ISLAMABAD: The recent outbreak of HIV, the human immunodeficiency virus, in Larkana has led to concerns in health circles that the virus could spread to the general population.

Stakeholders fear that the three main causes of the HIV outbreak, which as predominantly affected children, could be reused polio vaccine injections, unhygienic circumcision by barbers and the shaving of babies’ heads.

The National Aids Control Programme (NACP) is determined to control the virus at any cost, because once it moves to the general population it will become almost impossible to control due to the lack of awareness and education among the public.

NACP seeking to determine what caused outbreak, points to reuse of polio vaccine injections, unhygienic circumcision and shaving of babies’ heads

A team from the World Health Organisation has been invited by the government to investigate the outbreak in Larkana that happened last month.

The team has reached Pakistan, and its key tasks include ascertaining the source of the outbreak and controlling it, providing technical expertise particularly in the areas of HIV testing, paediatric treatment and family counselling, and ensuring that adequate supplies of rapid diagnostic tests and antiretroviral medicines for adults and children as well as single-use needles and syringes.

NACP Manager Dr Baseer Achakzai told Dawn that the major challenge for the programme is determining the reason behind the outbreak.

“It is a fact that we fear that there can be spill-over in the general population, so as a first step we want to know the reason for the outbreak. There can be many reasons, such as a lack of infection control measures. At many places, hospital waste is not burnt in incinerators, due to which there is a possibility that the injections were reused,” he said.

He said it was also possible that blood banks were providing contaminated blood because they do not have the mechanism to screen blood properly.

Dr Achakzai also pointed out that 600 of the 748 HIV+ patients were children, and the majority of them are between the ages of one and two with parents who tested negative for HIC.

“In Pakistan, it has been decided to give the inactivated polio vaccine (IPV) to one-year-old children, and we fear that, as IPV is injected, the syringes were used multiple times to vaccinate children,” he said.

He added that in rural areas, babies are circumcised by barbers who use the same blade every time.

“We also have a tradition that the baby’s head is shaved just after the birth, and cuts cannot be avoided due to the baby’s soft skin. There is also a possibility that the same blades were used to shave their heads. We hope that the investigation will be finalised soon and we will take steps according to the findings,” he said.

Ministry of National Health Services Director General Dr Asad Hafeez told Dawn that HIV prevails among people who inject drugs and male, female and transgender sex workers.

“However, the incident in Larkana has triggered fears that the virus can shift to the general population. The positive thing is that the WHO team has reached Pakistan and has been investigating the issue. We will ensure that their findings are implemented to stop the spill over,” he said.

Dr Achakzai added that although credible estimates suggest there are 150,000 patients of AIDS, only 25,000 are registered.

“Even a number of registered patients do not get treatment. So we keep trying to bring them back and convince them to start treatment. Although $15,000 are spent on treating one patient, the treatment is provided free of cost with the support of partners. Despite that, patients do not want treatment because they consider the disease a taboo and try to hide it,” he said.

Published in Dawn, June 5th, 2019