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ISLAMABAD: The National Assembly Standing Committee on National Health Services on Thursday directed the Ministry of National Health Services to hold seminars at district level to create awareness among people about HIV/ AIDS and the ways to control it.

The panel which met under the chairmanship of Khalid Hussain expressed concern over the lack of coordination among the provinces regarding a survey conducted about the prevalence of the deadly disease.

The committee members were of the view that most of the surveys were conducted only on papers which was in total disregard of ground realities.

The body summoned all provincial director generals of health and programme managers in the next meeting for a detailed briefing on the matter.

Pakistan has been placed on a list of 11 countries with the highest prevalence rates of HIV/AIDS. While in other countries, HIV/AIDS cases are on the decline, there has been a worrying upsurge of the disease in Pakistan.

165,000 people affected with AIDS in Pakistan

The number of HIV/AIDS patients in the country rose to over 160,000 in 2018. Of these, around 110,000 were men; 48,000 women; and 5,500 children under the age of 15. Approximately 6,400 died from the disease.

The health ministry officials informed the committee that screening tests had been conducted in different areas of the country, besides conducting training under the Global Funds programmes to control the disease.

The committee deferred Transplantation of Human Organs and Tissues (Amendment) Bill 2019, Prohibition of Smoking and Protection of Non-Smokers Health (Amendment) Bill, 2019 and Islamabad Transfusion of Safe Blood (Amendment) Bill 2019 due to the absences of their movers.

Committee members Haider Ali Khan, Nasir Khan Musa Zai, Raja Khurram Shahzad Nawaz, Dr Nousheen Hamid, Professor Shahnaz Naseer Baloch, Dr Nisar Ahmed Cheema, Dr Samina Matloob, Mahesh Kumar Malani, Dr Shazia Sobia Aslam Soomro, Ramesh Lal and Shamsun Nisa and health ministry officials attended the meeting.

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A group of Pakistani doctors blames a recent outbreak of HIV among children in a southern city on poor healthcare practices such as using dirty needles and contaminated blood, according to a statement released Friday.

The doctors are also urging Pakistan’s government to do more to understand how the virus went from high-risk groups such as drug users and sex workers to the general population.

They also warned that there isn’t enough medication in the city of Ratodero, in southern Sindh province, where 591 children need medical treatment.

The outbreak is extremely worrying, said the doctors, calling it “one of the worst” in Pakistan. They studied medical data of 31,239 people in Ratodero, where the HIV outbreak took place and who agreed to the study.

Out of that group, 930 were positive for HIV, with 604 of them being younger than 5 years of age and 763 younger than 16 years, according to the study published the international Lancet Infectious Disease Journal.

By the end of July when the study was being completed, only one in three children had started antiretroviral treatment “due to an inadequate supply of drugs and a lack of trained staff”, the statement said.

The study said 50 of the children examined are showing signs of “severe immunodeficiency” but did not specify if they have full-blown AIDS.

“The results, which are the first scientific report on the outbreak, appear to confirm observations … that HIV was mostly transmitted to children as a result of health care providers using contaminated needles and blood products,” said the statement.

“Pakistan has experienced a series of HIV outbreaks over the past two decades, but we’ve never before seen this many young children infected or so many health facilities involved,” said Dr Fatima Mir from The Aga Khan University in Karachi, the Sindh provincial capital, one of the authors of the study quoted in the statement.

About 70 per cent of Pakistan’s 220 million people use private health care sector, which is mostly unregulated and rarely monitored for cleanliness and safety. Among many Pakistanis, popular belief holds that intravenous or intramuscular injections are more effective that medicine taken by mouth, which has increased the use of syringes across the country and the likelihood of dirty needles being used.

In the immediate aftermath of the HIV outbreak in Ratodero, the government did act quickly, closing three blood banks as well as 300 clinics run by untrained medical staff, the statement said.

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More than 700 children in Pakistan were infected with HIV, the virus that can cause Aids, through unsafe injections to treat them for conditions such as diarrhoea and through contaminated blood donations, according to an investigation.

Until single-use, safe needles are introduced worldwide, which the World Health Organization says must happen by the end of 2020, experts say oral medicines should be the first choice wherever possible. They call for urgent action to improve infection control, the running of blood banks and the regulation of clinics in Pakistan.

Most of the affected children were given injections with contaminated, re-used needles. They were being treated for ailments such as diarrhoea and respiratory infections for which they could have had pills or medicine by mouth, but the use of injections is widespread and families, who usually have to pay for treatment, are said to have more confidence in them.

