For some while now, little Sarah, just 16 months old, had been suffering from a particularly nasty bout of high fever.
Several doctors had tried to help her and failed. Iman’s mother, scrambling from one doctor to the other in a desperate attempt to save her child, found herself at the doorstep of Dr Imran Akbar’s clinic on February 22 in Ratodero.
“They had done almost all of the tests, including Malaria and typhoid,” said Dr Imran. “She had a chest infection as well so I advised them to get her tested for HIV. When the report came back from the local testing facility, it showed she was HIV-positive. To confirm the result, I sent her to the Aga Khan University Hospital, where the results were similar.”
For Dr Imran, it was a shocking discovery. “Not only because of how young she was but also because neither of her parents had HIV,” he said. “Usually what happens is vertical transmission from mother to daughter but in this the father and mother were negative but the daughter was positive.”
Something didn’t sit right about this and Dr Imran had an uneasy hunch that Sarah’s strange case may not be a lone one. “I started advising HIV tests for all the babies who came to my clinic daily,” said Imran, gesturing with his writing hand.
Fifteen days, 20 HIV-positive patients. All children. Sarah was not an outlier.
“Dr Ghulam from the Sindh Aids Control Programme came to me the next day and told me that he didn’t recognise my reports and threw them aside,” said Dr Imran.
“I informed him that he can have doubts about my reports but he can’t just outright deny them and that the Sindh government should get these children tested themselves with their own kits.”
Health Secretary Saeed Ahmed Awan took notice and government camps were set up.
Different kits produced the same results.
“I have now identified a total of 85 children myself,” he said. “There have been more than 600 cases in the government camp. If we add those together then the number crosses 700.”
And Dr Imran is sure that this figure is just a very small portion of the total number of HIV cases in the region.
“This is just the tip of the iceberg which I have disclosed,” he said with an extra emphasis on the ‘I’. “The actual number, I fear, is in the thousands rather than hundreds. I hope I am wrong.”
What happens to the children who haven’t been diagnosed with HIV then? “The virus transforms into AIDS,” said Dr Imran. “If their CD4 cell count decreases then the virus transforms into AIDS.”
The children and babies who have been diagnosed with HIV have a difficult life ahead of them too. “They cannot miss a single day’s medicine. You know how when you take an antibiotics course, you have to stick to it until the course ends. This is similar but this doesn’t have an end, you have to take it for as long as you live.”
The repercussions don’t end there. With a lack of education, HIV patients have been shown to be shunned not only by friends and peers but also by family. What impact will that have on their mental health? “Depressed,” said Dr Imran, shaking his head. “They will grow up depressed.”
The government, Dr Imran feels, has let down the people by not helping raise awareness. “World AIDS day is observed on December 1,” he said. “I have been trying to raise awareness on the issue for the past 15 years on that day but I have never seen even a single government official do anything in that regard. The SACP was formed 24 years ago. They have existed since 1995, why aren’t they informing people about the ways that HIV spreads? More information has been spread in the past 20 days than had been done in the previous 25 years.”
It may not be long before the country’s collective conscience moves on from these children, whether their numbers are in the hundreds or in the thousands, but for them, there is no moving on from this. These children, most of whom are too young to talk let alone understand what is happening to them, have been given an irrevocable life sentence.
And this, as Dr Imran warned, is just the tip of the iceberg.
Names have been changed to protect identity.