Pakistan: Surge of Children with HIV

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world map with AIDS ribbon

Pakistan’s health system has always been notoriously unprincipled and now, more than ever before, is experiencing an unparalleled and urgent need for qualified, medical professionals and up-to-date equipment.

Since 1987, HIV infections have been increasing at an alarming rate in Pakistan.  In 2017, over 150,000 people were reported to be living with HIV.  In 2018, there were another 21,000 cases.

Now there is an unprecedented surge of HIV cases among children in Ratodero Taluka in the Larkana district of the Sindh province in Pakistan, reports the World Health Organization.

HIV and AIDS

Of the 876 people in the Larkana District who tested positive for HIV, 718 were under the age of 15.

Dr. Muzaffar Ghangaro, a paediatrician at the Ratodero Clinic, was arrested by local government authorities for criminal, medical negligence in reusing syringes and other medical equipment that were not properly sterilized and on the suspicion that he was intentionally infecting his patients.  While under custody, police discovered Dr. Ghangaro is HIV positive.

Pakistani children

Parents were drawn to Dr. Ghangaro because he charged only 30 rupees (.57ȼ Canadian) per examination.   It is important to note that he commonly received about 100 patients a day.

Dr. Imran Arbani examined hundreds of children from the Larkana district who were suffering from pneumonia and high fever.  He confirmed an alarming and unprecedented 615 new HIV infections.

What was once normal is now foreign ground

Children with HIV have become social pariah in their villages, no longer permitted to be who they once were – no longer allowed to be with their friends or talk with their neighbours.   While their physical surroundings remain the same, they inherently know that they are not.  It is this intrusive and overwhelming reality that confiscates their playful and exuberant innocence.

Parents are finding it increasingly difficult to care for their children both psychologically and medically - with stigma and urgent medical assistance at the top of the list.  While medication is free of charge in the Larkana district, some parents have to travel from villages much farther away and often wait in long lines while the hospital tries to accommodate the steady surge of children diagnosed with HIV.

world map with AIDS ribbon

Continued epidemiological investigations will determine the magnitude of the event; whether it is acute and isolated, or the beginning of something much larger.

Several risk factors were identified:

  1. unsafe intravenous injections during medical procedures,
  2. unsafe child delivery practices,
  3. unsafe practices at blood banks,
  4. poorly implemented infection control programs, and
  5. improper collection, storage, segregation and disposal of hospital waste.

A new HIV/AIDS ART Treatment Center for children has been established at Shaikh Zayed Children Hospital and concurrently, unauthorized laboratories, blood banks and clinics were closed.

WHO emphatically states the importance of linking all those diagnosed with HIV infection to antiretroviral treatment (ART), where the test should be repeated to rule out errors in diagnosis, and then ART should be started without delay.

The Federal Ministry of Health, WHO, UN partners and academia have created a coalition to identify sources and chains of transmission of HIV, map the high-risk areas, such as injection drug use and mother-to-baby transmission, and identify gaps in HIV diagnosis, care and treatment. 

WHO recommends three different medical tests to establish the diagnosis of HIV infection when a child reaches 18-months-of-age. However, infants less than 18 months of age who are born to HIV infected mother should be diagnosed through nucleic acid testing (NAT)3.

African mother and children

2018 Global Statistics

  • 37 million people are living with HIV
  • 22 million people are receiving antiretroviral therapy
  • 4 million people did not know that they were living with HIV
  • 1 million people are living with HIV in South Africa - the biggest HIV epidemic in the world. HIV prevalence is high among the general population at 18.9%.

In 2017…

  • 8 million people were infected with HIV
  • 940,000 people died from AIDS-related illnesses
  • 7 million people are living with HIV in Africa, which accounts for over two thirds of the global total of new HIV infections.

Since the Beginning of the HIV/AIDS Epidemic

  • 77.3 million people have become infected with HIV     
  • 35.4 million people have died from AIDS-related illnesses
African child

Resources

Additional Resources

Diligencia Investigative Reporting recommends the following articles:

Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. Interim guideline

Government of Canada – HIV and AIDS

Global Health Sector Strategy on HIV 2016-2021, World Health Organization, 2016

Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations – 2016 Update

WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection Recommendations for a public health approach-Second edition

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