The syringes catastrophe of the HIV outbreak in Faisalabad, Punjab, Pakistan

In recent years, the deadly catastrophes of HIV outbreaks in different areas have jolted the nation [1]. Pakistan is still working and fighting to combat this deadly disease which has now turned to an uncontrollable epidemic. Recently as per reports of June in Pakistan, UNAIDS and National AIDS Control Programme stated around 24,331 people (14.7%) are registered with the National AIDS Control Program for HIV. Among these HIV-positive patients, only 17,149 (70.5%) of the registered patients were receiving antiretroviral therapy, and 7182 (29.5%) did not follow-up proper appointments in the last 6 months [2].

On 25 April 2019, a small town of Larkana named Ratodero, faced the worst outbreak of history with around 13 new cases of HIV-positive children, aged between 1 and 5 years, increasing the total infected number to 812, of which 661 were children diagnosed in a time span of 2 months [3,4]. While the Nation was coping with this deadly ordeal, 2863 new cases of HIV were registered in Faisalabad, Punjab, Pakistan on 12 June 2019 [5]. Most of the diagnosed patients were drug addicts and had acquired HIV through reused syringes and needles, treatment by local fraudulent healthcare providers, also known as ‘quacks’ and dental surgeries with improper sanitation. The patients hailed mainly from nearby cities such as Chiniot, Sahiwal, Jhang, and Nankana Sahib in Punjab [6]. Although the estimated burden of HIV in Pakistan was not so high previously, as it was identified as a low-prevalence country for the spread of HIV infection. At the end of 2000, the prevalence of infection rose and the increasing number of cases in recent years has brought alarming concern for public health and safety to the national healthcare authorities [7]. The trend has, therefore, shifted from low to high rising HIV infection, in the country. Recently WHO declared the HIV outbreak as a grade II emergency in Pakistan [8]. International expert teams from WHO and CDC Atlanta reported that malpractices of unsafe injections, reuse of needles, intravenous drips and negligent infection control at healthcare centers, was one of the leading causes of the havoc. This was not limited to a single province as this malpractice is widespread throughout the nation and if not controlled quickly, will lead to further outbreaks across the country [9].

In March 2018, in Kot Momin, a village near Sargodha, many patients were diagnosed with HIV which alerted the provincial AIDS control authorities in Punjab. The use of contaminated syringes and needles by a local untrained health personnel, who later died of AIDS himself, infected a high proportion of rural populations in two villages and intensified the spread of the fatal disease, with a massive outbreak of HIV occurring [10,11]. Contaminated blood products, unchecked blood transfusions, ear and nose piercings, unsterilized surgical and dental instruments, razor sharing by local barbers have also contributed to the spread and transmission over time [12,13]. The Pakistan Medical Association reported that around 600,000 quacks are currently practicing in the country among which 80,000 are based in Punjab alone [14]. Social taboos and stigmas associated with HIV are also major risk factors preventing its eradication in a socially conservative society like Pakistan and many other similar underdeveloped countries. The National AIDS Control Program of the Government must take immediate action against quacks and develop novel strategies to overcome this health emergency. Increased access to screening, treatment and counseling at the national level is vital for prevention and elimination of AIDS and must be a priority to save the future generations from such fatal viral infections.