P A K I S T A N
HIV/AIDS Follows Some Migrants Home
by Zofeen Ebrahim
KARACHI — "I call him my failure," Dr Ashraf Memon said of Mohammad Wali, "because even after seven years we have not been able to persuade him to bring his family for testing."
Wali (not his real name) is 32 and has AIDS, for which he has been consulting Dr Memon, of Karachi's Sindh AIDS Control Programme, since 1996.
That was the year Wali's world began to fall apart. He was just 25, had a job in Dubai, the United Arab Emirates, in a pipe fabrication unit, and looked forward to meeting his two young children and wife. Then he was found to be HIV-positive and deported. "I just can't brace myself to tell my wife that I have AIDS," said the thin, forlorn young man who complained of suffering from "bouts of stomach problems, body aches and fever".
Ironically, his wife is a teacher who has also done a nursing course and, admitted Wali, "she very well knows what AIDS is".
Economic migration, particularly to regions like the Persian Gulf, has long been an attraction for the young and ambitious in Pakistan.
Yet the repatriation of much-needed foreign exchange from the Gulf countries to Pakistan also conceals the risks being borne by families at home and their earning members abroad.
As a study conducted by the Ministry of Health and the United Nations Programme on HIV/AIDS (UNAIDS) concluded, "a substantial number of the reported HIV infections in Pakistan have occurred among men who have worked in other countries".
In January 2003, there were over 3.1 million Pakistanis officially documented as working abroad, according to the Overseas Pakistanis Foundation (OPF). The number includes both skilled and unskilled labour, technicians and professionals.
"The very people who are most likely to become infected with HIV/AIDS in Pakistan are the younger members of society, the group that represents economically the most productive segment of the country's population," said the Ministry-UNAIDS report, which was released in 2000.
For Pakistani migrants, factors like the unfamiliar setting, loneliness, isolation, possessing a disposable income and the freedom of being away from home and family can and do contribute to engaging in high-risk behaviour.
Mohammad Nazir is only too aware of the risks, for he ran them and suffered the consequences. He had worked in Jeddah, Saudi Arabia, for eight years as a bookbinder. "I had the skill and was at the right place at the right time" he recalled. "Things could not have been better. For the first time in my life I had enough to spend even after sending a major chunk to my parents."
Until the day he fell unconscious and was taken to the hospital. The doctors, he said, told Nazir he had "tuberculosis of the brain" and he was deported, still bewildered about what he was told had happened to him. "When I arrived here I discovered why I was sent home," he said.
That was 18 months ago, and at home in the northern Pakistani city of Lahore, Nazir struggles every day with the treacherous turn his life has taken, for he is only 28. He talked about wanting to learn the Koran. "When problems weigh you down, turning to religion provides you with solace and comfort," he added sagely.
Nazir calls his time in Jeddah "an expensive adventure". He acknowledges his own faults, but also blames the society he left and has now returned to. With the help of New Light AIDS Control and Awareness Group, a non-governmental organisation (NGO) that spreads awareness of the issues confronted by people living with AIDS, he now holds group sessions in his hometown.
"It's not easy as people don't want to accept that it can happen to them," explained Nazir. "Most of them dismiss me completely by saying extramarital sex does not happen in our society. But when I tell them I'm from the same society, it hits home and they begin to listen. That is when I tell them about other modes of transmission and how to prevent contracting HIV."
Nazir did not return to Pakistan as composed as he is now. "I came back loaded with problems," he said. "I was so troubled I wanted to commit suicide. I still have the skill, but no money. When you suddenly find yourself with so much money and the freedom of being away from home, you lose perspective."
According to Mushtaq Ahmed, general manager (for Sindh) of the OPF, around 80 to 90 percent of HIV/AIDS cases involve high-risk behaviour by migrant workers.
"It is imperative that host countries pitch in if we are to control the spread of HIV/AIDS further. By and large, when the illiterate migrant is sent back because of having contracted HIV/AIDS, he has no idea that it is. He then becomes a carrier and comes home and unknowingly spreads it within his family."
Ahmed believes the migrant should be allowed to continue work in the host country, as the condition does not lead to debilitating illnesses in the early stages of infection. "Once the host country decides there is no choice other than sending the migrant home, he should be counseled and told how he can prevent its spread further," he said.
Dr Farrukh M Ansari, senior programme officer at UNAIDS, wants to see more interaction with NGOs working in the health sector in the host countries. "If we can train people from NGOs to become counsellors and to hold one-to-one pre-departure briefings for migrants, we can overcome some of the problems."
Ahmed of OPF however pointed out that from his experience he finds "such briefing sessions are not very useful".
The trauma of sudden departure, he said, makes it difficult for the migrant to attend such a session, and even were he to, the interaction with a technical person in a language that is not native would only add to the sense of hopelessness and despair. (END/Copyright IPS)
