Larkana, Bhuttos’ political stronghold, is making headlines these days for all the wrong reasons. Fifteen children were diagnosed with Human Immunodeficiency Virus infection and Acquired Immune Deficiency syndrome (HIV/AIDS) in late April.

Dr Imran Arbani, the first one to diagnose the HIV outbreak, has been practicing for the last 15 years in Ratto Dero. He told TNS that in mid-February 15 month old Emaan Fatima was brought to him with high fever. "I prescribed her blood screening on February 22. The child was diagnosed HIV positive."

Soon after, more children came to him with similar symptoms and "I started sending their blood samples for screening. The results were the same. Their parents’ blood was tested negative".

Emaan’s father, Syed Nazar Hussain, told TNS that his daughter was suffering from flu and fever. He took her to hospital and she got well but after 10 days she again had high fever. "We took her to a local hospital but her condition didn’t improve so we brought her to Larkana Chandka Hospital. But no one could diagnose the ailment. Her condition got worse. Finally we brought her to Dr Arbani who prescribed her some medicines but her condition didn’t improved," till the doctor prescribed a blood test which showed signs of HIV.

Nazar Hussain has another daughter older than Emaan. After Emaan was diagnosed with HIV, he along with his older daughter and the rest of the family, underwent blood screening thrice but the results came in negative for all of them.

According to him, "Emaan never got injured, she never had blood transferred and they never took her to a barber". They believe she got this virus through an injection or cannula.

Disappointed from the lack of facilities at Chandka Hospital, Hussain brought her to Civil Hospital in Karachi, where the incharge of AIDS control programme asked them for a new blood test. When the results came in they showed weak positive on which Civil Hospital refused to treat her for HIV saying they could not provide treatment at this level.

Meanwhile, Emaan’s condition got worse and she lost a lot of weight. She was taken to Aga Khan Hospital in Karachi where her blood transfusion was done and other treatment procedures were followed after which her condition improved.

Nazar is an employee in a private company and has already spent 0.6 million rupees till now. He has sold his wife’s jewellery and is in debt.

Nazar said he was in contact with Dr Arbani who informed him that 15 children had been diagnosed with HIV virus after which he uploaded a status on Facebook and local journalists got in touch with him.

So far, this virus has killed seven in Ratto Dero alone. Among them was three-year-old Ghulam Nabi Mirani, who died on February 3. Ghulam Nabi’s father Aga Zahid Mirani told TNS that almost two months ago his son had chest congestion and diarrhoea. They took him to a clinic where a reused cannula was inserted -- "This was something usual," he said.

Aga Zahid owns a cigarette cabin in Ratto Dero, he has spent Rs450,000 on the treatment which he must pay back by selling his cabin.

According to the Directorate General Health Services Sindh Hyderabad Provincial Disease Surveillance and Response Unit report, "Total 128 HIV Positive cases are reported so far from Ratto Dero in which 60 percent are male and 40 percent are female."

Dr Muzaffar Ghanghro, who is accused of spreading HIV through infected syringes, has been arrested from Larkana and his clinic sealed. Dr Ghanghro is a government doctor but he has also been practising privately.

Commissioner Larkana Saleem Raza Khokhar sees quacks as the main reason behind the outbreak of HIV. "Health Ministry puts their number at 270 while sources claim they are around 1100 in number. In my personal opinion they are around 4 to 5 thousand." He also blamed barbershops for playing a part in this outbreak by reusing blades.

A paper titled Alarming increase in reported HIV cases from Larkana, Pakistan: a matter of serious concern appeared in JPMC (Jinnah Postgraduate Medical Centre) Journal in 2014.

The researchers Ashraf Memon, Sameera Haider and Arshad Altaf found that HIV cases came to the fore in Larkana in June 2003 when the first outbreak of HIV among IDUs (injecting drug users) was reported in which 17 IDUs out of 175 were confirmed positive. In 2008, results of Round III of national surveillance suggested that around 28 percent transgender sex workers were confirmed HIV positive.

This has to be a unique town in Pakistan because of an unusual pattern of multiple commercial sex activities happening here. Allegedly it has a functioning brothel where clients from all over the district as well as from other cities visit women for commercial sex. Additionally, there are home-based sex workers working in the area along with some transgender and male sex workers. It is estimated that there are 1096 IDUs, 969 FSWs (female sex workers) and 1698 male and trans-sex workers.

The charges of commercial sex workers (male and female) often can be as low as Rs.50 to Rs.100. In other words this city has all the ingredients of an exploding HIV epidemic in the near or distant future.

Recent HIV data from Sindh AIDS Control Programme from Larkana suggested that it is a matter of serious concern.

Sindh Health Minister Dr Azra Pechuho stated that they have been running this HIV project on global funds in which they were screening populations at high risk when they received information on this immune deficient virus.

"We screened all the blood banks and quacks for this virus and we found out that all these children went to the same doctor who was injecting them with a used syringe, moreover when he was tested for HIV his tests came in positive. He was arrested and 6 laboratories along with 12 clinics have been sealed."

She presented a policy statement in the Sindh assembly and said that Sindh’s second largest city Hyderabad is at potential risk too and they want to perform community screening there. "We cannot perform screening everywhere so we are looking for suspicious communities to make it easier."