Experts have been warning that Larkana has “all the ingredients of an exploding HIV epidemic in the near or distant future”.
The Journal of Pakistan Medical Association has been publishing multiple articles over the years, chronicling the spread of AIDs/HIV in Pakistan. One of the experts with multiple articles is Arshad Altaf of the Canada-Pakistan HIV/AIDS Surveillance Project of Canadian International Development Agency. By 2014, he and, indeed, several other experts, were sounding alarm bells.
He wrote that Larkana, a small town of over half a million population “has surpassed” Karachi, a metropolis of almost 20 million persons, in risky practice.
The first major outbreak of HIV in Pakistan occurred in 2003 among persons who inject drugs in Larkana. At that time, a survey revealed that 17 out of 175 such people were confirmed HIV positive.
Larkana is a small town in upper Sindh. The Population Welfare Department estimates that in 2010 the total population of the district was around 1.4 million and that of Larkana city 539,075.
Larkana came into the HIV limelight in June 2003 when the first outbreak of HIV among IDUs was reported in which 17 IDUs out of 175 were confirmed positive.
By 2016, another outbreak was reported in Larkana, this time among dialysis patients in Chandka Medical College. Dawn reported 50 HIV cases. The National AIDS Control Programme did its own investigation. Dialysis patients were screened using the HIV rapid test kits (ImuMedOne Step Diagnostic Test). Fifty-six of 205 patients (27.3%) tested HIV seropositive.
Injection drug users and commercial sex workers are the high risk groups.
The Sindh AIDS Control Programme started working on prevention and control of HIV infection in Karachi, Hyderabad and Sukkur in 2006. The clientele of sex workers were unmarried or married men, migrant workers and long distance truck drivers living away from home. Condom use in paid commercial sex in Sindh has also been quite low (6.7%).
Larkana is a unique town in Pakistan because of an unusual pattern of multiple commercial sex activities happening here. In 2014, in a commentary piece in the JPMA, experts Ashraf Memon, Sameera Haider and Arshad Altaf noted that Larkana had a “functioning brothel where clients from all over district as well as from the other cities visit female sex workers in [the] day time for commercial sex”.
They noted that the city had “home-based sex workers”, at least two musafirkhanas (motels) on Station Road in the middle of the city where hijra and male sex workers were available “round the clock”. At that point in time the rates were as low as Rs50.
The average number of clients for female sex workers in one month was 76 while 48% of all commercial sex workers in Larkana did not use a condom in their last paid encounter, the experts noted.