'Rogue doctor' gives hundreds of people HIV with contaminated needle

More than 500 people have tested positive for HIV in southern Pakistan in an outbreak that local officials have blamed on a rogue paediatrician.

Almost 14,000 individuals have now been screened in the district outside Larkana where the sudden spike in HIV incidence was first detected, said Dr Sikandar Memon, the regional coordinator of the Aids Control Programme.

Of those testing positive, 410 are children, Dr Memon told Pakistani newspaper Dawn. He said that another 29 patients tested positive in the most recent round of blood screening on Wednesday at the main hospital in Rato Dero, 25km outside Larkana, seen as the centre of the epidemic.

A doctor accused of infecting his patients through repeated use of a single, contaminated syringe remains in custody since the outbreak was first reported in late April. Dr Muzaffar Ghangharo, who officials said is himself living with HIV, has been charged but denies the allegations.

Authorities are also not ruling out the possibility that the outbreak is the result of gross, widespread negligence in a region which has a high prevalence of shady medical practices.

UNAids said international partner organisations had joined local teams to try and contain and investigate the outbreak. In a statement, it said there were concerns that about 600,000 unqualified doctors are unlawfully operating in Pakistan, 270,000 of them in Sindh province where Larkana is located.

The outbreak is also bringing attention to the lack of HIV awareness and education among the mostly poor communities of this part of Sindh.

Resources have been stretched to the limit by parents demanding screening for their children and medicines for those testing positive. “They are coming by the dozens,” said a doctor at a makeshift clinic set up to try and cope with the situation.

“We are helpless. I have other children and I am afraid they might catch the disease," a mother whose daughter recently tested positive for HIV told the AFP news agency.

“[Please] send some medicine for our children so that they can be cured. If not, all of our children will die, right?”

The UN says Pakistan now has the second-fastest growing rate of HIV in Asia, with about 20,000 new infections in 2017 alone.

Dr Maria Elena G Filio Borromeo, UNAids’ country director for Pakistan and Afghanistan, visited Larkana to assess the response to the outbreak this weak.

She questioned why the first reports of a spike in HIV cases came from local media and not established official monitoring processes.

Dr Borromeo said children as young as two-months old were affected by the outbreak and said they would be dealing with the consequences for the rest of their lives. The UN’s Global Fund will stop paying for antiretroviral therapy (ART) in Pakistan from December 2020, leaving it up to the local government to cover the costs.

Such outbreaks will continue as long as “the practice of re-using needles and unsafe injection and blood transfusion is common throughout the country”, she told The News Pakistan. “The UN is ready to bring in experts from abroad and introduce best practices… but local authorities [must] prepare mid-term and long term strategies to prevent such outbreaks in future,” she said.