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Pakistan
Special Problems: Smoking, Drugs, and AIDS
Smoking is primarily a health threat for men. Nearly half of
all men smoked in the 1970s and 1980s, whereas only 5 percent
of women smoked. Twenty-five percent of all adults were estimated
to be smokers in 1985, with a marked increase among women (who
still generally smoke only at home). The national airline, Pakistan
International Airlines (PIA), instituted a no-smoking policy on
all its domestic flights in the late 1980s. In an unusual departure
from global trends, PIA reversed this policy in mid1992 , claiming
public pressure--despite no evident public outcry in newspapers
or other media (see Transportation , ch. 3). Men also take neswar,
a tobacco-based ground mixture including lime that is placed under
the tongue. Both men and women chew pan, betel nut plus
herbs and sometimes tobacco wrapped in betel leaf; the dark red
juice damages teeth and gums. Both neswar and pan
may engender mild dependency and may contribute to oral cancers
or other serious problems.
Opium smuggling and cultivation, as well as heroin production,
became major problems after the Soviet invasion of Afghanistan
in 1979. The war interrupted the opium pipeline from Afghanistan
to the West, and Ayatollah Ruhollah Khomeini's crackdown on drug
smuggling made shipment through Iran difficult. Pakistan was an
attractive route because corrupt officials could easily be bribed.
Although the government cooperated with international agencies,
most notably the United States Agency for International Development,
in their opium poppy substitution programs, Pakistan became a
major center for heroin production and a transshipment point for
the international drug market.
Opium poppy cultivation, already established in remote highland
areas of the North-West Frontier Province by the late nineteenth
century, increased after World War II and expanded again to become
the basis of some local economies in the mid1980s . Harvesting
requires intensive labor, but profits are great and storage and
marketing are easy. The annual yield from an entire village can
be transported from an isolated area on a few donkeys. Opium poppy
yields, estimated at 800 tons in 1979, dropped to between forty
and forty-five tons by 1985, but dramatically rose to 130 tons
in 1989 and then 180 tons in 1990. Yields then declined slowly
to 175 tons in 1992 and 140 tons in 1993. The area under opium
poppy cultivation followed the same pattern, from 5,850 hectares
in 1989 to 8,215 hectares in 1990. It reached 9,147 hectares in
1992 but dropped to 6,280 the following year. The caretaker government
of Moeen Qureshi (July to mid-October 1993) was responsible for
the reductions in production and area under cultivation; the succeeding
government of Benazir Bhutto has perpetuated his policies and
declared its intent to augment them.
Use of heroin within Pakistan has expanded significantly. The
Pakistan Narcotics Control Board estimates that although there
were no known heroin addicts in Pakistan in 1980, the figure had
reached 1.2 million by 1989; there were more than 2 million drug
addicts of all types in the country in 1991. This dramatic increase
is attributed the ready availability of drugs. There were only
thirty drug treatment centers in Pakistan in 1991, with a reported
cure rate of about 20 percent.
Acquired immune deficiency syndrome (AIDS) has not yet been much
of a problem in Pakistan, probably as a result of cultural mores
constricting premarital, extramarital, and openly homosexual relations.
The effect of poor quality control on blood supplies and needle
sharing among addicts is undetermined. The government has been
slow to respond to the threat posed by AIDS. Cultural and religious
restrictions prevent official policies encouraging "safe-sex"
or other programs that would prevent the spread of the disease.
State-run radio and television stations have made no attempt to
educate the public about AIDS. In fact, the government has minimized
the problem of AIDS in the same way that it has dealt with potentially
widespread alcoholism by labeling it as a "foreigners' disease."
The Ministry of Health, however, has established the National
AIDS Control Programme to monitor the disease and to try to prevent
its spread. During 1993 twenty-five AIDS screening centers were
established at various hospitals, including the Agha Khan University
Hospital in Karachi, the National Institute of Health in Islamabad,
and the Jinnah Postgraduate Medical Center. AIDS screening kits
and materials are provided free at these facilities. By early
1994, approximately 300,000 people in Pakistan had been tested.
A center for AIDS testing has also been established at the Port
Health Office in Keamari harbor in Karachi. Another is expected
to open during 1994 at Karachi Airport. Beginning in 1994, all
foreigners and sailors arriving in Pakistan will be required to
have certificates stating that they are AIDS-free. Certificates
of inspection are already required of Pakistani sailors. All imported
blood, blood products, and vaccines must also be certified.
Data as of April 1994
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