Pakistan’s Sindh grapples with outbreak of HIV infections

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A Pakistani paramedic takes a blood sample from a baby for a HIV test at a state-run hospital in the southern Sindh province. (AFP)
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Staff of Sindh AIDS control programs screen patients for HIV at Ratodero in May. (AN Photo)
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Staff of Sindh AIDS control programs screen patients for HIV at Ratodero in May. (AN Photo)
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Women and children line up outside a free medical and screening camp in Ratodero. (AN Photo)
Updated 11 July 2019
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Pakistan’s Sindh grapples with outbreak of HIV infections

  • Experts describe the HIV outbreak in a small town in Sindh as the tip of the iceberg
  • Police hold a pediatrician responsible but health officials say his treatment may not be the only source

KARACHI: A controversy simmers on in Pakistan since police in the southern Sindh province put the blame for a sudden outbreak of the virus that causes AIDS on a single pediatrician, accusing him in April of using contaminated syringes while treating his patients.

Positive results were found in the blood tests of hundreds of people for the human immunodeficiency virus (HIV) after a mass screening was undertaken between April 26 and June 6 in Ratodero, a small town on the outskirts of the city of Larkana.

Local doctors and health officials have questioned the police’s theory, pointing out that many of the new cases had never been handled by the pediatrician in question, Dr. Muzaffar Ghangharo.

“Over 32,000 people were screened in a population of over 300,000 and 899 had a positive result in the blood test for HIV,” said Dr. Ghulam Shabbir Imran Arbani, the first medical practitioner to report HIV cases to the media. “If a mass screening is done across the province, we are likely to discover that the situation in Ratodero is just the tip of the iceberg.”

According to estimates, Pakistan is registering about 20,000 new HIV infections annually even as, globally, the number of people newly infected with HIV, especially children, and the number of AIDS-related deaths have been declining.

The National AIDS Control Program estimates that 60,000 people carry the HIV virus in Sindh, and estimates that there are 9,500 AIDS cases. Only Punjab, Pakistan’s biggest and most populous province, has heavier HIV and AIDS caseloads.

Authorities in Pakistan realized there was an HIV outbreak in Ratodero when Dr. Arbani raised the alarm in April this year after 18 local children tested positive for the virus.

HIV, which is incurable, kills or damages the body’s immune system cells; AIDS is the name given to a number of potentially life-threatening illnesses that can happen when the immune system has been severely damaged by HIV. However, most people with HIV do not develop AIDS if they receive regular antiretroviral therapy. These medications have reduced AIDS deaths in many developed countries.

Sindh police insist Dr. Ghangharo was solely to blame for the spread of HIV and have charged him with criminal negligence.

“The joint investigation teams (JIT) has held Dr. Muzaffar Ghangharo responsible for spreading the virus by using contaminated syringes while vaccinating his patients,” Sartaj Jagirani, a local police officer in Ratodero, told Arab News.

He said he could confirm on the basis of statements made by family members up to 123 cases involving children infected by HIV after being treated by Dr. Ghangharo. “The doctor is guilty,” he said.

However, Dr Ramesh Kumar, the medical superintendent of Ratodero’s Taluka Hospital, said Dr. Ghangharo could be one of multiple sources of the HIV outbreak. “There are children with HIV infection belonging to other towns who went to other doctors for treatment,” he told Arab News.

“If a mass screening is conducted in other parts of Sindh, the results will not be different.”

According to Dr Arbani, the situation calls for extraordinary measures with “25 children and two adults having died, indicating that HIV has reached the next dangerous level of AIDS in certain cases.”

“Since medical malpractice persists across Sindh province, there should be a mass-screening program to save people from dying.”

Mass screening is usually conducted in “key HIV populations,” said Dr Safdar Kamal Pasha, who consults for WHO on HIV/AIDS in Pakistan.

WHO has cited several possible causes for the HIV outbreak.

“Preliminary results reveal that the major cause of the outbreak is the repeated use of unclean needles and syringes and unsafe blood transfusion,” said a statement issued after the conclusion of a WHO-led joint UN investigation into the outbreak.

Speaking to Arab News, Dr Pasha said: “Unsafe injection practices and poor infection control are among the most important drivers of the outbreak.” He also noted that this was not the first outbreak of HIV cases in Sindh.

The first outbreak had its roots in the practice of sharing needles by addicts to inject drugs, he said, adding that the second one mainly affected transgender people. 

“The third outbreak occurred in 2016 when a patient of chronic kidney disease in Chandka hospital tested positive” in the blood test for the HIV virus, Dr Pasha said. “Later, 46 other patients who used to use the hospital for blood transfusion showed a positive result for the virus.” 

