Larkana needs an empowered community to contain spread of HIV

The small town of Ratodero in Larkana was thrown into disarray after an HIV outbreak in children was unearthed this April. The crisis unfolding there dominated headlines, but little is known about the work being done to create awareness among the community and safeguard them against future outbreaks.

Officials from Sindh’s health department say they doubled down on efforts to counsel the local community and teach them about HIV, its prevention and treatment.

“We are trying our best to create awareness through groups,” Dr Sikander Memon, head of the Sindh AIDS Control Programme (SACP) told SAMAA Digital on Friday.

“We’ve counselled 100 teachers. We have also reached out to the heads of communities, imams (prayer leaders) at mosques and parents.”

Parents will be divided into two 100-member groups of mothers and fathers, he added. The purpose of these groups is to coordinate with other parents and remind them about their children’s anti-retroviral therapy for HIV, which needs to be continued for the rest of their lives.

This year, the theme for World AIDS Day is “Communities make the difference.” In line with this, the beleaguered communities in the rural areas of Sindh would be strengthened with help from field health workers, such as community midwives and lady health workers.

Dr Memon says he wants the health department’s field force of around 80,000 to work within communities and get high-risk populations tested for HIV. These include sex workers, men who have sex with men, transgender people, truck drivers and even those who’ve had invasive surgeries.

But these aren’t the only high-risk populations in the province. Throughout the year, people in Sindh attend festivals to honour saints such as Shah Latif Bhittai and Lal Shahbaz Qalandar. These festivals often include tattoo stalls where many people receive tattoos using the same needle.

Also prevalent are the dangerous practices of roadside barbers reusing blades to service multiple customers, untrained midwives reusing blades during deliveries, circumcisions performed by quacks and body piercings where the same needle is used for many people.

“There is no law to stop a person from using the same razor blade or needle for multiple people,” Dr Memon said.

A law that bans the use of disposable syringes in the province, however, has existed since 2011. Officials say it hasn’t been implemented because there is only one manufacturer of autolock syringes in the country.

Dr Memon revealed that the health department has now ensured a supply of autolock syringes throughout Larkana and the next general procurement for Sindh will include autolock syringes.

He believes there is still no way to completely ban disposable syringes as they would still be used to prepare infusions for injections. This is alarming as a majority of the population still insists on getting injections for treatment. Around 90% of these injections are said to be unnecessary.

It was a combination of patient behaviour and medical neglect that led, in part, to Ratodero’s recent HIV outbreak. A paediatrician, Dr Muzaffar Ghanghro, was implicated in the case and arrested after an FIR was lodged against him by the Sindh Healthcare Commission.

A joint investigation team consisting of three doctors and three police officers was formed who investigated him, said Dr Memon. Based on this investigation, reports were sent to the court. However, the Sindh High Court’s Larkana bench granted him bail and he was later released.

Dr Ghanghro has since been suspended by the government him and reported to the health department until the case proceeds.

Meanwhile, screening is ongoing at the Larkana and Ratodero HIV centres. Around 37,000 people have been screened at the camp, of which 1,182 patients have tested positive. Around 1,000 of them have been linked to treatment, said the SACP head, while the rest need to be cleared of underlying infections before they can be started on anti-retroviral therapy.

Seven more centres will be opened across Sindh, confirmed Dr Memon. These will be in the cities of Jacobababad, Sehwan Sharif, Khairpur, Mirpurkhas, Nawabshah, Badin and Sanghar. Infectious diseases specialists trained by AKU doctors will then go on to train medical professionals there.

An endowment fund of Rs1 billion was announced for those affected by HIV by PPP Chairperson Bilawal Bhutto Zardari. Sindh Chief Minister Murad Ali Shah notified two committees for the investment and utilisation of those funds in early October.

These committees will hold meetings after World AIDS Day on December 1, promised Dr Memon.