiterate and ignorant thus reacting aggressively towards HIV patients.
Cases have been recorded where HIV patients have been stoned to death, socially
boycotted and disowned by their families

• To council, diagnose and treat the HIV infected people. This includes training of
doctors and provision of free services.

• To create awareness amongst the most vulnerable population of Pakistan. These

include sex commercial workers, sea fearers, overseas workers, drug users, inmate
population, IV drug users, and people getting any sort of blood transfusions.

25
TESTINGOFHYPOTHESIS

The hypothesis for this research states:

“There has been a significant rise in the HIV rate amongst the youth of Pakistan
over the last decade due to a number of reasons, adversely affecting the whole
society”.
The reasoning and information collected from various sources of primary and
secondary data, given above, indicates that indeed the rate of diagnosis of HIV positive
patients and the development of AIDS has been on the rise. The rate of increase follows
a steady trend which has been shown in the statistics given above.
The total number of patients is increasing every year with a steady pattern. Thus it can
be rightly stated that there has been a significant rise in the HIV rate amongst the youth
of Pakistan, over the last decade due to a number of reasons, hence adversely affecting
the whole society. Therefore the hypothesis for this research has been accepted.

26
RECOMMENDATIONS

• In our opinion where Dr. Munir Afridi told us that the patient’s identity must
not be disclosed for the reason that people do not treat them properly such as they
socially boycott them and kick them out of hospitals. We instantly thought that
these doctors should not encourage keeping these patients identity a secret for
these reasons instead they should spread awareness among these ignorant people
that AIDS does not spread just by living, sitting, eating or drinking with these
infected people. It is the doctor who can make humanity overcome such a cruel
act of boycotting someone or actually trying to hurt them by acts like stoning.

• Their should be standardized testing for blood i.e. every bottle of blood should be
tested and it should meet a certain standard set by the government. A seal or
stamp of quality control should also be placed on the blood bags indicating that
the blood has been tested and proven fit for use.

• The government should give some sort of incentives to clinics and hospitals to
use disposable syringes and sterilized equipment.

• The government along with the doctors should prepare documentaries and plays
etc. to broadcast on national television, focusing on how this disease spreads and
how to prevent oneself against it.

• Since the primary source of AIDS in Pakistan are the overseas Pakistanis, a
thorough check up should be recommended for them, each time they travel back
and forth, so that the infection can be caught before the patient leaves the airport
premises and other people can be prevented from being contaminated.

• Informative literature should be published in course books of children, especially

students of higher secondary and higher education, to increase awareness.

27
CONCLUSI ON

After conducting a thorough research on the topic “The trend of the prevalent HIV in
the youth of Pakistan over the last decade: causes and effects”, it can be concluded that
in the past ten years, even though the rate of HIV has been constant (that is, the rate
itself has shown a steady pattern) yet every year the number of cases of AIDS is
continuously increasing.

AIDS stands for Acquired Immunodeficiency (or Immune Deficiency) Syndrome. It

results from infection with a virus called HIV, which stands for Human
Immunodeficiency Virus. There are a number of reasons, which have contributed
towards the spread of this fatal disease, ignorance being the most important. It is this
ignorance amongst the illiterate masses of our country, which has lead to the death of
our people. Since this disease is mostly found in the young population, every year we
loose a large number of our precious youth. One other reason for the rapidly increasing
rate of HIV is the highly expensive life long treatment of AIDS, which the common
man of Pakistan cannot afford.

Even though the Government is constantly trying to control AIDS and large measures
have been taken to create awareness in our youth, yet our research reveals that in the
last decade the number of patients of AIDS has increased considerably, because of
which are we not only loosing the precious lives of our youth but our whole society is
also being adversely effected continuously and is being exposed to the threat of this
fatal disease “AIDS”.

28
 BIBLOGRAPHY

Source:

• Articles from http://www.dawn.com

• http://www.who.org

• http://www.Google.com

• http://www.Undp.org/HIVMDGs

• http://www.Pak.gov. Pk

• http://www.ask.com

• http://www.who.org

• Medical magazine: NABZ (Urdu)

• National AIDS Control Programme

29