Pakistani women hold HIV infected children in Wasayo village in Sindh province on May 8, 2019. Photo: AFP / Rizwan Tabassum

Hundreds of people – including over 300 young children – are reported to have been infected with HIV in a district in southern Pakistan in a health scandal said to have been exacerbated by a doctor who allegedly used a contaminated syringe.

More than 500 people have been found with the disease and the “toll” appears to be rising quickly amid ramped up screening by health officials dispatched to Larkana district in Sindh province to help manage the crisis.

Teams from the provincial health department reportedly shut down two dental clinics on Wednesday in Ratodero subdivision, where syringes were allegedly being reused, Dawn reported. The newspaper said 524 people had been found with the disease by late Wednesday.

The repeated use of dirty syringes and rampant malpractice – often by unqualified or “quack” doctors – were given as key reasons for the latest outbreak.

IV drug use, unscreened blood

But Dr Naseem Salahuddin, a local specialist in infectious diseases, said “Larkana has been a hotbed of intravenous drug users” for decades and that “an astounding 27% are infected with HIV”.

“Moreover, unlicensed and unsupervised blood banks in the city either do not screen donors’ blood or use substandard kits for testing, thus eluding the true state of infection.”

Dr Naseem said a “deadly combination” of intravenous drug users and such people donating their blood to commercial blood banks had allowed the infection to be transferred to the general population.

The recent spate of HIV cases was noticed by pediatricians with knowledge of the disease who, she said, realized “that an unusually high number of children — whose mothers were uninfected — were being referred to their centers.” They alerted the National AIDS Control Program in Islamabad.

More than 9,000 people have been screened over the past week or more with unauthorized laboratories, blood banks and clinics shut down.

‘Gross negligence or malicious intent’

AFP said there had been a surge of anger and fear among families in Wasayo, a poor village outside Larkana “hit hard by the epidemic, which authorities say could be linked to either gross negligence or malicious intent by a local pediatrician”.

“They are coming by the dozens,” a doctor said at a makeshift clinic, struggling to cope with a lack of equipment and personnel to treat the surging number of patients.

Nisar Ahmed arrived at the clinic in a furious search for medicine after his one-year-old daughter tested positive three days earlier. “I curse [the doctor] who has caused all these children to be infected,” he was quoted as saying.

Others worried that their children’s futures had been irreparably harmed after contracting HIV, especially in a country whose masses of rural poor have little understanding of the disease or access to treatment.

“Who is she going to play with? And when she’s grown up, who would want to marry her?” asks a tearful mother from a nearby village, who asked not to named, of her four-year-old daughter who just tested positive.

A Pakistani doctor said to be partly responsible for the HIV outbreak is seen behind bars at a police station in Ratodero in southern Sindh province on May 9. Photo: AFP / Rizwan Tabassum

Second-fastest growth rate in Asia

Pakistan was long considered a low prevalence country for HIV, but the disease has been expanding at an alarming rate among intravenous drug users and sex workers. The country had about 20,000 new HIV infections in 2017 and now has the second fastest growth rate for HIV across Asia, according to the UN.

The country lacks access to quality healthcare following decades of under-investment by the state and impoverished rural communities have been especially vulnerable to unqualified medics.

“According to some government reports, around 600,000 quack doctors are operating across the country and around 270,000 are practicing in the province of Sindh,” UNAIDS said in a statement.

Provincial health officials have also noted that patients are at particular risk of contracting diseases or viruses at these clinics, where injections are often pushed as a primary treatment option.

“For the sake of saving money, these quacks will inject multiple patients with a single syringe. This could be the main cause of the spread of HIV cases,” said Sikandar Memon, the provincial program manager of the Sindh Aids Control Program.

Authorities investigating the outbreak in Sindh say the accused doctor has also tested positive for HIV.

From a ramshackle jail cell in the nearby city of Ratodero, he denied the charges and accusations he knowingly injected his patients with the virus, while complaining of being incarcerated with common criminals.

But for the parents of the newly diagnosed, the ongoing investigation means little if they are unable to secure access to better information and the necessary drugs that can help stave off the deadly AIDS virus.

– with reporting by AFP

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