Karachi: More than 1,400 children infected with HIV during the 2019 Ratodero outbreak are no longer in contact with treatment centres, raising fears about their wellbeing and survival, according to fresh data shared with senior Sindh government officials.
Of the 2,587 children diagnosed with HIV in Ratodero from 2019 to September 2025, only 1,144 are currently recorded as ‘alive’ in the Larkana division, according to data presented to Sindh Health Minister Dr Azra Fazal Pechuho during a recent meeting. The figures suggest a major loss to follow up, with no confirmed information available on the status of over half the affected children.
Pediatric infectious-diseases experts treating HIV-positive children said it was entirely plausible that nearly half of these children may have died because of severe malnutrition, poor vaccination status, repeated infections and late diagnosis. They added that deaths among HIV-infected children are neither documented nor reported by any official system.
According to UN agencies, children under 15 now account for only about 3 per cent of all people living with HIV globally, but they represent roughly 12 percent of all AIDS-related deaths. In 2024 alone, approximately 90,000 children under age 20 died of AIDS-related causes and about 250 children died each day; nearly 73 per cent of these occurred in children under 10.
As per Unicef infants and toddlers remain by far the most vulnerable and historic cohorts show that without treatment, around 50 per cent of HIV-infected infants die by age two and up to 80 per cent by age five.
In Pakistan the publicly disclosed age-specific mortality data for children with HIV is virtually non-existent, even though modelling estimates suggest children aged 0-14 account for approximately 3 per cent of people living with HIV in the country.
The paediatric outbreaks in Ratodero confirmed that among new HIV diagnoses in children, more than 80 per cent were under age 15 and over 60 per cent were under age 5, highlighting how the death burden is likely heavily concentrated in the youngest age bands.
Multiple officials contacted for comment said they were not in a position to confirm whether the ‘untraced’ children had died or simply stopped reporting to treatment sites, noting that deaths among people living with HIV are not systematically captured by provincial programmes.
However, in a formal response, health department rejected the claim of over 1,400 untraced children as “baseless”, saying Larkana paediatric centres reported only 30 lost to follow up cases in 2019 and that most have since been retrieved.
They said ‘Sindh has a functioning database of HIV related deaths and said their surveillance teams routinely trace cases through trained support officers and community mobilisers, who reportedly re-engaged over 2,000 clients province wide in the past year’. They added that confidentiality under the HIV and AIDS (Safety and Control) Act restricts public disclosure of individual case information.
Even so, the absence of verified information on Ratodero’s infected children years after the outbreak has raised concern among clinicians and public health experts familiar with the case. Specialists say that without confirmed data on treatment adherence, survival, or relocation, the gap remains significant for programme planning and community support.
The HIV outbreak in Ratodero came to light in early 2019 when hundreds of parents sought help for children suffering persistent fever and unexplained illness. A paediatrician was arrested at the time on allegations of unsafe injection practices, prompting investigations by national and international agencies.
WHO, UNAIDS, and experts from the United States CDC later reported that the spread had been fuelled by unsafe injections, reuse of instruments, unscreened blood transfusions and unregulated medical procedures in the area. Investigators cited serious gaps in infection prevention, weak oversight of healthcare providers, unlicensed clinics, and unsafe blood products. Although several establishments were sealed after the outbreak, local residents and civil society groups say many unsafe practices gradually resurfaced.
Across Sindh, the crisis continues to expand. There are now 3,995 children living with HIV in the province, most of them in Larkana. In the first nine months of 2025 alone, around 2,300 new HIV infections were reported in Sindh, bringing the province’s total registered cases close to 29,000.
A senior public health official said children in several districts remain exposed to infection risks due to unsafe circumcisions, unsterile dental work, contaminated injections and inadequate infection control in small clinics and maternity homes. Despite multiple crackdowns, over 600,000 informal or unqualified practitioners are still believed to be operating in Sindh, according to official estimates.
Illegal blood banks, cannula centres, barber shops and unlicensed dental and cosmetic operators also remain widespread. Officials say many facilities reopen shortly after being sealed unless district administrations pursue legal action.
Nationally, Pakistan has already crossed 10,000 new HIV infections this year. UN agencies warn that new cases could climb past 40,000 by the end of 2025. In Sindh, sexual transmission accounts for over 12,000 registered cases, while more than 4,000 are linked to infected blood transfusions. Nearly 2,000 cases are associated with reuse of contaminated syringes and around 874 were recorded as mother to child transmission.
Drug use continues to fuel a large share of infections. Around 38.4 percent of people who inject drugs in Pakistan live with HIV, with Sindh alone home to more than 100,000 drug injectors, according to UN agencies.
Following her recent briefing, Dr Pechuho directed district administrations to close illegal clinics and unregistered blood banks without exception, ordered mandatory HIV screening of pregnant women and instructed officials to ensure follow up on sealed facilities.
Still, the lack of clarity on Ratodero’s infected children has prompted renewed concern among clinicians and advocates who believe the matter requires a transparent review. Families from the region say they continue to struggle with access to treatment and travel, and many report that promised long term support became difficult to sustain once the initial emergency response ended.
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