Pakistan’s Sindh grapples with outbreak of HIV infections

1 / 4
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)
2 / 4
Staff of Sindh AIDS control programs screen patients for HIV at Ratodero in May. (AN Photo)
3 / 4
Staff of Sindh AIDS control programs screen patients for HIV at Ratodero in May. (AN Photo)
4 / 4
Women and children line up outside a free medical and screening camp in Ratodero. (AN Photo)
Updated 11 July 2019

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.

 

 

 


US officials push to revive Afghan peace talks

Updated 22 October 2019

US officials push to revive Afghan peace talks

  • High-level delegations in Kabul meet government, Taliban

KABUL: Top US officials including Defense Secretary Mark Esper and House of Representatives Speaker Nancy Pelosi are pushing for the revival of Afghan peace talks, despite President Donald Trump abruptly declaring the peace process dead.

Esper, who was making his first visit to Afghanistan as defense secretary, met President Ashraf Ghani and Chief Executive Dr. Abdullah Abdullah.

“The aim is to still get a peace agreement at some point, that’s the best way forward,” Esper told reporters who were traveling with him.

Multiple rounds of talks to end the fighting have been held between the Taliban and diplomats in a process led by US Special Representative Zalmay Khalilzad, with the Afghan government excluded at the insurgents’ insistence.

Pelosi, after meetings with Ghani and Abullah that were also attended by diplomats and the top US military commander in Afghanistan, said she had discussed the issue of peace talks with the Taliban.

“Our delegation received briefings from (US) Ambassador John Bass and other top diplomats on reconciliation efforts with the Taliban … We underscored that the women of Afghanistan must be at the table for reconciliation talks.”

Ghani discussed the Sept. 28 presidential election, bilateral matters and the peace process with Esper and Pelosi, his office said. 

“Peace is a priority for us, a peace which is led and owned by Afghans and the values of the constitution and women are protected in it,” a presidential palace statement cited him as saying.

Abdullah said he was backing the revival of talks and was ready to make a sacrifice for “real peace.”

“During a fruitful meeting with Pelosi, we exchanged views on the credibility of Afghan elections, credibility requisites, prospects for peace/political settlement. Peace is one of the priorities of the Afghan people and we are supporting these efforts and I am ready for any kind of sacrifice for gaining real peace and for the cessation of war.”

He, unlike Ghani, did not emphasize the need for the peace talks to be owned and led by Afghanistan, but stressed on keeping the gains made since the Taliban was removed from power.

Trump tasked Khalilzad with finding a peaceful solution to the war and the eventual withdrawal of US troops from the country. However the process was thrown into chaos when the president tweeted last month that he was canceling peace talks with Taliban leaders at Camp David after the group claimed responsibility for a Kabul attack that killed a US soldier and 11 other people.

Khalilzad made a surprise stopover in Pakistan earlier this month at the same time that Taliban delegates were on a visit to the country and, according to foreign media reports, discussed the revival of peace talks with the group which the US had toppled from power more than 18 years ago.

Waheed Mozhdah, an analyst who knows the Taliban’s leaders, said the US had already established contact with the group and was keen to sign a deal but was concerned about a potential political crisis between rivals Ghani and Abdullah who are the main candidates in the presidential poll.

The vote was twice delayed, while the initial results of the ballot have not yet been disclosed due to technical issues.

“Now everything has to wait for the result of the election … it seems the Americans are concerned that if it signs the deal with the Taliban now and a crisis begins due to the election, then it will make America’s position weak,” he told Arab News.

“Through these trips, American officials are trying to persuade both sides (Abdullah and Ghani) to respect the result of the election so that when the time of intra-Afghan dialogue starts with the arrival of a new government, the Taliban does not argue that there is a crisis with the government.”

He said Esper’s comments about troop withdrawal was part of the deal Khalilzad had discussed with the Taliban before Trump’s interjection. 

“Americans are confounded since Trump has come to power. First he pushed for the talks, then he canceled the talks and now wants them to be resumed,” he said.

Zubair Shafiqi, another analyst, said troop drawdown was a Trump goal that was aimed at his domestic audience and his re-election campaign next year.

He said Washington had come to the conclusion that the presidential election in Afghanistan would go to a second round, and that the visits by top US officials in recent weeks was aimed at telling leaders in Kabul that they had to brace for the formation of a broad-based interim set-up which should involve the Taliban too.

“I think Americans think that with the low turnout based on (last month’s) election, there will be no strong government in Afghanistan, so it is trying to convince the key sides that they have create a government in understanding with the Taliban,” he told Arab News.