The growing number of HIV-positive children represented the tip of the iceberg
In the city of Larkana, in Pakistan's Sindh province, seventy-three children were diagnosed with HIV in a single month — most of them too young to understand what that means, all of them dependent on a system struggling to hold itself together. The Anti-Retroviral Treatment Centre at Chandka Medical College stands as both a lifeline and a mirror, reflecting the consequences of unsafe medical practices, inadequate infrastructure, and years of delayed reckoning with a crisis that never truly ended after the 2019 Ratodero outbreak. What is unfolding here is not simply a public health emergency but a moral one — a society measuring, in the bodies of its youngest members, the cost of neglect.
- Seventy-three children, some as young as five months old, were registered HIV-positive at a single centre in June — a number that health officials describe as only the visible surface of a far deeper crisis.
- The centre treating them operates without a pharmacist, with too few doctors, and in a building where ceiling plaster falls in the very rooms where children receive care.
- Unsafe blood transfusions, reused syringes, and unqualified practitioners working in remote areas along the Indus River continue to create new infections, while social stigma keeps families silent and delays diagnosis.
- New ART centres have been opened in Gambat and Qambar, but one has not yet begun pediatric treatment and the other lacks medicines and diagnostic kits — leaving Larkana to absorb a burden it was never built to carry alone.
- Families like that of a labourer who could afford neither medicine nor travel to Karachi arrive at the centre with nowhere else to turn, while an infant in the Nutrition Ward fails to gain weight despite uninterrupted treatment.
- Experts are unambiguous: without expanded screening, enforced blood safety standards, and strengthened ART infrastructure across Sindh, the seventy-three diagnoses of June will simply repeat, month after month.
In June alone, seventy-three children arrived at the Anti-Retroviral Treatment Centre at Chandka Medical College in Larkana carrying an HIV diagnosis — most from Khairpur district, ranging in age from five months to fourteen years. The centre, already receiving around twenty follow-up patients daily, had no pharmacist on staff, too few junior doctors, and ceiling plaster falling in its clinical areas. Prof Dr Shanti Lal, head of Paediatrics, called the situation alarming, noting that routine HIV screening introduced in January was revealing just how widespread infection had become among the youngest patients.
The pathways of transmission were familiar and preventable: unsafe blood transfusions, repeated use of unsterilized syringes, and unqualified practitioners operating in remote kutcha areas along the Indus. The 2019 Ratodero outbreak had already exposed these vulnerabilities, yet the conditions that enabled it had not been fully dismantled. Social stigma continued to delay diagnosis, and weak surveillance allowed infections to accumulate in silence.
Amid the grim picture, one development offered a measure of hope. Mother-to-child transmission had become nearly negligible when mothers received timely treatment. Dr Shanti Lal cited the case of a hospital employee who, after diagnosis and treatment, achieved an undetectable viral load and gave birth to an HIV-negative child — a small but meaningful proof of what early intervention could accomplish.
The infrastructure meant to respond to the crisis remained incomplete. A new ART Centre opened in Gambat in late May had not yet begun pediatric services, its assigned doctor still in training. A third centre in Qambar lacked medicines and diagnostic kits entirely. Until both became operational, children from across the region would continue to converge on an already overstretched Larkana.
For families, the weight was immediate. A labourer who could afford neither medicine nor travel to Karachi found his only option in the centre's free services. A mother from Dadu watched her infant fail to gain weight despite consistent treatment. Health experts were direct about the path forward: blood transfusion safety must be enforced, injection practices standardized, screening expanded, and ART capacity distributed across Sindh. Without these changes, the seventy-three children of June would be the first of many such months.
In June alone, seventy-three children walked through the doors of the Anti-Retroviral Treatment Centre at Chandka Medical College in Larkana with a diagnosis that would reshape their lives and their families' futures. Most came from Khairpur district, ranging in age from five months to fourteen years old. The centre, which operates under the provincial Directorate of Communicable Disease Control, was already stretched thin. Around twenty follow-up patients arrived daily. There was no pharmacist on staff. The junior doctors were few. And in the clinical areas where these children received care, ceiling plaster had begun to fall.
The surge raised immediate alarm among health officials and doctors. Prof Dr Shanti Lal, head of the Department of Paediatrics at the hospital, described the situation as alarming—a phrase he chose carefully. The growing number of HIV-positive children, he said, represented only the visible part of a much larger problem. The hospital had introduced routine HIV screening in its outpatient department on January 7th, which meant more cases were being caught, but it also meant the system was discovering just how widespread the infection had become among the youngest patients.
