Independent experts in Pakistan say government figures on HIV and AIDS patients are not accurate. They warn underplaying the slow spread of the deadly virus may lead to calamity.
There are officially some 2,200 HIV positive people in Pakistan, of which 246 are full-blown AIDS cases.
But health experts are skeptical of these numbers, saying government methods of counting are based on random testing of only high-risk groups - such as prostitutes and drug addicts - rather than the general population.
The World Health Organization estimates that for every reported case in Pakistan, there may actually be between another hundred to 5,000 people with HIV. That means the current number of infected people could be as high as 200,000.
There are many reasons here why HIV cases do not get reported. One of the most significant is that people who suspect they may have the virus do not seek treatment because of fears of judgment - particularly in strict religious communities in Muslim Pakistan.
Dr. Asma Bokhari is the head of the National Aids Control Program. She admits prejudice is a factor in underreporting, but says the government is working to combat that.
"There is a lot of stigma attached with the disease so there is always under reporting just not in our country, worldwide. But in recent years the numbers [of HIV/AIDS infected people] are going up because of our very heavy electronic media campaign, which we have on for the last 10 years and people do come forward voluntarily for testing as well," says Dr. Bokhari. "But as you understand, because of low literacy levels, lack of education at the rural areas, people who are infected don't come forward."
Dr. Bokhari says the government is further expanding its prevention campaign and blood testing. "The government of Pakistan has approved a very big project with World Bank's support at a cost of $48 million for the prevention activities related to HIV/AIDS in the country," she says. 'And we already have blood safety ordinances [laws] in place in all the provinces and also at the federal level."
Medical experts say these measures are good - but do not go far enough.
Ali Abbas Qazalbash is a microbiologist and researcher [for the international Volunteer Service Overseas] in Islamabad. He says while Pakistan has a low incidence of HIV transmission through sexual intercourse, there are major problems with the nation's blood supply because screening regulations are not being uniformly implemented - especially in rural areas.
"Because of the cost of the testing kit and because of the in-built system that is subject to corruption, these tests are not carried out at the government-level hospitals. In the urban centers it is more accountable," he says. "But in the rural centers, the chances the tests being run are remote, if not at all."
Mr. Qazalbash also notes that the current government AIDS education programs are not tackling the issue head-on because of entrenched social and religious taboos.
"The conservative attitude and the governmental censorship have made it more difficult to create the HIV and AIDS awareness. It has become more of a scare. There is this taboo, you cannot talk about it or, if someone has it, they are shunned from the society rather than counseled and taken care of," he says. "This requires actually the mass movement, which would involve the clergy as well. Because here in our mosques we could use the clergy as people to talk about HIV and AIDS -not as a Western agenda - but as an agenda that would preserve Pakistanis' health."
Maimoona Masood Khan is the head of a private organization, All Women Advancement and Resource Development (AWARD), working with HIV patients in the northwestern border city of Peshawar. She says the government is particularly lax at stemming one of the biggest sources of the virus: Pakistani workers with HIV being deported back home from Persian Gulf countries.
"Once they are deported, our government does not keep any track where these people go. Then these people are not counseled properly," she says. "What happens is they go and disappear or merge into the general public or in their communities and the result is I am getting full families who are HIV positive."
Ms. Maimoona, like a number of U.N. experts, suggests that Pakistan has maybe five years to implement more effective action to stem HIV/AIDS becoming a significant health issue in Pakistan.
"I think [that] in a couple of years' time this is going to become a major issue if we do not take timely action. And we have to get over our own mental inhibitions and blocks," she says. "Look at China, look at India, they were also in the same state as we are today in Pakistan: denial. Sometimes I feel that: who are we fooling? Are we trying to satisfy and fool ourselves, people, what?"
The World Bank special mission report lists Pakistan as a low-prevalence, but high-risk country for HIV infections. It says the most significant mode of transmission is now sexual - from infected men to their families. It says high priority should be given to educating commercial sex workers and their male clients.