Allegations abound in this small Pakistani town of Ratodero, in the province of Sindh. Stung by poverty, pediatricians, barbers and dentists alike brave the risk of transmitting fatal and incurable HIV infection by sharing the same needles, tools and blades for multiple patients and clients, without sterilizing them in between uses. Now, 900 children have tested positive for HIV, and 200 adults, since the epidemic was confirmed in April 2019. And 35 However, testing is far from over, with only a quarter of the city’s 200,000 population covered so far.
Digital illustration of HIV Virus in Blood Stream. Image Credit: RAJ CREATIONZS / Shutterstock
Grief and death in Ratodero
Today, Imtiaz Jalbani sits grief-stricken, with all four of his surviving children having been diagnosed as HIV-positive. The youngest two are already dead. He is the face of a mysterious spreading illness that left children battling for life with soaring fevers that refused to come down with all treatments. With panic spreading, the word was out that there was a sick child in almost every family. This led to official investigation, resulting in the news that the illness was none other than HIV, but targeting children. He. Hoping for more rapid government action, he contacted.
A local doctor first noticed the many children visiting his practice with persistent fevers. Once the epidemic turned out to be HIV, he tipped off a journalist, Gulbahar Shaikh, hoping to get rapid official attention and help for the devastated town. Gulbahar Shaikh reported the news both to the community and the nation – but was horrified to find that many of the patients who were newly diagnosed had taken their children to the same pediatrician he had. On having his family tested, his worst fears came true –his 2-year old daughter had the dreaded virus. Meanwhile, 35 children have died already.
Doctor of death
Initially, the allegations centered on this pediatrician, named Muzaffar Ghanghro, who charged only 20 cents a visit, making his clinic among the most affordable in this city. Many of his patients, including Jalbani, have reported seeing him reusing dirty syringes on their children. The police and health department investigated these charges, leading to his arrest under charges of negligence and manslaughter.
However, he was not convicted and is now a GP at a public hospital outside the city. He renewed his medical certificate earlier this year. All this has happened despite the fact that reusing syringes is a non-bailable offence in Pakistan.
The doctor, predictably, says he never reuses syringes, and is innocent of all the accusations leveled against him. Health officials, while not exonerating him, say he is unlikely to be the only cause for the epidemic. The reuse of syringes is routine in this city, as is the use of unsterilized tools to pull teeth by the roadside, and the use of the same razor blade on all customers in barber shops. And unqualified doctors number in hundreds of thousands – Sindh itself has over 250,000 of them, among the 600,000 making an unlawful living off hard-pressed patients in Pakistan.
HIV-positive – a death warrant in Ratodero
The status of the newly diagnosed HIV-positive children is precarious. Shunned by family and friends, they are segregated at school and often find themselves alone. The widespread illiteracy makes explaining the true nature of HIV transmission a tedious chore in most areas of Pakistan, where it is widely believed to occur even by touch. One HIV-positive woman was strangled by her husband, while another was tied to a tree until police intervened. Even now, she is kept under strict confinement to a single room, unable to move out of it.
HIV in Pakistan – the situation
And it’s not just Ratodero, unfortunately. The number of HIV cases has doubled from 2010 onwards, to 160,000, reports the United Nations task force on HIV and AIDS. Among those aged 15 -24 years, the percentage of new infections has gone up by almost 40%. And this is with minimal testing at population level. No less than 8 outbreaks of HIV have occurred in Pakistan, and this is the second in Ratodero itself – in 2016, there were 1,500 adult male victims who had contact with infected prostitutes, according to official data. Yet the current wave is remarkable for targeting children below 12.
The Pakistani government has clamped down on unregistered doctors practicing in clinics and on illegal blood banks, and found a shocking number of facilities were reusing syringes. However, now that the first wave of media attention is over, it is business-as-usual for many of these establishments.
Governmental reactions have been incredibly slow, with scanty resources to fund expensive HIV testing on a city-wide status, much less to provide treatment to the 1,100 already sick patients. Pakistan has called for international help, and hundreds of testing kits have come from the WHO (World Health Organization). Many international teams have also come to Ratodero to help set up testing centers. Meanwhile, all over Pakistan, only one in 10 HIV-positive patients are under regular treatment. The national health budget allocates almost nothing to HIV control. Most such programs are funded by other countries, whether for testing, or for retroviral therapy.
The whistleblower, Dr. Imran Akbar Arbani, who first tipped off the media about the epidemic, says sorrowfully, “Unless these quack doctors, barbers and dentists are not checked, the number of incidents of HIV infection will continue going up.” Yet public reaction against these sources of infection is muted, most attributing their children’s disease to fate or God’s will. As one mother of a 3-year old victim says, “It seems it is God’s affliction on us. How could so many of our children have such a terrible disease?”
Experts urge to promote healthy movement behaviors in children under five in Europe