December reminds us of an incurable pandemic – AIDS (Acquired Immunodeficiency Syndrome) caused by a virus named HIV (Human Immunodeficiency Virus) – that has taken millions of lives globally. AIDS awareness month is observed every December.

Decades of rigorous awareness and educational campaigns, both by governmental and non-governmental organisations about AIDS transmission and prevention, have succeeded in abating the many fears and myths associated with the disease. People today accept AIDS as a medical condition instead of a social or moral inadequacy.

The HIV virus can be transmitted via different modes such as contact with infected blood e.g after blood transfusion, sharing syringes with someone who has AIDS, sexual contact where the HIV virus is transmitted through infected semen or vaginal fluids, and from mother to child during delivery or after breastfeeding. Today, the public is relatively aware of the above mentioned routes, but two modes which have failed to achieve recognition, particularly in Pakistan, is the spread of AIDS through unscreened dialysis procedure and by the usage of the same razor blade on multiple customers by roadside barbers.

Last week, a patient of Chronic Kidney Disease (old term: Chronic Renal Failure) who was on regular dialysis, came to a tertiary care hospital with complaints of unexplained fever and significant weight loss. Initial investigations revealed no apparent cause of the symptoms.The patient was then tested for HIV using ELISA and western blot techniques which came out to be positive and was later re-confirmed. This sudden and unexpected diagnosis of AIDS shattered the whole family who was left to mourn the passing away of their patient the very next day.

The kidney is one of the most sensitive organ which malfunctions in a number of common diseases such as diabetes,hypertension, heart failure, and AIDS. Patients who have a chronically sub-functional kidney have to undergo dialysis wherein the blood containing nitrogenous wastes (which the failing kidney is unable to excrete in urine) is removed from the body, entered into a dialysis machine, cleaned and then transferred back into the body.

Unfortunately, many peripheral centres of dialysis across Pakistan, where hundreds of patients undergo the procedure daily, do not screen their patients for HIV resulting in transmission of the virus and loss of precious lives. There is an urgent need to educate healthcare workers regarding the importance of HIV screening among patients undergoing dialysis. At the same time, blood testing authorities should also license dialysis centers after checking all machines for hepatitis and AIDS viruses. Those facilities which do not use necessary screening kits before starting dialysis, must be blacklisted and shut down.

Furthermore, despite of the widespread awareness programs our barber shops, especially the open-air roadside establishments, are still a major source of harbouring the HIV virus. The practice of using the same razor blade on multiple customers is how the HIV virus takes its leap. Recently, I saw a patient who complained of breathing difficulty. His history was insignificant but digging deeper he was found to be a frequent visitor of a local street barber. Soon after, a diagnosis of respiratory failure was made which was secondary to pneumocystis jiroveci pneumonia – which is an AIDS-defining condition.

The World Health Organization estimates that globally 9.4 million people who have AIDS are unaware of their disease. In Pakistan alone, hundreds of thousands remain undiagnosed. Owing to anti-HIV (anti-retroviral) medicines, much progress has been made in terms of controlling AIDS and improving health and longevity of patients, but unfortunately no functional cure has yet been found. It is therefore imperative that we focus our attention, more than ever before, on preventive and screening measures so that the death sentence, which AIDS is, can be contained.