Doctors are hunting the source of an HIV outbreak that has infected hundreds of people, mostly young children, in southern Pakistan.
In the month since the outbreak was first detected, more than 600 people have tested positive for the virus that causes AIDS, leading to panic in the province of Sindh.
Health officials describe the outbreak as unprecedented because the number of babies and toddlers infected far exceeds the number of adults.
Official figures showed that by Monday more than 18,000 people had been screened in Larkana and 607 had tested positive. The number of infected will rise, officials believe.
Around three-quarters of those testing positive were children, while nearly two-thirds of them were aged under six. In many families the children have tested positive, whereas the adults have not.
Those affected currently have little chance of receiving lifesaving medicine, officials told The National.
Dr Maria Elena Filio-Borromeo, Pakistan director for the United Nations' AIDS and HIV programme, said unqualified, or 'quack' doctors were being blamed for spreading the virus with lax hygiene precautions.
“It's blood transfusion, or unsafe medical injections, the reuse of needles,” she said.
Pakistan is one of only three countries in Asia where the virus is still spreading, alongside the Philippines and Malaysia.
An estimated 150,000 Pakistanis are believed to carry the virus, with the number increasing by 20,000 each year. However, few people have been tested and estimates could be inaccurate.
The biggest risk groups in Pakistan have been drug users and those who visit sex workers. Doctors said the Larkana outbreak, in the town of Rato Dero, was alarming because it had broken out into the wider population.
Quack doctors reusing syringes while administering injections or intravenous drips are a major health risk in Pakistan, responsible for spreading blood-borne diseases including HIV and hepatitis. Backstreet dentists who do not sterilise instruments are also common. Regulations to prevent blood diseases being spread by blood transfusions are also rarely adhered to, officials said.
A paediatrician first alerted health officials to a possible outbreak last month after she noticed eight of her patients were not responding to medicine and were not recovering from bouts of fever. When their blood was tested, all eight were diagnosed as HIV positive. Mass screening began in late April.
The outbreak has hit the home district of the Bhutto political dynasty. The family has produced Prime Minister Benazir Bhutto, who was killed in a bomb and gun attack in 2007, and her father, Zulfikar Ali Bhutto, who was prime minister in the 1970s and hanged by Gen Zia-ul Haq. The family's political party, the PPP, governs Sindh and has been accused of mismanagement over the outbreak.
Dr Filio-Borromeo said on a recent visit to see screening at the local hospital, it was overwhelmed by people queueing for an HIV test or medicine.
“I was speechless when I saw it in the hospital. It's so chaotic, in such a mess,” she said.
Epidemiologists are now attempting to trace the source of the outbreak. Dr Filio-Borromeo said the scale of the cases meant it was unlikely to have a single source, but more likely several clusters.
Officials say they have sealed dozens of quack surgeries and one doctor has been arrested for spreading the virus. The doctor, who is claimed to have HIV himself, denies wrongdoing.
Infections have risen sharply in Pakistan, with an estimated 57 per cent increase from 2010 to 2018. Last year an estimated 6,200 people died of AIDS. Yet treatment is rare, particularly for the rural poor, with fewer than one-in-10 of those needing HIV treatment able to access it.