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

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.

 

 

 


White House rejects participation in ‘baseless’ impeachment probe against Trump

Updated 27 min 26 sec ago

White House rejects participation in ‘baseless’ impeachment probe against Trump

  • The House Judiciary Committee is to meet starting Monday to review the evidence from investigators and decide whether to charge Trump with abuse of power, bribery and obstruction

WASHINGTON: The White House blasted the impeachment inquiry into Donald Trump as “completely baseless” Friday, signaling it would not seek to defend the president in Democratic-led hearings to draw up formal charges against him.
But Republicans demanded that Joe Biden’s son Hunter, the lawmaker leading the impeachment probe Adam Schiff, and the whistleblower at the origin of the inquiry all testify next week before the House Judiciary Committee.
“As you know, your impeachment inquiry is completely baseless and has violated basic principles of due process and fundamental fairness,” White House chief lawyer Pat Cipollone wrote in a letter to the committee chair, Jerry Nadler.
“House Democrats have wasted enough of America’s time with this charade. You should end this inquiry now and not waste even more time with additional hearings,” he wrote.
Cipollone issued the letter minutes before a deadline to declare whether the White House would deploy representatives to defend Trump against accusations he abused his office by pressuring Ukraine to find dirt on former vice president Biden, his potential challenger in the 2020 election.
Nadler’s committee is to meet starting Monday to review the evidence from investigators and decide whether to charge Trump with abuse of power, bribery and obstruction.
Those charges could become articles of impeachment sent to the full House to vote on within weeks.
If they pass the Democratic-led House as expected, it would make Trump only the third president in US history to be impeached.
That would set up a trial next month in the Republican-controlled Senate, seen as likely to acquit him.
Trump is accused of pressuring Ukrainian President Volodymyr Zelensky to open investigations into Biden and his son, and also into a widely-dismissed theory that Ukraine helped Democrats in the 2016 election.
The US leader is accused of demanding Zelensky announce the investigations in exchange for the release of military aid and a high-profile summit — which Democrats say constitutes bribery.
Democrats also say Trump’s actions amount to soliciting foreign interference in American elections — which is barred by US laws.
Trump denies any wrongdoing but has refused to cooperate with the inquiry, citing his privilege as president to prevent top aides from testifying.
Cipollone told Nadler in the letter that adopting articles of impeachment “would be a reckless abuse of power” and constitute “the most unjust, highly partisan, and unconstitutional attempt at impeachment in our nation’s history.”

Blocking 'key evidence'
He repeated Trump’s tweet of Thursday: “If you are going to impeach me, do it now, fast, so we can have a fair trial in the Senate, and so that our country can get back to business.”
In a statement Nadler accused Trump of continuing to block “key evidence” from Congress.
“We gave President Trump a fair opportunity to question witnesses and present his own to address the overwhelming evidence before us,” Nadler said.
“If the President has no good response to the allegations, then he would not want to appear before the committee. Having declined this opportunity, he cannot claim that the process is unfair.”
Meanwhile the senior Republican on the Judiciary Committee, Doug Collins, announced a list of witnesses his camp wishes to subpoena “to provide context and transparency about the underlying facts at issue.”
Besides Schiff, the list includes Hunter Biden and his business partner Devon Archer, who both sat on the board of a Ukraine energy company Burisma, which Trump allegedly pressured Zelensky to investigate.
Also included were the whistleblower, believed to be a CIA analyst who reported his concerns about Trump’s demands of Zelensky; possible government contacts of the whistleblower; White House national security official Alexander Vindman, whose earlier testimony strongly supported the allegations against Trump.
With the exception of Vindman, there was little likelihood Nadler would accept the witness list.