In April, the disease was pinned down, and the diagnosis was devastating: The city was the epicenter of an H.I.V. outbreak that overwhelmingly affected children. Health officials initially blamed the outbreak on a single pediatrician, saying he was reusing syringes.Since then, about 1,100 citizens have tested positive for the virus, or one in every 200 residents. Almost 900 are younger than 12. Health officials believe the real numbers are probably much higher, as only a fraction of the population has been tested so far.Gulbahar Shaikh, the local journalist who broke the news of the epidemic to residents of his city and the nation in April, watched as his neighbors and relatives rushed to clinics to line up and test for the virus.Mr. Ghanghro was the cheapest option in this city, charging 20 cents a visit for the many parents here who earn less than $60 a month.The pediatrician treated all six of Imtiaz Jalbaniās children, four of whom contracted H.I.V. His two youngest, 14-month-old Rida and 3-year-old Sameena, have died. Mr. Jalbani, a laborer, said he first grew alarmed when he saw Mr. Ghanghro rummage through the trash for a syringe to use on Ali, his 6-year-old son, who is also infected. When Mr. Jalbani protested, he said, Mr. Ghanghro snapped at him and told him he was using an old syringe because Mr. Jalbani was too poor to pay for a new one. āHe said, āIf you donāt want my treatment, go to another doctor.āā Mr. Jalbani said. āMy wife and I had to starve ourselves to pay for the medicine.āThe doctor recently renewed his medical certificate and now works as a general practitioner at a government hospital on the outskirts of Ratodero, despite laws that make the reuse of syringes an offense that is not eligible for bail.From 2010 to 2018, the number of H.I.V.-positive people in Pakistan nearly doubled, to about 160,000, according to estimates by UNAIDS, the United Nations task force that specializes in H.I.V. and AIDS. During that time, the number of new infections jumped 38 percent in those 15 to 24.The real number is likely higher; much of the population goes untested, while only about 10 percent of people thought to be H.I.V.-positive are being treated.The country spends very little on its efforts to counter H.I.V. and AIDS and is nearly entirely dependent on support from other countries for its programs, whether for funding to staff testing centers or to provide retroviral drugs to counter the virus.Since 2003, there have been eight H.I.V. outbreaks in Pakistan. And Ratodero had been the site of one before:āIn Pakistan, the government does not act unless there is a national uproar sparked by media coverage,ā Dr. Arbani said, explaining why he was quick to tell Mr. Shaikh, the journalist, when he realized the scale of infection.
ttps://www.nytimes.com/2019/10/26/world/asia/hiv-aids-pakistan-ratodero.html