Specialists recommend medical probe to assess HIV outbreak

KARACHI: Infectious illnesses specialists say that while a medical research needs to be carried out to assess the HIV ‘outbreak’ in Ratodero, Larkana district, the Sindh govt must ensure availability of secure blood, sterile syringes, proper healthcare waste disposal system and respecting the comfort of most individuals, adding in the accused surgeon.

The information of 282 infants and also adults ( as of May 9 ) allegedly infected by an HIV+ doctor in Larkana made the headlines. The information of a lot of cases in a small city saw an almost sensational end when the doctor was arrested and put behind bars. Presently a combined research group is probing the issue. The human immunodeficiency virus ( HIV ) can lead to acquired immunodeficiency syndrome ( AIDS ) if not treated. Based on the Pakistan Economic Survey 2017-18, “Till date 4,500 HIV positive cases have been recorded to the AIDS Control Programmes at federal and provincial level” — a phrase repeated in the survey records since 2012-13. Meanwhile, the UNAIDS 2017 fact page approximations 150,000 adults and infants living with HIV in Pakistan.

Dawn arrived at out to infectious diseases specialists to find out the reasons for the modern HIV outbreak in Larkana, whether a person with HIV ( or Hepatitis B/C ) could work in medical center settings ( and just about anywhere else ) and what measures are needed immediately to curtail further spread of the disease. Ask Sindh govt to ensure availability of secure blood, sterile syringes, and proper medical waste disposal mechanism

“The HIV epidemic has been brewing for longer than a decade. The condition has remained unrecognized because no one thought of looking into it,” says Dr. Bushra Jamil, president of the Medical Microbiologists and Infectious Illness Society of Pakistan and head of Infectious Diseases at Aga Khan University. She notes that the HIV ‘outbreak’ surfaces from time to time when observant physicians recognized something not conforming to the normal design of usual conditions.

For the uninitiated, an explainer on WebMD says a disease ‘outbreak happens when an illness appears in bigger numbers than expected in a community or region or during a season’, and defines an ‘epidemic as one which occurs when an infectious illness spreads rapidly to a lot of people’ while ‘a pandemic is a global disease outbreak’. “HIV is probably endemic in Larkana and adjacent spots. Patients get diagnosed only when somebody chooses to buy a screening check. Since this ( screening ) happens sporadically, it gives an incorrect impression of an outbreak,” says Dr. Jamil.

“This is how the 2016 hemodialysis-unit-related outbreak of Larkana was identified with HIV being present in a high-risk population for around 2 decades, unregulated blood banks which give blood without screening and rampant reuse of unsterile syringes, rudimentary healthcare facilities, and untrained healthcare employees. There is dire need to create alertness about not giving unnecessary injections ( unless lifesaving ) to infants and kids, keeping strict security and hygiene protocols and availability of screened blood for transfusions,” the pressure.

Safe to practice ?

When asked if an HIV positive doctor can practice, Dr. Jamil says, “It’s fine. HIV positive doctors taking treatment can exercise and also undertake medical treatments, excluding certain complicated operations.” The same opinion was shared by Assistant Professor at Infectious Diseases, SIUT, Dr. Sunil Dodai who asked for de-stigmatization of the illnesses and said HIV+ medical care providers could work in a hospital and medical settings.

The Centre for Disease Control ( CDC ) in Atlanta, United States, has estimated that the average risk of sporadic HIV transmission from an HIV-infected doctor to a patient during an invasive procedure was 2.4 to 24 shows of transmission per one million methods. It further adds that HIV transmission from ( asymptomatic ) healthcare workers to sufferers utilizing standard antiseptic technique is quite unlikely. The CDC notes that though HIV transmission is possible in medical care configurations, it is extremely rare.

Dr. Dodai stresses the requirement for cutting down the use of injections and increasing hygiene protocols at all medical features, adding in non-public clinics. He is of the judgment that the mass media must respect the privacy of all individuals who have tested positive. Dr. Dodai is part of a three-member specialized team ( led by Dr. Shehla Baqi, with Dr. Azizullah Khan Dhillon as a member ) assisting the JIT investigating accused Dr. Muzaffar Ghangro. The group has submitted its in-depth research report.

While not disclosing the report’s summary until it is made public by the authorities, the JIT technical team members and other infectious illness experts say the current outbreak is ‘multifactorial’ ( involving or dependent on several factors, particularly genetic or environmental factors ) and ‘making one man a scapegoat for this is unfair’. They also urged the media to report responsibly and quit demonizing the doctor and the illness. The whole province is affected with such weak practices and micro-outbreaks have happened before, the doctors opined.

The infectious illnesses specialists in their recommendation point out the govt must ensure that screened blood is available, and alertness is made about the usage of auto-lock syringes which can’t be reused. Furthermore, they stressed compliance by healthcare professionals, hospitals and blood banks with the required security standards.

Privacy for the positives ?

One of the biggest concerns shared by the medical community was that comfort of HIV+ individuals ( including the doctor ) was not respected in the latest reporting of HIV crisis. 1 healthcare provider mentioned that lots of the men, females and also infants outed in the present and prior outbreak episodes were not in a position to give ‘informed consent’ and faced societal negativity.

Sindh AIDS Control Programme manager Dr. Sikandar Memon says the press should refrain from sensationalising the news. “It would be great if an awareness campaign is released to educate the masses and waiting for a consolidated report on the problem.” He stressed that the provincial AIDS control programme respected the security of all positive individuals.

So what do the Constitution and law say about the comfort of individuals? Article 14 of the Constitution warranties the ‘dignity’ of man as a fundamental right. Under the Sindh HIV and AIDS Control Treatment and Protection Act, 2013, any person who publicizes the confidential health data and/or records of another person in contravention to the provisions of this Act, shall be liable to imprisonment not exceeding five years and not lower than 2 yrs and a fine of Rs200,000. Health experts, as well as a lot of Television subscribers, accept that outing the identities of HIV+ individuals ( particularly vulnerable females and children ) serves no journalistic purpose.

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