NEW DELHI — The bicycling doctor made an offer his patients couldn't turn down: medical cures for 10 Indian rupees, or less than two dimes.

Now dozens of patients in northern India are bearing what could be lifelong costs of HIV infection after the medically unqualified man reused an infected needle, officials said Tuesday, a grim consequence of quacks and unlicensed practitioners filling in the gaps of a health-care system struggling to meet the needs of 1.3 billion people.

Rajendra Yadav used a dirty syringe to infect 33 people with the virus that can cause AIDS, said S.P. Choudhary, the chief medical officer for the city of Unnao, where the patients were infected. Authorities expect to find more victims.

“What patients tell us is that this man was using the same syringe on many people without cleaning it. An investigation is going on to find him and patients are being given treatment for free in a government hospital,” he said. Yadav has yet to be apprehended.

Unlicensed people calling themselves doctors, known as jhola chaap doctors, circulate in poor and rural communities in India. Hospitals and physicians can be sparse in the world's second-most populous country, where there is fewer than one doctor per 1,000 people, below the standard set by the World Health Organization, the government said in July.

About a third of those claiming to be a doctor never received formal medical schooling, according to a 2016 report by WHO. About 19 percent of them in rural areas possessed the necessary qualifications, compared with 58 percent in urban areas.

The problem is so acute that the Delhi Medical Council operates a running list of hundreds of unlicensed doctors it refers to as “quacks,” who are distinguished from legitimate alternatives to licensed medical professionals. Many Indians rely on folk medicine Ayurveda practitioners and shamans in tribal areas.


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Arun Pratap Singh, a police officer from Bangarmau, said that a complaint was first made at the end of January by a doctor who had run health camps in the district and had found an unusually high number of HIV-positive patients in three hamlets. When authorities pressed villagers on how they became ill, stories about the bicycling doctor emerged.

On Wednesday, television news channels in India showed groups of people in Unnao who had gathered to tell reporters about the bicycling doctor. One of the interviewees on NDTV was 13 years old, and showed reporters a document saying that he was HIV positive. It is not clear whether those who tested HIV positive were infected by the quack doctor's syringe.

Authorities said teams from the state government and from the National Aids Control Organization were taking stock of how widely the disease had spread in the community.

Victims range from children as young as 6 to people in their 70s. In one family, six were infected. “All of them were treated by him in the past,” Chowdhary said, according to the paper.

Government officials pledged to take action; state health minister Sidharth Nath Singh said a crackdown on unqualified doctors is possible. “The state government has ordered an investigation,” Singh said. “It was found that a local quack has given injection to the patients. The district administration has identified him and he will be arrested soon.”

According to the Hindustan Times, officials had an opportunity to blunt the actions of Yadav and halt the infection rate. The paper said Tuesday that it had obtained documents indicating that a top regional official was notified of the problem in July and did not act. Chief district doctor Rajendra Prasad received letters of inquiry from Uma Shankar Dixit, the medical superintendent at Unnao, and from Chowdhary.

Prasad said he did not recall receiving the letters, the paper reported.

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