RATODERO, Pakistan — Nearly 900 children in the small Pakistani city of Ratodero were bedridden early this year with raging fevers that resisted treatment. Parents were frantic, with everyone seeming to know a family with a sick child.
In April, the disease was pinned down, and the diagnosis was devastating: The city was the epicenter of an H.I.V. outbreak that overwhelmingly affected children. Health officials initially blamed the outbreak on a single pediatrician, saying he was reusing syringes.
Since then, about 1,100 citizens have tested positive for the virus, or one in every 200 residents. Almost 900 are younger than 12. Health officials believe the real numbers are probably much higher, as only a fraction of the population has been tested so far.
Gulbahar Shaikh, the local journalist who broke the news of the epidemic to residents of his city and the nation in April, watched as his neighbors and relatives rushed to clinics to line up and test for the virus.
When officials descended on Ratodero to investigate, they discovered that many of the infected children had gone to the same pediatrician, Muzaffar Ghanghro, who served the city’s poorest families and appeared to be at the center of the outbreak.
Mr. Shaikh panicked — that was his children’s pediatrician. He rushed his family to be tested, and his 2-year-old daughter was confirmed to have the virus, which is the cause of AIDS.
“It was devastating,” said Mr. Shaikh, a 44-year-old television journalist in Ratodero, a city of 200,000 whose residents are some of Pakistan’s poorest, with high illiteracy rates.
Mr. Ghanghro was the cheapest option in this city, charging 20 cents a visit for the many parents here who earn less than $60 a month.
The pediatrician treated all six of Imtiaz Jalbani’s children, four of whom contracted H.I.V. His two youngest, 14-month-old Rida and 3-year-old Sameena, have died.
Mr. Jalbani, a laborer, said he first grew alarmed when he saw Mr. Ghanghro rummage through the trash for a syringe to use on Ali, his 6-year-old son, who is also infected. When Mr. Jalbani protested, he said, Mr. Ghanghro snapped at him and told him he was using an old syringe because Mr. Jalbani was too poor to pay for a new one.
“He said, ‘If you don’t want my treatment, go to another doctor.’” Mr. Jalbani said. “My wife and I had to starve ourselves to pay for the medicine.”
Mr. Ghanghro was arrested and charged by the police with negligence, manslaughter and causing unintentional harm. But he has not yet been convicted, and in an interview with The New York Times, he insisted he is innocent and has never reused syringes.