Fresh cases of HIV are coming to light in Ratodero, Larkana, everyday. The figure has already risen to more than 500. This is a very alarming situation. The Joint United Nations Programme on HIV/AIDS chief to Pakistan and Afghanistan, currently on a visit to Karachi and Larkana to assess the situation after the recent HIV outbreak in Sindh, said that the last HIV outbreak in Asia was reported from Cambodia in 2014 when a cluster of HIV infections in Roka, Battambang province, were reported. UNAIDS fear that Pakistan could have more HIV outbreaks, similar to the one in Rattodero, Larkana, in other parts of the country if re-use of needles and unsafe blood transfusion procedures remain in practice, and quacks continue to inject people with lethal viral and bacterial infections, including HIV and hepatitis. This is not the first outbreak of HIV in Pakistan. Similar outbreaks have earlier been reported from Sargodha and Jalalpur Jattan in the Punjab. This can also happen in other areas of Pakistan, as the practice of re-using needles and unsafe injection and blood transfusion is common throughout the country. This was stated by Dr Maria Elena G Filio Borromeo, the UNAIDS country director for Pakistan and Afghanistan. We need to educate people and general practitioners that there is no need for injections and IV drips in most cases. We need to reduce the demand for unnecessary injections and IV drips. There is a need to rationalise the use of injections, needles and IV drips. While countries like India and Cambodia have been able to successfully reduce new HIV infections through effective prevention programmes, countries like Pakistan and the Philippines continue to show an upward trend Almost 500 people, including children, have so far been tested HIV positive since April 25, in Rattodero. Rxperts believe that sharing of needles and IV drips, mostly by quacks, is the root cause of the latest outbreak. National and international experts fear that hundreds more could be infected with HIV in the area as well as the surrounding towns due to unsafe medical practices of quacks. Provincial governments of Sindh and other provinces must be urged to introduce auto-destructible or auto-lock syringes that cannot be reused. The provincial assembly has passed a law regarding the use of auto-destructible syringes, adding that strict monitoring on implementation of the law is required in order to prevent further infections and save lives of thousands, especially children, in the province. Children as young as two and seven months old have tested HIV positive in Rattodero. These children need to take the antiretroviral therapy (ART) for life in addition to psychosocial support. The first report of new HIV infections among children came from the local media, hence there is a need to strengthen current HIV reporting and monitoring system. The Sindh government has quickly responded and is carrying out voluntary HIV testing in medical camps. Those who have tested HIV positive are being treated. As far as treatment is concerned, UNAIDS, a global fund, is currently providing 100 per cent of ART in Pakistan, free of charge. However, this arrangement will end in December 2020; it is imperative for the federal and provincial governments to start planning now to sustain it beyond 2020. According to UNAIDS, the UN is ready to bring in experts from abroad and introduce best practices that have resulted in preventing such outbreaks in other high-risk countries, but local authorities would have to prepare mid-term and long term strategies to prevent such outbreaks in the future and deal with the existing burden of people with HIV/Aids in Pakistan. According to UNAIDS, HIV infection has increased by 57 per cent between 2010 and 2018 in Pakistan. While countries like India and Cambodia have been able to successfully reduce new HIV infections through effective prevention programmes, countries like Pakistan and the Philippines continue to show an upward trend. The UNAIDS official also held talks with Sindh Health Minister Dr Azra Pechuho and other government officials on the recent HIV outbreak in Larkana, and assured UNAIDS support in carrying out a scientific investigation of the outbreak, linking those tested HIV positive to treatment, implementing of education, prevention programme as well as reporting and monitoring to prevent such outbreaks in the future. On Monday, PPP chairperson Bilawal Bhutto presided over a high-level meeting regarding the HIV infections in Rattodero. Dr Azra Pecuho visited Rattodero on Tuesday to monitor the situation. A crackdown has been started in the district against quacks, and many people have been arrested. A centre for HIV treatment has been activated in Larkana CMC Hospital under the supervision of the Sindh AIDS Control Programme. The writer is a freelancer