In CRF02-AG in West and Central Africa [11].Fig.2. Worldwide

In central and eastern Africa like Kenya, Uganda, Rwanda and Tanzania and in eastern European (Soviet Union) subtype A of HIV-1 is predominant. While in Americas, Australia, western and central Europe and in some countries of Southeast Asia and northern Africa subtype B is predominant. Subtype C viruses share the burden of almost 50% of all HIV-1 infections worldwide and is predominant in southern Africa and India. The CRFs are accounting for 18% of infection globally and a local form such as CRF01-AE is predominant in Southeast Asia and CRF02-AG in West and Central Africa 11.Fig.2. Worldwide prevalence of genetic forms of group M of HIV-1.  A percentage of total number of HIV-1 forms identified worldwide is shown. Group O and N are not included in this analysis.(Global Epidemic of HIV-1. Worldwide distribution of Human Immunodeficiency Virus Type 1. Pathogenetic and Therapeutic Implications, July 2007)HIV epidemiology in PakistanIn Pakistan the first ever HIV-carrier case was reported in Lahore (the provincial capital of Punjab) in 1987 and after that the number of HIV patients began increasing multifold. As per 2008 census the figure reached to 145 million. Pakistan is one of the Asian countries which are HIV epidemic, characterized by various risk factors. Previously Pakistan was having low prevalence of HIV, but now it falls in the group of ‘Countries in Transition’ with a concentrated epidemic among high risk groups and where the AIDS problem has been increasing for the last five years, according to a national English daily The News and NACP NIH.The number of infected persons is suspected to be running in millions if proper screening is performed. In Pakistan, the behaviors which make the spread of HIV favorable in young people are the negative peer pressure, curiosity about sex and drugs and economic frustration. There are many other serious risk factors which put the country in danger of facing a high spread of HIV, some of them are as extensive poverty, substantial power imbalances in men and women, lack of any system to check the HIV carrier reported persons, labour migration, unselective transfusion of unscreened blood, rising number of drug addicts and little condom use rates.About 9 percent of the tested injecting drugs users (IDU’s) were found to be HIV positive in 2005-2006 and the percentage jumped to 15.8pc in 2006-2007, and it further reached upto 20pc in 2007-2008.As many 97,400 cases of HIV/AIDS were estimated in 2009 and more than 6,000 cases have been registered till now (2010). Till March 2010, 3,325 HIV patients were registered at the National AIDS Control Center NIH Islamabad and 1,425 patients are on ARVS (Figure 3).(A situational analysis of HIV and AIDS in Pakistan, Apr 2011) HIV/AIDS transmission mode in Pakistan ·         The largest mode of HIV/AIDS transmission in Pakistan is heterosexual (52.55%).·         The second largest mode of transmission is contaminated blood or blood products (11.73%).·         Intravenous drug users (IDU’s) (2.02%).·         Male-to-male or homosexual relations (4.55%).·         Mother-to-child transmission (2.2%).·         Transmission due to undetermined origin (26.9%).According to the recent studies, the Pakistan’s major concern is HIV infected IDUs which figures up to 2.5-3.5% during 2004-05. The most alarming thing is that many of these IDUs are professional blood donors where in our country blood transfusion screening is inadequate; only 50% of the transfused blood is screened for HIV. According to the study conducted by Pakistan Demographic Health Survey, 2007-08, from all the four provinces of Pakistan along with FATA and AJK. In the light of the above said study, total 1998 patients were identified as HIV infected out of which, 1765 were HIV positive only while 233 developed AIDS. The study above said study showed that HIV is most prevalent in the Sindh province while least prevalent in AJK (Figure 4). 86.8% of reported HIV positive cases are found to be men. Furthermore 51.88% of the HIV infected men fall within the age group of 20-40 years. 24.59% of the reported cases are of unknown origin, 13.20% are females, and 45.10% of the total HIV carriers acquired the disease through sexual contact 10.(A situational analysis of HIV and AIDS in Pakistan, Apr 2011)The HIV epidemic in Pakistan              NACP: The National AIDS Control Program of Pakistan (Ministry of Health). ANC Study: The Antenatal Clinic Study (2001).                   EACP: The Enhanced AIDS Control Program of Pakistan. HASP: The HIV/AIDS Surveillance Project.                   RT/STI Study: The National Study of Reproductive Tract and Sexually Transmitted Infections (2004).                   IDUs: Injeciton Drug Users. MSWs: Male Sex Workers.  Figure: Timeline of HIV in Pakistan.                                             (Adnan Ahmad Khan (The HIV epidemic in Pakistan, April 2010) Members of high risk groups in major Pakistani cities Population size calculated based on 1998 census data and adjusted according to the Federal Bureau of Statistics provided adjustment for increase in  population.Karachi and Rawalpindi were surveyed in 2005. All other cities were surveyed in 2006 and 2007. IDU: Injection Drug User. FSW: Female Sex Worker. Hijra: Transgenders. MSW: Male Sex Worker(Adnan Ahmad Khan (The HIV epidemic in Pakistan, April 2010)