Unsafe medical practices drive a rise in child HIV cases in Pakistan

0:00This week on Up First, we talk about the economy. trucks, trains, and tractors run on diesel, which is now priced at record highs, with less than 50 days until the midterm elections. So the next six weeks are going to be intense. Let Up First get you through it one morning at a time with three stories you need to know each day. Listen to Up First on the NPR app or wherever you get your podcasts. Today on State of the World, unsafe medical practices drive a rise in child HIV cases in Pakistan.

0:37You're listening to State of the World from NPR, a human perspective on global events. It's Tuesday, September 22nd. I'm Christine Arismeth. In Pakistan's port city of Karachi, at least 140 people, most of them children, have recently tested positive for HIV. Many of these cases are now being linked to everyday medical care. This isn't the first time Pakistan has seen a surge in HIV infections among kids. And as Betsy Joles reports, it once again points to shortcomings in hospital safety. Aisha Aftab took two of her children to Kulsambai Valika Hospital for what she suspected were symptoms of typhoid or malaria.

1:27She brought along her youngest, Mohamed Rehan. He was soon flushed with fever too. The doctor on duty suggested an antibiotic injection to knock out Rehan's symptoms faster than a pill or syrup. I thought, okay, the doctor knows better, Afdab says. It was then she noticed that injections were being given to child after child. For God's sake, you're giving injections to three or four patients from different families, Aftab recalls saying. Why are you using injections in this way? Her children later tested positive for HIV. Dozens of other parents who brought their children to Valika Hospital say their kids now have HIV too.

2:11At least six of them have died. Parents accuse hospital staff of spreading the virus by reusing syringes and needles for injections and IV drips. One father, Syed Mehtab Shah, says he watched a nurse retrieve a syringe from inside a trash can. This happened in front of our eyes, he says. Multiple government-ordered inquiries since last November have found safety issues at Valika Hospital, including improper handling of syringes. The department that manages the hospital suspended some staff, and the provincial government promised families financial compensation. But parents say more action is needed.

2:50They brought their kids to Valika Hospital in the first place because they could get free care there through a social security program that generally serves low-income workers.

3:03So on a weekday this summer, families gathered to demand accountability from hospital administration and the government.

3:16They're still sleeping, 24-year-old Aisha Kamran says of those in charge. they're not waking up because these are the children of laborers. Whether they live or die, it makes no difference to them. Another mother places a hand on Aisha's shoulder to calm her down. Enough, she tells her. Be quiet. Two significant pediatric HIV outbreaks were flagged in Pakistan in 2019 and 2024. They saw many of the same problems now being alleged at Valika Hospital. There's so many chinks in the armor and so many things in healthcare practice which are suboptimal. They have to be dealt with in an organized way.

3:56Fatima Mir is a pediatric infectious disease specialist at the Aga Khan University Hospital in Karachi. She says without major reforms, more hospitals in the country risk spreading HIV. Infection prevention and control is actually the emergency right now. The stakes are high, says prominent activist Zulfiqar Ali Bhutto Jr., because in addition to lifelong symptoms, children with HIV face the stigma that can come with a positive diagnosis. He's pushing for education about even the basics, like how HIV can't be spread through touching or sharing food. In many people's minds, HIV and AIDS relate to sex, which can carry shame in Pakistan.

4:36Maybe there'll be a cure for HIV soon, but at the same time, most likely these children will have to live with this disease for the rest of their life as far as we know. So they need to live in a world that is kind to them. For now, discrimination is prevalent. On the way to an interview, NPR received this WhatsApp voice note from the father of two HIV-positive children. How many people are coming with you for the visit, he asks. No one in our area knows that our children have HIV. He worried that if too big a group arrived at his house, people might start asking questions. His daughter, Manahil, was already refused admission to school because of her diagnosis.

5:17Three of his other daughters were denied admission by association.

5:24Another parent, Umaima Ansari, says her three-year-old son, Hussain, has also been turned away from medical care.

5:36Hussein tested positive for HIV following a potentially life-saving operation soon after birth. His family suspects the surgery or a later blood transfusion gave him the virus. Ansari recalls the advice she received after her son was diagnosed. Don't tell anyone he has HIV. People will stop meeting you. People will stop coming over to your house, she says. At home, Hussein receives the opposite kind of attention, says his oldest sister Rahimeen. Without him, we are nothing because the love we gave him, he is the star of our house. She looks over at her brother's small body lying on the bed under a worrying fan.

6:16We just love Hussein. Don't want him to suffer that much. Hussein's family says they're prepared to fight the judgment he faces outside these walls. They just never imagined his life would be forever altered by medical care meant to keep him healthy. For NPR News, I'm Betsy Jules in Karachi, Pakistan.

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