A paper in the Lancet medical journal reports the findings from the study of more than 30,000 people in the town of Ratodero, who were tested for HIV after the outbreak became obvious in April. Experts were called in and the government closed three blood banks, almost 300 clinics and the Sindh health care Commission.

Dr Fatima Mir from the Aga Khan University in Pakistan, the lead author, said: “Pakistan has experienced a series of HIV outbreaks over the past two decades, but we’ve never before seen this many young children infected or so many health facilities involved.

“Use of syringes and needles is widespread, and Pakistan has one of the highest rates of unsafe injections in the world. Health practitioners need to use intravenous treatment only when necessary, use needles only once and screen blood for infections before using it for transfusions.”

A quarter of the children were found to be in a state of advanced disease, indicating that they had been infected some time ago. Only two-thirds of them were able to start antiretroviral therapy to keep the HIV virus at bay, because there were not adequate drug supplies or trained staff. Nine children have died. Many children were also found to be infected with the blood-borne viruses hepatitis B and C.

Once the outbreak became public, a screening camp was set up at Tehsil hospital in Ratodero, where 31,239 people were tested for HIV and 930 were found to be positive. Of those, 763 were under 16 and most (604) were under 5. More boys were affected than girls.

The paper says blood banks are often unregistered and unregulated. Those who give blood are often paid. Screening for infections is “erratic”, it says. The outbreak could be seen as the spillover from groups who have high rates of HIV infection in Larkana, including intravenous drug users, the authors wrote.

In a commentary to the journal, Prof Mark Cotton from Stellenbosch University, South Africa, wrote: “Poor infection control, unsafe injections, unlicensed practitioners, low HIV awareness, and stigma have combined with horrific consequences.

“The most worrying aspect of the outbreak is the link with a breakdown in safe injection practice and poor management of donor blood. Of 16bn injections administered every year globally, only 5% of these each are for immunisation and for contraception, respectively.

“During the 1950s and 1960s, cheap disposable syringes made of plastic were developed on an industrial scale and became available globally. With exposure to the efficacy of painful but effective intramuscular penicillin injections, the general public incorporated a belief in the importance of painful injections. These factors encouraged traditional healers and unlicensed practitioners to offer injections.”

The WHO has set a deadline of 2020 for the transition to safe, single-use syringes. Until then, it is essential that injections are limited to those that are strictly necessary, he said.

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he number of HIV/AIDS patients in Pakistan currently stands at 1,65,000, the National AIDS Control Programme (NACP) said, adding that 9,565 new cases were detected this year.

“Only 36,902 people are registered with the NACP. Of which, around 20,994 are undergoing treatment,” The Express Tribune reported on Monday citing the NACP data as saying.

As many as 6,426 people contracted the disease after administering drugs from contagious syringes.

“There are 18,220 male and 4,170 female patients – including 546 male children and 426 female children – registered with the NACP,” the data said.

During the year, Rato Dero, a small area in Larkana city of Sindh, alone reported 895 cases of AIDS. Of which, 754 constitute children and 141 adults.

From April to November 30, about 37,558 people had undergone HIV screening in Larkana, out of which 1,195 were reported with suspected presence of the virulent germs.

The NACP data further states, at the end of 2018, the number of registered AIDS affected patients was 23,757 out of which 15,821 were receiving treatment.

On the other hand, according to a report issued by the UN AIDS Control Program last year, the number of AIDS patients in Pakistan had increased alarmingly over the past two decades.

The estimated number of patients during the year 2000 was just 500, which increased to more than 160,000. The total number of deaths cause by the disease till 2000 was only 100 that shoot-up to 6,400 in 2018.

In 2000, the number of patients registered for AIDS in Pakistan was 200, which had risen up to 22,000 in 2018.

As per the report, 14 per cent of the AIDS patients are aware of the disease, but 10 per cent of the patients were having self-treatment. Out of 160,000 patients, over 48,000 were women.

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Nearly 900 children in a Pakistani city have tested positive for HIV after a rogue paediatrician allegedly reused infected syringes.

About 200 adults have also tested positive for the virus since the epidemic in Ratodero was confirmed in April.

But health officials fear the true number affected could be far higher, with less a quarter of city’s 200,000 residents tested so far.

The outbreak was initially blamed on Dr Muzaffar Ghanghro, a paediatrician who at 16p a visit was one of the cheapest in the small central city.

He was arrested and charged with negligence and manslaughter after his patients accused him of frequently reusing syringes on their children.

Imtiaz Jalbani, whose six children were treated by the paediatrician, told The New York Times Dr Ganghro searched through his bin for an old needle to use on his six-year-old son, later diagnosed as HIV-positive. When Mr Jalbani protested, the doctor said the father was too poor to pay for a new needle. 

