Poor Outlook for HIV-positive Children in Pakistan

By Charlotte Munns
UNITED NATIONS, Jun 20 2019 – Over 785 people have been diagnosed with HIV in Larkana, Pakistan. 82% of those individuals are children, and only half are receiving the treatment they need.

A World Health Organisation (WHO) report titled ‘HIV Outbreak Investigation in Larkana’ rated the situation a Grade-II emergency requiring US$1.5 million to contain. WHO is able to provide only US$200,000 of those funds.

This report comes as it is announced South Africa has attained the UN goal of 90-90-90 diagnosis-treatment-suppression of HIV ahead of the 2020 objective. Pakistan’s recent leap away from that target illustrates the profound disparity in treatment and prevention of HIV across the globe.

On April 25th, a number of children from Larkana, a city in the north-west of the Sindh province of Pakistan, were referred for HIV testing after they exhibited a persistent fever. An initial HIV-positive diagnosis of 15 children aged between 2 and 8 years old prompted a large-scale screening programme beginning on April 28th.

Larkana Deputy Commissioner Muhammad Nauman Siddique wrote in an op-ed, “the results of the screening within the first few days were shocking. The tests revealed that the parents of the HIV-positive children were HIV negative.”

The disease was not spread through those means commonly associated with the disease: sexual intercourse, births and drug use. Perhaps more disturbingly, the outbreak seemed to be due to systemic poor medical practice in the region.

Interviews with parents regarding their childrens’ medical history revealed a local doctor, Muzaffar Ghangro, as a possible source for the outbreak. 123 of the diagnosed patients had been treated at his practice.

Authorities arrested the doctor on charges of unintentional murder. He was later found to be HIV-positive, however there is no evidence that he injected the patients deliberately.

WHO noted, “iatrogenic transmission via unsafe injection practices and poor infection control is likely to be the most important driver of the outbreak.” This includes re-use of syringes, poor disposal of used equipment and little protection between doctor and patient.

UNAIDS Country Director for Pakistan and Afghanistan Maria Elena Filio Borromeo told IPS, “as this practice is widespread in Pakistan, it is likely that the same will happen again if no corrective measures are implemented now.”

Organisations working in the area have also pointed to unsafe cheap circumcisions, sometimes in barber shops, as accountable for some of the cases.

“Around 82% of those infected were children less than 15 years old, and most of these children are also malnourished, have concomitant infections and come from very poor, illiterate families in Ratodero, Larkana,” Borromeo said.

With 20,000 new HIV infections in 2017, Pakistan already has the second largest growing AIDS epidemic in the Asia-Pacfic region. Low literacy rates, poverty, gender inequality and little understanding of the disease increase the risk of transmission in Pakistan.

In response to claims the outbreak was a result of systemic issues in the Pakistani health system, the province expanded testing facilities under the Sindh AIDS Control Program. More than 26,000 people have now been tested.

The Sindh Ministry of Health also instigated a widespread crackdown on unlicensed and informal medical practices, closing more than 900 health clinics and unlicensed blood banks following investigation.

WHO, UNAIDS and the UN children’s agency UNICEF are all on the ground assisting local authorities in containing the outbreak. Despite this support, on June 17th only 396 of the nearly 800 people diagnosed had been referred to their facilities for treatment.

Further, Pakistan is almost entirely dependent on foreign aid. The country has the resources to treat only 240 of the diagnosed patients.

The burden on the healthcare system will only deepen as time progresses. These children diagnosed must now regularly take antiretroviral therapy drugs for life.

Borromeo underscored that the implications of such an outbreak extend far deeper than access to medical services. “The community in general lacks HIV education; myths and misconceptions prevail,” noting that as a result of the outbreak, “stigma, discrimination and even rejection will deepen.”

The Los Angeles Times reported that police in Ratodero, a town in the Sindh Province at the heart of the outbreak, arrested a man for killing his wife after she was diagnosed with HIV. He apparently accused her of having sex outside of the marriage. Borromeo also recalled hearing of a father of four children who hung his wife after learning she was HIV positive.

While over half may not receive treatment at all, the outlook for those children with access to life-saving antiretroviral therapy is one of social isolation. Misunderstandings surrounding how HIV is spread lead to stigmatisation and discrimination.

Systemic issues in the Pakistani healthcare system caused the outbreak in the Sindh Province, however endemic socio-cultural issues mean its effects will be felt long after the outbreak is contained.

‘Born A Refugee, I Dream of a Place Called Home’

By Mohammed Eid
CHAPEL HILL, North Carolina, USA, Jun 20 2019 – I am a refugee, born to a refugee family. I was granted that status on the day I came into this world. I was not aware of what had happened before then. I did not fight any battle, I did not threaten anyone. I did not even choose my own race or ethnicity. I just came to this world to find myself a displaced person.

Being a refugee means, I am a stranger on every spot on this planet. Some see me as a burden on the people of the hosting country. I drink their water, I eat their food, and I breathe their air. Day after day, their resources are less and less because of me, the alien person who came from outside. Maybe that explains why I never had access to education or healthcare, and I will never have access to work in the future.

Not being welcomed at one place, my family decided to travel to another. One expulsion after another, one deportation after another, we roamed the planet looking for one spot to claim. We found none.

Very often, I felt as if we came to the wrong planet, but it was the only one. We decided to return to the place we once called home, we were stopped at a man-built wall called a border and sent to a refugee concentration camp. We were told it was a temporary solution but we learned that temporary solutions can often last forever.

Mohammed Eid

The place was crowded. People had been forced into only one fifth of what once was all theirs. We were constantly threatened, bombed, displaced and even slaughtered. We felt insecure and scared but we could not go anywhere. I was upgraded from a refugee to internally displaced person (IDP). Not much change – just different words to describe the same suffering and pain.

As internally displaced people, we were assigned a monthly food package by a United Nations agency. It allowed us to survive, thanks to donors who shared their money and food with us. My childhood memories? Standing for hours in food lines, moving from one shelter to another, burying loved ones and struggling with disease and health problems.

Life for me has never been stable. Yet I have always dreamed of a place called home. I have often stood by the walls that keep us inside the camps and peeped through holes in them. What my eyes took in was another world.
I saw open space and fields. I felt the fresh breeze on my face. I imagined myself at home – in a place where I belonged to the earth, to the sky, to the rocks, to the sand, to the trees, to the hills and to the breeze. A place where I would be welcomed as a human being. To me, home is like nothing else.

Today, the world observes World Refugee Day. On this day, we do not celebrate. We are reminded that there is no place for us in this world. We just remember the moral failure of our human race. On the World Refugee Day, I will only make one wish: that all those around the world forced from their homes, longing for home, will be refugees no more.

Footnote: I’ve just graduated my double major master’s program in Global Studies from University of North Carolina at Chapel Hill and International Development from Duke University. I’m now still in Chapel Hill, North Carolina waiting for my certificate and transcript to be issued and at the same time I’m working on a temporary job with Duke University on designing programs on training youth from the Middle East and North Africa on leadership and democracy.