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 millionb7c on 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