IN July, Baby F* is going to a hospital in Karachi for a third follow-up of her HIV treatment. They will check her CD4 count and viral load and carry out a blood culture test. Her father is hopeful that the virus will grow weaker and soon she will become negative.

Baby F was one of the first children diagnosed with the virus in Ratodero back in March allegedly due to negligence on part of the only children’s specialist available in the vicinity at the time. Her father, Mr Shah, told Dawn that he took her to Dr Muzzaffar Ghanghro as she had a fever, but her condition worsened after he gave her a shot and some medication. “My wife and I took her to several other doctors for check-ups. They would just up her dosage or change her antibiotics. By the time we approached a friend who is also a doctor my daughter was unable to breathe properly with blisters in throat. She was also unable to swallow water, eat and cry. My friend, Dr Imran Akbar Arbani, gave her some instant relief medication and told me to come back the next day. This all happened in the last week of February,” he recalled.

When he returned, Dr Arbani told him that he suspected his daughter might have HIV. The symptoms were all there. “I had seen the same thing last year with a family of seven from the Seelro community, where the parents, their siblings and children also had HIV,” said the doctor. From Feb 22 to March 1, Baby F gave three blood samples to get tested for the virus. “The first test showed a weak strain. I encouraged the family to send a sample to Aga Khan University Hospital for confirmation,” Dr Arbani said. Three days later when the result was out, it was positive, compelling her father to take the child to Karachi. Their first stop was the civil hospital where “doctors refused to accept the reports we had, but agreed to treat my daughter. They did not test her for HIV”, he said. As her condition did not show improvement with the treatment, he father took her to the AKUH. With three days of treatment, there was a difference as “we could hear her cry!” he said.

“I wrote a post about my daughter’s story on Facebook and I’m glad I did as it got the word out and many other people, friends and family members also went to get tested,” he added.

Nearly 3pc people among 20,800 men, women and children screened in recent weeks found HIV positive, according to Sindh Aids Control Programme figures

The outbreak

Since the last week of February, Dr Arbani has confirmed over 80 cases in Ratodero. He claims he has even received some death threats over the nature of his work.

According to Sindh Aids Control Programme, more than 608 people, including over 500 children, out of 20,800 men, women and children who had been screened were found HIV positive.

HIV/AIDS screening camps have been set up in and around Ratodero to identify and contain the outbreak.

A doctor said children aged less than 12 were being referred to Karachi for treatment, while another believed that no one was being treated at the moment. “Right now they are just trying to identify who has HIV,” said the doctor.

Doctor sent to jail, clinic sealed

Residents claimed that Dr Ghanghro, who was sent to jail on judicial remand, was the only paediatrician in Ratodero and surrounding areas. He also saw patients at a basic health unit though his practice left a lot to be desired, they said.

Since his arrest, his clinic has been sealed. “There was zero cleanliness at his clinic. Often you could see used syringes and drips on the consulting table etc,” said a parent whose two children now have HIV.

“My daughter is barely three. I took her to Dr Ghanghro for a shot to cure her fever but things only got worse. Now I’ve found out she has HIV,” said another mother who has brought her daughter to Sheikh Zayed Children’s Hospital in Larkana, roughly half-an-hour drive from Ratodero.

Screening centre

At an HIV screening centre in Ratodero’s taluka hospital, Dr Shah Mohammed Sheikh, an HIV physician with the Sindh Aids Control Programme, says initially they had 500 to 600 people coming in daily. Now their number has dropped to less than half, he says. “We do two tests here which are approved by the World Health Organization (WHO),” the doctor says, explaining that the first test takes seconds to diagnose if someone is HIV positive or not and the second test is carried out to confirm the finding of the previous test.

Since the outbreak, many clinics run by fake doctors have been shut down, Dr Sheikh says. “One good thing that has come out of this is the fact that people don’t ask doctors for injections for a quick fix,” he says.

Waiting in another room for her turn, Begum Ariba says her grandson tested positive for HIV and now she’s brought her entire family for the tests. “My grandson, barely a few months old, had been unwell. We took him to a doctor, not Dr Ghangro, but another doctor who we now know was not qualified,” she regrets.

Reuse of syringes, other causes

In the 2006 outbreak, Dr Anila of the Sheikh Zayed Women’s Hospital said the virus was transmitted mostly through intravenous drug users. Since 2011, she said she had seen nearly 100 patients. But their number had increased in recent months, said the doctor who treats HIV positive pregnant women at her clinic — Prevention of parent-to-child transmission at Sheikh Zayed Women’s Hospital (the only clinic of its kind in upper Sindh). “I used to get maybe two to three women a month. I recently had nine women in a week. There was a woman here who was recently diagnosed at the [screening camp] but her husband is negative. She also had TB. It is suspected that she became HIV positive after a blood transfusion during the delivery of her third child last year. She is currently six months pregnant with her fourth child,” she said while talking to Dawn.

Many women become HIV positive due to reuse of syringes, blood transfusion or because their husbands don’t practise safe sex, according to the doctor.

“HIV is not something that you can cure. You can only contain and treat it. There is no vaccine for this either. The medicine we give is to lower the viral load and keep the patient healthy. These are some of the things I tell my patients,” Dr Anila said, adding that she also gave nutritional guidance and therapy to her patients. Out of the 75 women who have given birth at her clinic, she said, we haven’t had any children with HIV. “In HIV positive mothers, there is a danger of a vertical transfer of the virus. But it is not certain. In many cases this can be avoided if the mother is treated. I encourage HIV-positive mothers to breastfeed their kids for six months at least,” she said, adding that it was imperative to create more awareness on the issue.

According to the medical superintendent of Sheikh Zayed Women’s and Children’s Hospital, one way to ensure people stop reusing syringes is to burn them all. “We have a large incinerator so why not use it to get rid of the hospital waste,” he remarked before going to take a round of children’s hospital as a matter of routine.

• Names of children have been changed to protect their privacy.

Published in Dawn, May 23rd, 2019