The first sign that something was in place in the small town of southern Pakistani Ratto Dero appeared in February.
A handful of anxious parents had taken their children to the doctor, complaining that their little ones could not shake a fever.
Within weeks, more children came forward who had similar illnesses.
Sadly, Dr Imran Aarbani sent the children's blood away to test it. He confirmed what came back his worst fears. The children were infected with HIV – and nobody knows why.
"By 24 April, 15 children had experienced positive, although they were not found to have the same of their parents carrying the virus," the hospital doctor told the BBC.
It was just the tip of the iceberg.
Over the last month, over 607 people – 75% of whom are children – have been diagnosed with the virus after rumors of the case of sending families rushing to a special camp set up in the town government hospital by a health department. Sindh province.
However, perhaps more surprising is the fact that this is not the first case to reach the region in recent years.
Rumors of a possible cause in Larkana in the state of Sindh, which Ratto Dero is a subdivision, provoked thousands of people back in 2016.
On that occasion, 1,521 people were found to be HIV positive, according to figures available with the Sindh Aids Management Program (SACP).
The vast majority of those infected were male and, at the time, the case related to sex workers in the area, who were predominantly transsexual, and 32 were found to carry the virus Aids.
The discovery of the cause led to a fight against Larkana passenger pubs, where sex workers had managed to trade relatively freely, despite a ban on prostitution in Pakistan.
But could that case be linked to the recent discovery of health officials?
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Dr Asad Memon, who leads SACP operations in Larkana, believes that – though not directly.
"I think the virus (Aids) is carried by members of the high-risk group (transgender and female sex workers) and then lax practices by local quacks caused him to infect other patients," he said. he told the BBC.
According to quack it refers to people who are not adequately qualified, ranging from paramedics who run a private clinic to doctors, to medical graduates who have not been able to find work in hospitals and who are not. come into contact with standard medical practices.
In Pakistan, especially in rural areas, people often go to “stairs” rather than qualified doctors because they are cheaper, easily available, and have more time to donate to & # 39 w patients.
Dr Fatima Mir, who works for Aga Khan University Hospital and specializes in Aids among children, is currently doing voluntary work in Ratto Dero. We agree that negligent medical practice is the most likely contact between the children and the case of 2016.
"There are three ways a child may have to infect," he explained. "It is either through a mother who is lactating our virus, through a blood transfusion, or through an infected surgical instrument or a syringe."
In most cases she has dealt with them, mothers tested negative for HIV and very few children had blood transfusions. So the only explanation that was left was the practice of using one syringe for a number of patients in local clinics.
Officers also seem to agree. Around 500 non-regulated clinics have been closed across the province, health authorities reported.
More than that, local children's expert Dr Muzaffar Ghangro has been arrested on charges of spreading Aids through syringes.
He has denied the charge, saying that his patients were not all infected people.
Meanwhile, officials in Sindh – who have one of the highest HIV infection rates in Pakistan – have set up an investigation to identify the causes of the case.
But that won't help people who have already been diagnosed that will affect their whole lives.
Doctors at the hospital camp in Ratto Dero have now experienced more than 18,418 people since 25 April.
At least 607 of them have experienced positive so far, three quarters of them are children aged between 15 and 15 years.
That means hundreds of parents leave the cost – to their children's health and their existence every day.
"Medicines for adults are usually available [with health authorities] in Larkana, but for the child's medicines we have to go to Karachi, which means we spend thousands of rupees on every trip, "said one mother, who got her daughter aged three diagnosed with HIV-positive, told the BBC.
"My husband is just a day laborer, so I wouldn't be able to afford this for a long time."