Four of Mr Jalbani’s children have since tested positive for the virus and the two youngest have died.

Another parent whose three children contracted the disease after being treated by Dr Ganghro told Reuters the paediatrician “applied the same drip on 50 children without changing the needle”.

Dr Ganghro has not yet been convicted, and despite laws to deny bail to those accused of reusing syringes, is now working as a GP at a public hospital on the city’s outskirts after renewing his medical certificate.

He has denied all accusations and insists he is innocent.

Despite an initial investigation by police and health officials concluding Dr Ganghro’s “negligence and carelessness” as the “prime” reason for the outbreak, officials believe he is unlikely to be the sole cause.

Visiting health workers often see doctors in Ratodero reusing syringes, while dentists use unsterilised tools in roadside surgeries and barbers use the same razor on various customers, The New York Times reported.

There is still a widespread lack of awareness about the realities of the virus among locals, with many fearing it can be contracted via touch.

This has reportedly led to some of the nearly 900 known HIV-positive children being shunned by their peers and forced to sit away from others at school. Some relatives also reportedly fear contracting the virus via physical contact with their children.

A lack of literacy on the subject is not uncommon among poorer communities across much of Pakistan, where cases of HIV have nearly doubled since 2010 to 160,000, according to the United Nations’ taskforce on HIV and Aids.

About 600,000 unqualified doctors are thought to be unlawfully operating in the country, 270,000 of them in Sindh province where Ratodero is located, according to the United Nations joint programme on HIV and Aids

The Pakistani government responded to the crisis by shutting down clinics with unregistered doctors and illegal blood banks. It emerged many had been reusing syringes.

But as international and media attention waned, some clinics began to reopen.

Imran Akbar Arbani, the doctor who first identified the wave of sick children as an outbreak of HIV, told The New York Times: “Unless these quack doctors, barbers and dentists are not checked, the number of incidents of HIV infection will continue going up.”

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Karachi: Pakistan has recorded a 13 per cent jump in the new HIV infections, according to a UN report that recorded the fastest surge among the transgender people and sex workers, a media report said on Tuesday.

The total number of HIV cases in Pakistan has increased to 160,000 this year, a significant increase from 67,000 in 2010, the Express Tribune reported, quoting a latest UN report on HIV cases in the country. The report indicates that there was a jump of 1,500 cases between 2015 and 2018 among those aged14, the report said.

“Similarly, female HIV patients above the age of 15 rose to 37,000 in 2015 and 48,000 in 2018. HIV rates among injection drug users increased by 21 per cent during 2019, followed by 3.7 per cent among homosexuals and 3.8 per cent in sex workers,” the paper reported the UN report as saying.

The UN report on the country’s HIV infections came amidst nearly 800 people tested positive for the infection in Sindh province’s Larkana district since April this year.

Health officials had attributed the cause to the use of unsanitary equipment, unsafe blood transfusion and rampant malpractice often at the hands of quacks.

“Globally, 37.9 million people are infected with HIV out of which 13.3 million have access to antiretroviral therapy, which is used to treat the infectious disease,” the report said.

According to statistics gathered by the UN and the World Health Organization, since 1985, a total of 25 million people lost the battle against HIV globally.

In recent years, government awareness campaigns around the world helped reduce the number of HIV cases transmitted through drug use.

However, awareness campaigns were mostly missing from the radar in Pakistan, the paper reported. Pakistan’s first HIV case surfaced 34 years ago in 1985. Since then, the country has witnessed a dangerous surge in the number of infected patients, partly because of the lack of a coherent national policy to prevent the disease from spreading, the report said.

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LAHORE: Inadequate mea­sures for curtailing HIV/AIDs have brought embarrassment to Pakistan as the United Nations has put it on the list of 11 countries which have the highest prevalence of the disease — 13 per cent — in its latest report.

It is the highest ratio of HIV prevalence the country has touched during the last decade, raising concerns among global health partners.

The UNAIDS-2019 analysis revealed that the world is on track to end the AIDS epidemic by 2030, but Pakistan is among the countries where ratio of new AIDs cases saw a sharp increase. The report termed it a blow to global efforts to curtail the disease.

It stated that the average HIV incidence per 1000 people in Pakistan was 0.08 in 2010, which had risen to 0.11 last year.

The situation has aggravated despite grant of “massive funding” by international health partners to curtail HIV.

The report, which has already been communicated to Islamabad, stated that the number of people living with HIV in the country stood at 160,000 last year. The number was 120,000 in 2015 and 67,000 in 2010.

The number of people living with HIV under 14 years of age was 5,500 in 2018, 4,000 in 2015 and 1,800 in 2010, according to the report.

