Hundreds of babies and children tested positive for HIV in 2019 after a whistleblower doctor uncovered a scandal involving the re-use of needles in southern Sindh province in Pakistan. 

In wake of the disaster, Pakistan's largest HIV testing and treatment center was established in the rural town of Rota Dero, dishing out life-saving anti-retroviral drugs.

However, affected families must cover the bludgeoning costs arising from the illness themselves.

"The government doesn’t give us Septran [drug name], no multivitamins are given to us. What kind of help is this from the government?" asked an HIV-positive villager who has a daughter who is HIV-positive as well.

Another man, Shahzado Shar, whose son was diagnosed with HIV during the mass outbreak in Pakistan among babies and children, has often been forced to choose between food and medicine.

The number of patients quickly swelled and two years later the figure stands at more than 1,500 children and babies infected with HIV, according to data from the provincial health ministry.

"They tell us to go for further tests in private hospitals, but we don't have sufficient money," Shar told AFP, describing how his son continues to suffer from regular fever, abdominal and kidney pain.

Around 30 other children are also HIV positive in their small village of Subhani Shar, just a few kilometers from Rato Dero.

Pakistan's public hospitals, located largely in cities, are often chaotic and inefficient, leaving rural families to rely on private clinics they can seldom afford that are often loaded with unlicensed doctors.

At least 50 children have died since they were diagnosed, said a paediatric specialist Fatima Mir from the Aga Khan University in Karachi, who has analysed the data.

Additionally, Mir had expected the number to be higher given the malnutrition and poverty among families in the area.

Authorities blamed a single physician -- a popular child specialist in Rato Dero -- for causing the outbreak.

The accused, Muzaffar Ghangro, is currently out on bail, with court hearings repeatedly pushed back, much to the anger of many families.

He denies the charges against him, saying other doctors have pinned the outbreak on him because of his successful practice.

- 'Ruthless' malpractice -

Poor infection control is rife across impoverished Pakistan, where doctors often re-use equipment to cut costs -- out of necessity or greed.

The doctor who first exposed Sindh's dirty needle scandal said little has changed since 2019.

"Things are as bad as they were at the time of the outbreak," said whistleblower Imran Akbar Arbani, who called malpractice in the country "ruthless."

Arbani took his data on the outbreak to local media after discovering an alarming number of babies with HIV in Rato Dero, where he has a private clinic.

He said authorities were quick to react at the time, but that discipline has since slipped.

"In the first three months, quacks and unauthorized medical practitioners were banned and their clinics were sealed, but they obtained clearance later on," he said.

Another doctor and president of the Infectious Diseases Society of Pakistan, Rafiq Khanani, said regulations were ineffective or routinely ignored.

"The regulatory departments exist only on documents and in offices... practically, they are ineffective."

In the wake of the scandal, the government banned the import of conventional syringes, insisting only on single-use auto-lock needles which cannot be re-deployed.

But a Sindh health official who did not want to be named told reporters that many doctors were circumventing the ban and still buying the cheaper models.