Reports of the recent HIV outbreak in Larkana’s Ratodero have been alarming, contradictory and mostly damning. In most cases, they showcase the neglect of authorities, but the government says it is working hard to control the situation. As of September 5, 1,038 people have tested positive for HIV, of which 833 are children, according to the Sindh AIDS Control Programme.
Of these 53 were adult males, 152 adult females, 508 male children and 325 female children. In all 34,299 people have been screened at the centre in Ratodero, however, not all of them are from this district.
“Since it was holiday season, a lot of people came from neighbouring towns and villages to spend the holiday with family and got tested,” explained Dr Sikander Iqbal, NGO coordinator at the enhanced HIV/AIDS programme cell of the Sindh health department.
The HIV treatment centre in Ratodero was opened on August 16. Media reports on the HIV outbreak in Larkana have been pouring in since April. Officials say the need for a centre in the district wasn’t felt as there was no outbreak in the district earlier.
Larkana has the second highest number of people living with HIV in the province since 1996 after Karachi, according to district-wise data provided by the enhanced HIV/AIDS control programme.
“Larkana has two treatment centres, one in Ratodero and one in Chandka. The Larkana centre has 786 people registered and 658 have started treatment. Another 152 cases have been detected at the Ratodero centre, out of which 33 are being treated,” said Dr Iqbal.
Why isn’t everyone who tested positive on antiretroviral therapy? “Not all of them are on this treatment because some are in the testing phase. They are tested for other infections first,” explained Dr Aftab Ahmad, a monitoring and evaluation officer at the Sindh AIDS Control Programme.
He added that not every child can be on this treatment because of existing co-infections which need to be treated first. For instance, if a child has pneumonia or tuberculosis, they will be treated for those conditions before starting the therapy for HIV.
“99% of the adults are on this treatment,” said Dr Iqbal. “Starting medicine in HIV is not an emergency. Sustaining it is the important thing. If a patient doesn’t take medicine regularly the virus becomes resistant.”
This happens often in people who inject drugs. “For injecting drug users we don’t start treatment until we’re sure there’s someone to support them and make sure they will take their medicine regularly,” explained Dr Ahmad.
These conversations take place during counselling sessions at the ART centres. Everyone who visits the centres undergoes pre-test and post-test counselling, Dr Ahmad said. During these counselling session, they explain to patients what a positive report means and how best to proceed.
“We also counsel those whose tests come out negative as they may be in the window period and they’re from a high risk population. They have to come back for a test in three months,” he said.
The window period is the amount of time it takes for an HIV test to show the presence of antibodies to the virus in a person’s blood. This can be any time between six weeks to three months, according to the World Health Organisation.
As for future plans to tackle the disease, the officials explained that two more treatment centres are in the pipeline in Sindh. These are the ones established in Nawabshah and Mirpurkhas.
The government in collaboration with healthcare providers, donor agencies and UN partners is also working on a plan to strengthen infection prevention and control and mobilise communities to raise awareness about the disease, they said.