The ratio also witnessed an increase in the number of females aged 15 and above living with HIV. The numbers were 19,000 in 2010, 37,000 in 2015 and 48,000 last year.

The number of males aged 15 and above living with HIV stood at 110,000 last year, compared to 84,000 in 2015 and 46,000 in 2010.

The UNAIDS report also dwelt on mortality ratio because of this deadly disease as a good number of patients living with HIV remained untraced and untreated. It stated that the average annual death ratio of HIV patients was 6400 in 2018, 4700 in 2015 and 1400 in 2010.

The report put the number of fresh HIV infection cases for all age groups at 2200 for 2018, 18,000 for 2015 and 14000 for 2010.

The UNAIDS analysis recorded HIV prevalence at 3.8pc among sex workers in 2018, 3.7pc among gay men, 21pc among drug addicts and 5.5pc for transgender people.

It revealed 45pc of sex workers were aware of their HIV status, 35.1pc use condom and 0.7pc had access to an HIV prevention programme.

Forty-four per cent of gay men know their HIV status, 22.4pc use condom and 1.2pc had access to an HIV prevention porgramme.

Among drug addicts, 39.3pc were aware of their HIV status, 15.3pc use condom and 1.6pc were benefiting from any HIV prevention programme.

The situation was not satisfactory in respect of transgender people as 69.1pc know their HIV status, 24pc use condom and only 1.1pc had access to an HIV prevention programme.

According to the report, 18pc children and eight per cent women living with HIV who know their status had undergone tests and treatment last year.

The percentage of pregnant women living with HIV who have access to antiretroviral medicines was reported at 10pc last year.

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Islamabad: In the first six months of 2019, from January to date, the Centre for Treatment of AIDS (Acquired Immune Deficiency Syndrome) at Pakistan Institute of Medical Sciences has received as many as 95 new patients with Human Immunodeficiency Virus (HIV) positive and AIDS.

Data collected by ‘The News’ on Tuesday has revealed that a total of 66 male patients, 22 female patients and five children with HIV Positive reported at PIMS AIDS Centre in last six months while two new transgender patients with AIDS have also been reported so far in 2019.

Registration of 95 new patients have taken the total number of registered patients at PIMS AIDS Centre to 3,232 of which 2,684 patients are male, 456 female, 69 children and 20 transgender. The PIMS AIDS Centre was established in 2005 by National Aids Control Programme.

It is worth mentioning here that AIDS is considered as the most advanced stage of HIV infection and generally, it may take 10-15 years for an HIV-infected person to develop AIDS, the end-stage of HIV infection. In case a patient is not having treatment after developing AIDS, he or she may die within six months though antiretroviral therapy (ART) can slow down the progress and people with HIV may enjoy healthy and productive lives for years with ART. There is no vaccine or specific treatment for AIDS however.

The total number of patients who are on ART at PIMS AIDS department is 1,913 including 1,503 male patients, 348 female patients, 58 children and 12 transgender patients. Of these, as many as 438 patients are intravenous drugs users (IDUs).

As many as 323 HIV positive patients are suffering from hepatitis B while 158 patients are suffering from hepatitis C, said Deputy Director at PIMS Dr. Waseem Khawaja while talking to ‘The News’.

He added that Dr. Naila is in charge of AIDS centre at PIMS who along with dedicated staff deputed at the centre has made the unit an ideal treatment facility for HIV positive patients. The PIMS Executive Director Dr. Amjad has made special arrangements to cater to the needs of HIV/AIDS patients reaching hospital, he said.

The standard of services at the AIDS centre can be gauged from the fact that not a single baby has so far been borne with HIV positive to any female patient at the centre, he said. The female HIV patients having pregnancy are being given excellent treatment before child birth and surgeries so far have been done successfully to avoid infection in new born babies, he said.

It is important that HIV can be transmitted from an HIV positive mother to her child during pregnancy, childbirth and breastfeeding and mother-to-child transmission accounts for over 90 per cent of new HIV infections among children.

Dr. Khawaja said the PIMS AIDS Centre has so far provided management facilities to as many as 91 pregnancy cases through PPTCT, a program for prevention of mother-to-child transmission (PMTCT) of HIV. Nine thalassemia patients are also registered with the centre who are HIV positive, he said.

He added the centre has received a total of 1031 IDUs having HIV positive though 438 of them are on ART while of a total of 69 child patients so far reported at the centre, 58 are receiving ART.

All diagnostic tests for HIV/AIDS patients are free including screening and PCR and also the centre provides free of cost treatment to all patients. The pregnant women having HIV/AIDS are given free of cost treatment not only for the infection but also for deliveries, said Dr. Khawaja.

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