SCOTT SIMON, HOST:
There’s an HIV crisis in Pakistan. And it affects children. Since April, more than 850 cases of infected children have been reported. And health care workers are raising the alarm over systemic issues in Pakistan’s health care system. Fatima Mir teaches pediatrics at Karachi’s Aga Khan University. She joins us from Karachi. Thanks so much for being with us, Dr. Mir.
FATIMA MIR: Thank you for having me, Scott.
SIMON: We’ve reached you in Karachi. But you also work in Ratodero, where I gather at least one doctor has been reusing dirty syringes on children. What have you seen? What do you know about?
MIR: In Pakistan, most of the children who are positive for HIV are either through maternal transmission or through an unsafe blood transfusion. This is the first time we have found a very large cohort of children. Very few of their mothers are infected. Very few have had transfusion. But almost all of them have had multiple injections from local physicians – not just one – for very, very minor childhood illnesses.
As a community, rural send and interior send this place where Ratodero and Larkana is – this is a place where your population is from the lower socioeconomic strata of society. They may not necessarily be able to afford a five to seven-day or a seven to 10-day course of oral medication. So what they do, Scott, is they ask for one or two injections because that is the magic bullet to break the fever, to help the symptoms resolve. And this is why people sort of hanker for parenteral injections over oral.
SIMON: Forgive me, Dr. Mir, but don’t physicians and health care workers know not to reuse an old needles?
MIR: I think over time, Scott, infection control has not been given a lot of importance in medical training. We’re also finding that just because of lack of resources and poor commitment and poor organization of infection control committees, infection control is a very, very low priority in a place where most emphasis is on provision of medicines and on diagnosis.
SIMON: What are authorities doing? What can they do?
MIR: They shut down all the quacks and the unregistered medical practitioners who were practicing in Larkana at that time. And they set up this regulating body, known as the Sindh Health Care Commission, which has – I think up to date – closed down at least 300 clinics. Also, Scott, a special committee has been set up with the government which is going to work on infection control, especially in public-sector hospitals because the system right now is pretty much dysfunctional.
SIMON: Well, how will that health care system now confront hundreds of children and possibly adults who might have HIV?
MIR: You’re very, very correct. So you see, HIV in Pakistan up till now was predominantly an adult disease. Suddenly now, it has affected a large cohort of children and – children who actually were supposed to have standard risk not high risk. Now, Larkana, Scott, is a district with almost 13% stunting and about 9% wasting. So malnutrition has a high prevalence. The under-5 mortality is high in this district.
Initially, there was so much hysteria that people were not looking at stigma so much. But now as the dust is settling down, people are now being ostracized. Their livelihoods are threatened because say if a merchant is known to have an HIV child in the family, people will stop buying from him. So we are seeing these stories come up. And the government is now trying to work with communities and to build up communities so that we can provide social support to these patients. So it’s a large task which lies ahead of us.
SIMON: Fatima Mir, who teaches pediatrics at Karachi’s Aga Khan University, thanks so much for being with us.
MIR: Thank you, Scott. Transcript provided by NPR, Copyright NPR.