The children arriving at the centre came from circumstances of profound vulnerability. Unsafe blood transfusions, medical malpractice, the repeated use of syringes without sterilization, and weak surveillance systems had created pathways for the virus to spread. The 2019 outbreak in nearby Ratodero had primarily affected children between two and five years old, traced to contaminated blood. Now, years later, the problem persisted. Unqualified practitioners operating in kutcha areas along the Indus River continued to perform medical procedures without proper training or equipment. Social stigma kept families silent about infections, delaying diagnosis and treatment.
Yet there was one piece of progress worth noting. Mother-to-child transmission of HIV had become almost negligible. When mothers received timely diagnosis and treatment, their newborns could be born free of the virus. Prof Dr Shanti Lal recounted the case of a hospital employee who tested positive, received prompt treatment, achieved an undetectable viral load, and gave birth to an HIV-negative child. It was a small victory in an otherwise grim landscape, but it mattered.
The infrastructure to handle this crisis remained fragmented and inadequate. A new ART Centre had been established at Gambat on May 26th, but paediatric HIV services had not yet begun. The doctor assigned to the facility was undergoing specialized training. Medicines had arrived, but treatment would not start for at least another two weeks. Meanwhile, children from Khairpur continued to be referred to Larkana, adding to the burden. A third centre at District Headquarters Hospital in Qambar had been established but lacked medicines and diagnostic kits. Until it became operational, more children would make the journey to Larkana.
For families, the reality was immediate and unforgiving. Rahib Ali Junejo, a labourer from Larkana, had exhausted his options before bringing his young son to the centre. He could not afford medicines. He could not afford to travel to Karachi for treatment. At the ART Centre, his son received free examination, testing, and medication. A mother from Dadu sat in the Nutrition Ward watching her HIV-positive infant fail to gain weight despite uninterrupted treatment, a sign that the child's body was struggling even as the virus was being managed. These were the human costs that statistics could not capture.
Health experts were clear about what needed to happen next. Screening had to expand further. Blood transfusions had to be safe. Injection practices had to be standardized and enforced. ART facilities had to be strengthened across Sindh, not concentrated in a single overwhelmed centre. The Sindh Safe Blood Transfusion Authority needed to enforce stricter scrutiny of pathology laboratories and mandatory screening of donated blood. Without these changes, the seventy-three children diagnosed in June would be followed by seventy-three more, and then seventy-three more after that.
Notable Quotes
I cannot afford medicines or travel to Karachi for my son's treatment. Here, the doctors examined him, carried out the required tests and provided medicines free of cost.— Rahib Ali Junejo, labourer from Larkana, whose young son was diagnosed with HIV
The growing number of HIV-positive children represented the tip of the iceberg, calling for stronger preventive measures and greater public awareness.— Prof Dr Shanti Lal, head of Department of Paediatrics at CMC Children's Hospital
The Hearth Conversation Another angle on the story
Why did so many cases appear in June specifically? Was there an outbreak, or is this just what happens when you start looking?
Both, really. The hospital introduced routine screening in January, so they're catching cases that might have gone undiagnosed before. But there's also a real surge happening—unsafe practices have been going on for years, and now you're seeing the accumulated result.
The article mentions unsafe blood transfusions and unqualified practitioners. How does that translate to children getting infected?
A child needs a transfusion, or a doctor gives an injection with a reused syringe, or a procedure is done in unsanitary conditions. The virus travels through blood. In kutcha areas along the river, there's no regulation, no sterilization, no training. It's a direct pipeline for transmission.
But the article also says mother-to-child transmission has become negligible. That sounds like progress.
It is, genuinely. When mothers are diagnosed and treated early, their viral load drops to undetectable levels and the baby is born free of infection. That's a real win. But it only works if the mother gets diagnosed and treated in the first place—which many don't, because of stigma and lack of access.
So why is the Larkana centre so overwhelmed if there are other centres being built?
The new centres aren't ready yet. Gambat's doctor is still in training. Qambar doesn't have medicines or diagnostic kits. So every child in the region still ends up in Larkana, which has no pharmacist and not enough junior doctors. It's a bottleneck.
What happens to a family like Rahib Ali Junejo's when they arrive at the centre?
They get free care—examination, testing, medication. For a labourer who can't afford private treatment or travel to Karachi, that's everything. But it also means the centre is absorbing the entire financial burden of care for the poorest families in the region.
Is there any sense of what comes next?
The experts are calling for expansion—more screening, safer blood transfusions, enforcement against unqualified practitioners, stronger facilities across Sindh. But that requires resources and political will. Right now, the system is just trying to keep up.