In June alone, 73 children tested positive for HIV at the Antiretroviral Treatment Centre in Larkana—a figure that health officials call just the visible tip of a far larger problem. Most of these new patients come from Khairpur district, and the centre, already strained by staff shortages and a crumbling building, now faces an escalating burden that reveals systemic failures in Pakistan's healthcare and blood safety systems. Main Developments The ART Centre at Chandka Medical College Children’s Hospital registered 73 new HIV-positive pediatric cases in June 2026, with the majority originating from different parts of Khairpur district. Officials report that around 20 follow-up patients visit daily, yet the facility operates without a pharmacist and urgently needs additional junior doctors. Read also: 47 Undocumented Afghans Detained in Khyber-Pakhtunkhwa Crackdown During a visit, Dawn observed fallen ceiling plaster in the area where doctors and support staff work. The centre falls under the Directorate of Communicable Disease Control, and its dilapidated condition mirrors the broader neglect of pediatric HIV care infrastructure. Routine HIV screening in the hospital’s outpatient department began on January 7, according to Prof Dr Shanti Lal, head of Pediatrics at CMC Children’s Hospital. He stated that data on HIV cases is being maintained and that coordination with ART centres ensures confirmatory testing and medicine access for every screened patient. HIV-positive children referred to the hospital range in age from five months to 14 years, though ART Centre officials say most patients are between five months and eight years old. Prof Shanti Lal noted that boys account for 52 percent of reported pediatric HIV cases, while girls make up 48 percent. Background The 2019 HIV outbreak in Ratodero primarily affected children aged two to five years, with contaminated blood identified as the principal route of transmission. ART Centre sources now point to unsafe blood transfusions, weak surveillance, medical malpractice, and syringe reuse as major ongoing contributors to HIV spread. Mother-to-child transmission, however, has become almost negligible due to timely diagnosis and treatment. Prof Shanti Lal cited the case of a hospital employee who achieved an undetectable viral load after prompt treatment, and whose newborn tested HIV-negative—demonstrating that early intervention works. Despite the establishment of an ART Centre at Gambat on May 26, 2026, pediatric HIV services there have not yet started. Dr Rahim Bakhsh Bhatti, Director of the Pir Abdul Qadir Shah Jillani Institute of Medical Sciences in Gambat, explained that the assigned lady doctor is undergoing specialized training, and medicines recently arrived. He expressed hope that treatment for children would begin within a fortnight after training completion. Similarly, an ART Centre at District Headquarters Hospital in Qambar has been established but medicines and diagnostic kits have yet to arrive, according to Medical Superintendent Dr Sartaj Jaj. Until these facilities become operational, HIV-positive children from both Khairpur and Qambar districts continue to be referred to Larkana, compounding the workload. Why It Matters The human cost is immediate: Rahib Ali Junejo, a labourer from Larkana, brought his young son to the ART Centre after exhausting all other options. He told Dawn he could not afford medicines or travel to Karachi, and only at this centre did doctors examine his son, run tests, and provide free medication. Another mother from Dadu said her HIV-positive child, admitted to the Nutrition Ward, failed to gain weight despite uninterrupted treatment. Health experts stress that expanding screening, ensuring safe blood transfusions, eliminating unsafe injection practices, and strengthening ART facilities across Sindh are essential to preventing further spread among children. They also call for closer scrutiny of pathology laboratories to enforce mandatory screening of donated blood and stronger action by the Sindh Safe Blood Transfusion Authority. Dr Bhatti attributes the rising number of reported HIV cases in Khairpur largely to unsafe medical practices by unqualified practitioners operating in the kutcha areas along the Indus River. He noted that increased screening has led to more detections, but social stigma discourages many families from disclosing infections. Strict action against quacks is needed, he said. What's Next Pediatric HIV services at the Gambat ART Centre are expected to begin within two weeks, once the lady doctor completes her specialized training. Until then, and until medicines arrive at the Qambar facility, referrals to Larkana will continue—further straining an already overburdened centre. Prof Shanti Lal has called for stronger preventive measures and greater public awareness, describing the growing number of HIV-positive children as the tip of the iceberg. The coming months will test whether the health system c