A death warrant for Pakistan's drug users

Like in many Asian countries, the issue of opiate use has been prevalent in Pakistan for decades. The causes of opiate addiction in Pakistan are the same as throughout the world with poverty, lack of education and a lack of employment being the central causes. However, whereas in many developed countries their are state provided treatments and counselling as well as charity provided in support, in regions of Pakistan, such as Punjab, these services are provided by a single NGO. Considering the scale of the problem in Pakistan which according to the UNODC has around 620,000 chronic opiate users, of which 125,000 inject on a regular basis, any disruption to these services would be disastrous.

The crippling poverty and lack of education that grips large sections Pakistan has resulted in issues like HIV being posing a far greater threat in Pakistan than in other countries attempting to come to terms with widespread drug use. With 21% of injecting drug users in Pakistan having HIV, drug treatment and provision should be a key public health issue in Pakistan. However, the Nai Zindagi (new life) NGO is the sole provider of service in the Punjab region providing services to some 14,000 users and their partners and families. The drop-in centres provided by the charity who are funded by the World Bank, provide syringes, the treatment of wounds, free shoes and clothing alongside counselling, HIV testing and drug treatment. The crucial service provided by Nai Zindagi has had vital impact on reducing the levels of HIV infection in the areas in operates. In Lahore for example, the level of HIV infection among injecting drug users is 6%, far less than surrounding areas, something that can be directly attributed to the work carried out by the NGO. 

However, these services have been cut after the failure to resolve an ongoing dispute with the new health secretary. After the refusal by the chief executive of the charity to give out the names and contact details of its users, explaining how the confidentiality of its registered injecting drug users is key to its success, the new health ministry refuses to sign the documentation which authorises the world bank’s money to the charity. For harm reduction charities such as Nai Zindagi to work effectively, the patients must trust and have confidence in those providing these services, something which confidentiality guarantees. Breaking the confidentiality agreement in the NGO’s contract would have a disastrous impact on the services provided by the charity. 

The closing down of the charities shelters and services is having a calamitous impact. The 14,000 people who are dependent on the vital services provided aren’t receiving life-saving treatment because of one signature. The spreading of HIV will undoubtedly increase. Where clean needles were once provided on a daily basis, up to 20 users are now sharing single syringes which will have a calamitous impact on the spread of HIV. When one considers that around 50% of injecting drug users in Pakistan are married, many will spread HIV to their unknowing wives who will then pass it on to their children and eventually to the wider population.  A continuous cycle will occur, undermining all the work the charity has done to keep the levels of HIV infection down over the past decade. It is clear therefore that the closure will have a wider impact not only on users but on the families of users who are dependent on the service provided by the charity. The impact on the already overstretched local health services will also be extremely damaging, as they struggle to cope with the increased demand on their services. With the age of users shifting from the 25-35 to 18-30 and the levels of HIV among young users around 60% in some areas, cutting the funding to the vital work this NGO provides would not only undermine all the work they have carried out since 1999, but create a far greater problem for the next generation.