Several HIV outbreaks from healthcare have been investigated in Pakistan. We are aware of four reported here. If you are aware of others, please advise!
HIV is not the only threat from unsafe healthcare. Pakistan has one of the worst epidemics of hepatitis C in the world due to unsterile practices during healthcare and cosmetic services. Hepatitis B is also common. Both hepatitis B and C were introduced a long time ago, and so have had more time to spread than HIV. In this link, Sohail Rabbani characterizes hepatitis B, C, and HIV as a Three Headed Monster threatening Pakistan. The same monster threatens other countries.
Kot Imrana, near Kot Momin, Sargodha, 2018
In early March 2018, the Pakistan Observer reported “elders of the area [Kot Imrana village] brought the matter [of many HIV-positive residents] to the knowledge of the Punjab government.” Tests reported in early March identified 37 residents to be HIV-positive. Subsequently, the health department drew and sent blood from 2,757 residents for HIV tests; in mid-March 2018, the department reported 204 of 1,406 were HIV-positive, but had not yet reported results from more than 1,300 samples.
The local District Health Authority Chief Executive Officer Dr Nusrat Riaz “told the publication that the disease had mainly spread in the area due to the use of one syringe on multiple [people] by a local quack.”
Chiniot, near Sargodha, 2017
After initial reports of HIV in a village near Chiniot, health officials set up a camp to test residents. Seventy came for tests, of which 42 tested HIV-positive: 27 women, 17 men, and a 7 year old girl. The article reporting these infections quotes a doctor: “It’s a misconception that HIV is contracted because of sexual contact only. It also spreads if an infected blood syringe or shaving blade is used. The use of infected blood in a transfusion also causes it.” A later report raised the number infected to 48.
After reports of HIV infection among persons getting dialysis at the Chandka Medical College, Pakistan’s National AIDS Control Program investigated. The investigation found that 56 (27.3%) of 205 dialysis patients were HIV-positive. “The report mentions that infection control practices were few…”
Jalalpur Jattan, 2008
In 2008, an HIV voluntary counseling and testing (VCT) center near Jalalpur Jattan town in Gujrat noted some unexpected HIV infections. To get a better idea about what was happening, the New Light AIDS Control Society, a local NGO, organized two 1-day HIV-testing camps in Jalalpur Jattan in June-July 2008. During these two days, 246 were tested, and 88 were found to be HIV-positive.
Subsequently, the New Light AIDS Control Society worked with the Canada Pakistan HIV/AIDS Surveillance Project (HASP) and Punjab’s Provincial AIDS Control Program to analyze information from the 88 found HIV-positive in the testing camps plus three tested elsewhere. They concluded many infections came from “local medics (quacks) who have not been observing the sterilization and infection control techniques…” Two HIV-positive children had HIV-negative parents, and many women with no sex risk were HIV-positive.
The many HIV infections the New Light AIDS Control Society found got the attention of Pakistan’s National AIDS Control Program in the Ministry of Health. In November 2008, a team from the Ministry made a 1-day visit to Jalalpur Jattan. The report from the 1-day visit recommended an epidemiological investigation. Pakistan’s National Institute of Health assigned Pakistan’s Field Epidemiology & Laboratory Training Program (FELTP) to investigate, with assistance from the US Centers for Disease Control and Prevention (CDC). The terms of reference asked the team to: “determine the extent and chain of transmission” and to “identify…sites of potential transmission.”
FELTP’s resulting “Report on HIV/AIDS Outbreak Investigation at Jalalpur Jattan (JPJ), Gujarat” is better termed a cover-up than an investigation (to protect the confidentiality of people with HIV, this link omits family trees on pages 36-48).
Because it was fairly clear unsafe healthcare was responsible for many infections, at least part of the challenge was to trace and test people who had visited suspected clinics. The FELTP team didn’t do that. Instead, beginning with a list of 20 HIV-positive people provided by the local government hospital, the team traced relatives and looked for people with stigmatized behaviors (sex work, male-male sex, injection drug use). The resulting report contains a lot of family trees, but no trees linking infections to specific clinics and skin-piercing procedures. Overall, the team identified 53 persons with HIV, including 26 previously tested.
The FELTP team noted that 95% of cases reported therapeutic injections and many reported surgeries and dental care. But instead of digging further to go from suspicion to confirmation and to identify the sources of the infections, the FELTP team stopped at suspicion: “These observations in the presence of the poor sterilization practices could have promoted the spread of HIV and other blood borne viruses.”
1. Rabbani S. HBV HCV, HIV these blood borne viruses are a three headed monster. No date. Available at: https://dontgetstuck.files.wordpress.com/2012/02/pakistan-three-headed-monster-looming-aids-threat.pdf.
2. HIV, AIDS outbreak alarms residents. Pakistan Observer, 2 March 2018. Available at: https://pakobserver.net/hiv-aids-outbreak-alarms-residents/ (accessed 13 October 2018).
3. 204 patients test positive for HIV/AIDS in Sarghoda. Dunya News, 19 March 2018. Available at: https://dunyanews.tv/en/Pakistan/431865-patients-test-positive-HIV/AIDS-Sargodha (accessed 4 April 2018).
4. 100 more people tested positive for HIV/AIDS: report. Monitoring report, 16 March 2018. Available at: https://www.pakistantoday.com.pk/2018/03/16/100-more-people-tested-positive-for-hivaids-report/ (accessed 13 October 2018).
5. Islam S. AIDS scare in a Chiniot village as 42 residents test positive for HIV. The Express Tribute, 31 July 20178. Available at: https://tribune.com.pk/story/1470850/aids-scare-chiniot-village-42-residents-test-positive-hiv/ (accessed 4 April 2018).
6. 48 people including children diagnosed with AIDS in Chiniot. Daily Dunya 16 September 2017. Available at: http://dunyanews.tv/en/Pakistan/405397-48-people-including-children-diagnosed-with-AIDS-in-Chiniot (accessed 13 October 2018).
7. Altaf A, Pasha S, Vermund SH, Shah SA. A second major HIV outbreak in Larkana, Pakistan. J Pak Med Assoc 2016; 66: 1510-1511. Available at: http://jpma.org.pk/full_article_text.php?article_id=7991 (accessed 4 April 2018).
8. Emmanuel F. Outbreak investigation: Mohalla JogiPura, Jalal Pur Jatan, Distt Gujrat, Punjab. no date. Available at: https://dontgetstuck.files.wordpress.com/2012/01/new-lights-hiv-outbreak-investigation-gujrat-pakistan.pdf.
9. National AIDS Control Program, Ministry of Health, Islamabad. Report on rapid situation analysis of the HIV outbreak in Jalal Pur Jattan, Gujrat District. November 2008. Available at: https://dontgetstuck.files.wordpress.com/2012/02/natlaidscontrolprogramjpjvisit.pdf.
10. Field Epidemiology & Laboratory Training Program, National Institute of Health, Ministry of Health, Islamabad. Report on HIV/AIDS outbreak investigation at Jalalpur Jattan, Gujrat, June 2009. Available at: https://dontgetstuck.files.wordpress.com/2012/02/feltp-investigation.pdf.