Could one pediatrician be the cause of Pakistan's new HIV outbreak?

LARKANA, Pakistan — A two-year-old boy shivered in the lap of his mother. His head was shaved and tears welled up in his eyes. 

“This is my youngest son," the mother said while waiting in the corridor of a local hospital in Larkana, a city in the southern province of Pakistan. "He's got some skin rashes, suffers from frequent fever. He can’t breathe properly.”

Doctors later conducted tests and found the boy was HIV positive. More patients with similar symptoms followed and panic gripped the city. 

Since April 23, paramedics have taken blood samples from at least 14,800 people. As of May 20, 607 were tested HIV positive, including 494 children. The screening continues amid the fear of a larger epidemic.

“It looks like the reuse of syringes and drip sets by a large number of quacks in this area is the contributing factor," said the World Health Organization (WHO) consultant Arshad Altaf.

With the severe health crisis looming over Larkana, the government dispatched a health team from Karachi and set up several test labs at a local hospital. 

A large crowd of parents along with their children stand in queues outside these labs for long hours.  

Gulbahar Shaikh got his seven children tested in one of the labs last week. “All my family members are fit except for my two-year-old daughter who has been diagnosed with the virus,” he told TRT World. 

His daughter Rida Batool, he said, suffered from a chest infection last winter. 

"We visited the clinic of a child specialist Dr. Muzaffar Ghanghro. He gave a drip to my daughter. I think the needle carried the infection,” Shaikh said.

With many complaints against Ghanghro, the blame for the outbreak became focussed on the pediatrician, who runs the only pediatric clinic in the area. 

“I have personally seen him using the same syringes and drip sets on multiple patients,” said Agha Zahid Mirani, who recently lost his three-year-old son to the HIV virus. 

The death of Mirani's son and 15 other children suspected to be HIV positive made the headlines in the local media a few months ago but didn’t make it into the international media. 

“He was my only son and I had enrolled him in Montessori English medium school," Mirani told TRT World. "My son turned pale. He lost weight and suffered from the bouts of severe fever, flu, and cough.”

He added: “No one is HIV/AIDS carrier in my entire family. We took our son to different clinics and bought medicine from different stores. I don’t know who played with my son's life.”

The police pressed charges against Ghanghro, accusing him of infecting "dozens of his patients" with HIV.  

“This doctor is himself suffering from AIDS," Deputy Commissioner Larkana Mohammad Noman Siddique told TRT World. "He frequently gave injections to patients with reused syringes and IV cannulas. He has infected around 42 people.” 

Siddique said the police have collected strong evidence against the doctor and also sealed his clinic. 

But Ghanghro has refuted the allegations saying he was the only qualified doctor in the area and would not have even thought about administering injections with used syringes. 

“My screening test was conducted in the police custody and turns out I am HIV positive," he said. "It is really a surprise for me because I have no viral complications." 

Ghanghro said one of his legs were fractured in a road accident about two years ago and doctors gave him a blood transfusion. “They may have injected me with unsafe blood where from the virus is being transmitted,” he said.

Pakistan has 165,000 HIV cases and according to health experts, 90 percent of them are from the Sindh and Punjab provinces alone. HIV virus is transmitted through medical malpractice, unsafe blood transfusions and needle reuse among drug addicts and sex workers. 

According to local journalist Aijaz Kunbhar, who has been covering this issue, people being diagnosed with HIV is not a new phenomenon. “Around eight children and one woman have died a few months ago,” he said, adding that there's hardly a village left in Larkana's Ratodero Town where someone is not infected. “There is a village which has around 19 HIV positive carriers. All are getting the medicines from the Global Fund [an NGO]."

Prior to 2003, health officials said unprotected sex was the common cause of HIV transmission in the area. Later, several HIV surveillance reports came to the common conclusion that needle abuse was the main source. And 30 percent of drug addicts infected with HIV pass on the virus to their partners through sexual encounters, according to various reports.  

Dr. Arshad Altaf of the World Health Organisation said the spread of the virus is also linked to major failures in the country's healthcare system. "It's the dismal performance of government healthcare system where doctors work only until 2pm, which has resulted into mushroom growth of private clinics and a large number of quack practitioners," he said. 

It remains to be seen whether it is Ghanghro who is the sole cause of spreading the virus or whether there is more to the scandal than meets the eye. But Dr. Fatima Mir, an expert from Aga Khan University, said she's examining the virus and its history in the area. "After the research, we can find out how it has affected people and how old is it,” she said.