Dirty Needles, Social Stigma Contribute to Troubling HIV Outbreak in Pakistan: Public Health Watch

The Trump administration may be talking about ending the HIV epidemic by 2030, and researchers may be touting a new treatment that effectively eliminates person-to-person transmission, but for children in Pakistan—not to mention other regions in the developing world—the virus is and will likely remain a very real threat.

That’s the underlying message, experts say, of recent reports regarding an outbreak of HIV among 494—and counting—children in the country’s Sindh province, in particular in the largest city in the region, Larkana. The city and province are located in the south-central part of Pakistan, not far from the border with regional rivals India.

“Almost all under-privileged countries of the world face similar problems,” Braira Wahid, an infectious disease researcher in the Department of Life Sciences at the University of Management and Technology in Lahore, Pakistan, told Contagion®. Wahid has published articles on similar outbreaks in the country in the past.

In an NPR report on the Sindh HIV case cluster, officials in the region noted that the virus hardly represents a new clinical challenge. In fact, they said, the province accounts for roughly half of Pakistan’s HIV-positive population of more than 150,000.

“Lack of awareness is a [major] problem,” Wahid explained. “Infected people don’t have enough courage to open up…and they prefer to stay undiagnosed because of the stigma attached with HIV/AIDS. An incident that happened last week…a husband killed his wife after she [was] found [to be] HIV positive. Upon being interviewed, he said he did this to save other family members because the disease is contagious and spread by touching and eating together.”

Closer to Larkana, she added, local officials have confirmed what’s being described as an “honor killing” of an HIV-positive person after the current outbreak became public.

Such crimes are abhorrent, of course, but it would take a person with a particularly hardened heart to pursue such violent punishment against the victims of the most recent case cluster. According to the NPR report, many of the initial confirmed cases involved children as young as 2 months old, and most of them were simply the patients of a local pediatrician whom, it was later revealed, is HIV-positive himself (although he has since told officials he was unaware of his status prior to the outbreak).

Indeed, most of the victims involved here are not part of a so-called “at-risk” group, other than being poor and lacking access to safe—and satisfactory—medical care. Wahid echoed the sources who spoke with NPR in blaming the Sindh outbreak on “unsafe medical practices, specifically use of contaminated syringes.” The NPR report also noted the lack of standards surrounding the provision of blood transfusions in the country. The pediatrician implicated in this case cluster may have used dirty needles to administer vaccines to his young patients—at least that’s the current theory.

“There are millions of quacks or untrained medical practitioners [effectively] spreading different blood-borne infections to massive communities,” Wahid added.

In an effort to take control of the situation, officials in Larkana ordered the offering of free HIV screenings to both children and adults. By May 20^th, according to NPR, some 10,000 people in the area had been tested, with 607 found to be HIV-positive.

For local experts like Wahid, such efforts are, and should be, only the beginning.

“Poverty is also a major issue [in this case],” she said. “The infected communities do not have access to screening and treatment, or they can’t afford it. The global public health community should step forward and help us organize free screenings, run awareness campaigns, and provide free of cost treatment in heavily affected areas.”

Before we have more innocent victims.