Karachi: The state of Pakistan and federal and provincial governments are trying to hush up the HIV epidemic and showing a criminally inadequate response by playing down outbreaks among children because they largely belong to the “poorest of the poor” families, public health experts said at a seminar here on Tuesday.
They said the state’s response would have been vastly different had children of wealthy or educated middle-class families been infected, as these sections had the means to demand answers and hold those in power accountable.
The one-day 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 (CBEC) of the Sindh Institute of Urology and Transplantation (SIUT) 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 the implementation of the task force’s far-reaching recommendations.
The chief executive officer of the Sindh Healthcare Commission, Dr Ahson Qavi, said its inquiry into the HIV cluster at Kulsoom Bai Valika Hospital had not found evidence of syringe reuse at the hospital.
He said unsafe injection practices were not confined to quacks and could also occur among trained doctors. He stressed the need to improve infection-prevention and control training, including the safe use of needles, at medical colleges and health facilities.
Dr Qavi added that HIV could be transmitted through several routes and every cluster required a thorough, evidence-based inquiry to establish how infections had occurred.
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 non-availability of HIV data, particularly from Punjab, was preventing an accurate assessment of the epidemic and undermining control efforts.
He urged health authorities, healthcare providers and civil society to press for the timely release of provincial and national HIV data. He also called for thorough investigation into all possible routes behind recurring HIV outbreaks, followed by action based on the findings.
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.
Prof Elizabeth Bukusi of Kenya, who delivered the keynote address online, shared lessons from Africa’s HIV response, emphasising stronger health systems, improved access to treatment and meaningful involvement of affected communities.
Dr Muhammad Shahid Jamil of WHO-EMRO discussed common regional challenges and the need for cooperation, while Dr Samreen Sarfaraz of Indus Hospital and Health Network spoke on changing patterns of HIV among children and key populations, healthcare-associated transmission, stigma and delayed diagnosis.
Prof Aamir Jafarey, chairperson of CBEC, and Dr Arshad Altaf of WHO-EMRO welcomed participants. 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.
Ends