In rural Sindh, public awareness of HIV and other serious infections is poor, which means very large numbers of people are ignorant about how the virus is transmitted.

There is also the stigma of HIV infection, which can cause people to act in insensitive ways even towards even family members when they get a positive result in a blood test for the virus.

In one tragic incident, a man strangled his wife on May 30 after she had a positive result in her blood test. “The husband, who himself had not undergone HIV screening, claimed his wife had an affair with a man, implying that she had contracted the virus from someone else,” Farooq Amjad, a police officer, told Arab News.

Dr Arbani said the woman’s murder reflected a social attitude that victimizes people whose blood test for HIV yields a positive result. He recalled a case where a father was unwilling to have his 16-month baby tested for the virus, arguing that it was meant only “for adults with bad moral character.”

During an awareness campaign in one village in Sindh, Dr Arbani said, he came across a woman who had been tied to a tree like an animal. “The family told us she was HIV positive and would spread the deadly virus if she was not tied properly to the tree,” he said.

WHO says its team has found widespread social stigma associated with HIV infection. This, it adds, “can be crippling for those experiencing [HIV symptoms].”

To fight misconceptions at the social, political and religious levels, a high-level UNAIDS delegation recently met Maulana Fazlur Rehman, of the Jamiat-e-Ulema-e-Islam (JUI-F) party.

Murtaza Wahab, a spokesperson for the Sindh provincial administration, said authorities swung into action as soon as the latest HIV outbreak was reported.

“The Sindh government has allocated Rs1 billion ($6.37 million) in its 2019-20 fiscal budget for an endowment fund for the welfare and well-being of HIV-affected patients,” he told Arab News.

Dr Pasha said WHO was satisfied with the response of the government to the HIV outbreak. 

“These include action against unregulated blood banks, a crackdown on fake doctors and emphasis on the use of auto-destroyable syringe,” he said.

However, treatment is a different matter. Of the positive cases in Ratodero, only 43 percent are receiving anti-retroviral treatment due to insufficient stocks in the country, WHO said, adding that current stocks are enough to meet the needs of 240 children until July 15. This leaves many other children who have tested positive without treatment.

 

 

 


Monsoon flooding death toll rises to 152 in South Asia

Updated 38 min 57 sec ago
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Monsoon flooding death toll rises to 152 in South Asia

  • At least 90 people have died in Nepal and 50 in northeastern India’s Assam state over the past week
  • South Asia’s monsoon rains, which hit the region from June to September, are crucial for the rain-fed crops planted during the season

GAUHATI, India: The death toll in monsoon flooding in South Asia has risen to 152 as millions of people and animals continue to face the brunt in three countries, officials said Saturday.
At least 90 people have died in Nepal and 50 in northeastern India’s Assam state over the past week. A dozen have been killed in Bangladesh.
Shiv Kumar, a government official in Assam, said 10 rare one-horned rhinos have died in Kaziranga National Park since the Brahmaputra River burst its banks, flooding the reserve.
Some 4.8 million people spread over 3,700 villages across the state are still affected by the floods, though the frequency of rains has decreased in the past 24 hours, the Assam Disaster Response Authority said. More than 2.5 million have also been hit by flooding in India’s Bihar state.
Amid the flooding, 20-year-old Imrana Khatoon delivered her first baby on a boat in floodwaters early Friday while on her way to a hospital in Assam’s flooded Gagalmari village, locals said. The woman and the newborn were brought back to their home without getting to the hospital.
Community health worker Parag Jyoti Das, who visited the family, said there were no post-delivery health complications. However, the mother and the child were moved to a hospital on a boat to the nearby town of Jhargaon because of unhygienic conditions due to floodwaters, Das said. The health center in Khatoon’s village was flooded and closed.
“I would have felt happier if the baby’s father was here,” said Khatoon, whose husband works in a hotel in the southern state of Kerala.
More than 147,000 people have taken shelter in 755 government-run camps across Assam, officials said.
Authorities warned they would take action against suppliers who were reported to be distributing poor quality rice and other essentials to marooned people and inmates of temporary shelters at some places.
“We have ordered the arrest of those unscrupulous elements supplying substandard materials and playing with the lives of the affected people,” said Himanta Biswa Sarma, Assam’s finance minister.
In Nepal, the Home Ministry said about 36,728 families were affected by the monsoon rains. The flooding and mudslides forced some 13,000 families to flee their homes.
In at least two of Nepal’s districts, helicopters were used to transport emergency food supplies, while other transport means were being used to move tents and other supplies to the victims.
South Asia’s monsoon rains, which hit the region from June to September, are crucial for the rain-fed crops planted during the season.