Sources of infection still present, says doctor who unearthed outbreak
It has been 19 months since the HIV outbreak in children was unearthed in the town of Ratodero in Sindh’s Larkana district. The news shook Pakistan and made international headlines, but sadly not much has changed since.
On November 30, we finally received an update from the Sindh health department on the number of people screened and infected at the Ratodero anti-retroviral therapy (ART) centre. The last update shared with the media was on June 2.
A total of 42,533 people have been screened, of which 1,540 were positive for HIV. Children made up the bulk of positive cases with 686 male children and 446 female children. The screening also detected cases in 286 women, 121 men and one transgender person. According to the government’s statistics, there have been 38 deaths from HIV infection. The death toll includes 20 male children, 14 female children, three women and one man.
Dr Imran Akbar Arbani, the doctor who first reported the HIV outbreak in Ratodero, however, terms these figures “discordant”. He has been carrying out his own screening at his private clinic in the city.
“After June 2, I collected data on my own of people sent for [HIV] screening and found reactive for HIV,” Dr Arbani told SAMAA Digital. “Those who came for the first time at my clinic, I advised screening because they had a lengthy history of medication [prescribed] by doctors.”
He shared his record with us:
This would bring the total number of HIV positive cases to 1,613. Dr Arbani said the real number was probably higher as these were only patients coming to his clinic.
The urologist added that 44 babies and one young girl had died of AIDS-related illness since the beginning of the outbreak. Five adults had also succumbed to the HIV virus, bringing the death toll to 50.
Most children die from secondary illnesses such as pneumonia, recurrent gastroenteritis, or a failure to thrive. The families take their ailing child from one doctor to another, and by the time they reach the ART centre or Dr Arbani’s clinic, their condition is critical.
Before the HIV outbreak was reported Dr Arbani said he had suspected HIV in young children mainly on symptoms and sent them for screening from “reputable labs like Aga Khan lab and PPHI.”
The most probable cause of the HIV outbreak seems to be exposure to unsafe health care practices, specifically reuse of syringes, needles and drip sets by untrained health care providers, according to Dr Arbani.
The World Health Organisation has listed several other risk factors: unsafe child delivery practices, unsafe practices at blood banks, poorly implemented infection control programs, and improper collection, storage, segregation and disposal of hospital waste.
“The Sindh Healthcare Commission has been taking action against quacks and unsafe practices,” Additional Director of the Enhanced HIV/Aids Control Program Sindh Dr Saquib Ali Shaikh told SAMAA Digital.
I don’t have the authority to close down these facilities and practices, he added. Dr Shaikh explained how the SACP’s functions were mostly programmatic such as setting up the treatment centres, ensuring screening and coordinating with other government bodies to implement programmes.
SAMAA Digital was unable to reach the SHCC for comment.
Dr Arbani, however, says the sources of infection are still present in Ratodero.
Dangerous medical waste is being dumped into the landfill and on streets while incinerators that were provided to hospitals lie packed, he said. Most barbers, goldsmiths and tattoo artists have no knowledge about infection prevention methods such as sterilisation.
“Unauthorised laboratories are again working without pathologists,” he said. “They had been sealed after this outbreak for 3 months.”
One of the most important sources of infection not just in Ratodero but all over Pakistan is the use of piston free syringes. These are reused by medical practitioners and IV drug users. The WHO has repeatedly urged to replace them with auto-lock syringes.
The Drug Regulatory Authority of Pakistan is overlooking auto-lock syringes, Dr Shaikh said. “We can’t switch completely to auto-lock; we have to keep using the conventional syringes too.”
To control the source of infection through syringes and needles, we’re working with the Sindh Blood Transfusion Authority, he added.
An endowment fund of Rs1 billion was announced last June by PPP Chairperson Bilawal Bhutto Zardari for those affected by HIV. There hadn’t been updates on the fund’s disbursement from the government for a while.
“The fund has been partially released,” the SACP additional director said.
Sindh health minister Dr Azra Pechuho wanted mothers to become the beneficiaries, he added. The government believes if mothers are made beneficiaries of monetary schemes they ensure the money is utilised for their children.
Delays in disbursement have also occurred due to documentation problems, according to Dr Shaikh. “Some women don’t have CNICs and other personal documents,” he said.
So far, more than 200 accounts have been opened with the help of Sindh Bank which would help around 200 to 300 children, Dr Shaikh added.