Karachi: The Sindh Healthcare Commission (SHCC) did not find evidence that syringes or needles were reused at Karachi’s Kulsoom Bai Valika Social Security Hospital in connection with HIV infections among dozens of children, SHCC Chief Executive Officer Dr Ahson Qavi has claimed.
Speaking at a seminar on Pakistan’s evolving HIV epidemic, Dr Qavi said the commission’s investigation had not made a definitive finding of syringe reuse at the SESSI-run hospital.
However, he said its follow-up report had documented serious lapses in sharps disposal, medical-waste handling and infection-prevention practices, requiring further inquiry.
The report, issued after a July 16 follow-up inspection, found syringes in sharp boxes without attached needles, recapped needles, and used capped syringes lying in treatment areas. Hospital staff could not satisfactorily explain where detached needles were being discarded, it said.
It also recorded evidence of sharp boxes and medical-waste bags being opened before incineration, while no proper logs were available to verify the quantity of waste generated, collected, transported or destroyed.
The commission said these deficiencies created a risk of unsafe handling, misuse, illegal recycling or sale of medical waste, and recommended a complete audit of the disposal pathway of detached needles, opened sharp boxes and waste bags to rule out any such possibility.
The report further found that the hospital’s autoclave had no documentary record of repair, calibration, preventive maintenance or performance testing. It also cited poor waste segregation, weak operation theatre hygiene, unsafe handling of used linen and inadequate knowledge of infection-prevention protocols among staff and outsourced service providers.
The commission recommended hands-on infection-prevention training for doctors, nurses, paramedics, janitorial and outsourced staff, the appointment of a dedicated infection-control focal person, and an immediate review of waste disposal and laundry contracts.
It also recommended suspension of operation theatre services until shortcomings in sterilisation, cleanliness, instrument processing and staff competency were rectified and verified.
Dr Qavi said unsafe injection practices were not confined to unqualified practitioners and could also occur among trained healthcare workers. He stressed the need to improve infection-prevention and control training, including the safe use of needles, at medical colleges and health facilities.
He added that HIV could be transmitted through several routes and that each cluster required a thorough, evidence-based inquiry to establish how infections had occurred.
The seminar, titled “Nothing About Us, Without Us: Ethical Responses to the Evolving HIV Epidemic in Pakistan: Regional and Global Implications”, was organised by the Centre of Biomedical Ethics and Culture of the Sindh Institute of Urology and Transplantation in collaboration with the World Health Organisation’s Eastern Mediterranean Regional Office.
Former health minister Dr Zafar Mirza said poor families affected by HIV had little social or political voice, resulting in an absence of urgency and accountability in the official response.
“The state and the federal and provincial governments are treating children getting infected with HIV throughout the country as children of a lesser god,” he said.
He said affluent and educated middle-class families generally did not seek treatment at basic health units, rural health centres or informal providers, where poor families often took children for fever, flu, diarrhoea and other common ailments.
Weak infection-prevention practices, unsafe medical procedures and poor regulatory oversight at such facilities, he said, could expose children to HIV, hepatitis C and other blood-borne infections.
Calling it a failure of healthcare delivery and governance, Dr Mirza urged citizens, particularly health professionals and the educated middle class, to raise their voices for safe and quality healthcare. He said Lok Sehat, a citizens’ group, had been formed to provide an independent platform for people to speak up on HIV and wider health-system failures.
Referring to the Taunsa HIV incident, he said media coverage had led the prime minister to constitute a task force, which submitted recommendations. He urged citizens and health professionals to monitor whether the subsequently formed Technical Working Group ensured implementation of the task force’s far-reaching recommendations.
Hepatologist Prof Saeed Hamid highlighted the overlap between HIV and viral hepatitis among people who inject drugs. Citing Pakistani studies, he said hepatitis C infection in this group ranged from 54 to 72 per cent, HIV prevalence from 8.6 to 74 per cent, and HIV-HCV co-infection from 24 to 93 per cent.
Health journalist M. Waqar Bhatti said concealment and the non-availability of HIV data, particularly from Punjab, were preventing an accurate assessment of the epidemic and undermining control efforts.
According to WHO reporting shared at the event, new HIV cases among Pakistani children aged up to 14 years rose from 530 in 2010 to around 1,800 in 2023. The speakers stressed that an effective HIV response required safe and accountable healthcare, wider access to testing and treatment, reliable data, and protection of the rights, dignity and privacy of people living with HIV.