Pakistan’s HIV crisis deepens as child infections rise and health system faces serious safety gaps

Pakistan is facing a growing HIV crisis, with an estimated 369,000 people living with the virus while only about 84,400 cases

Islamabad: Pakistan is facing a growing HIV crisis, with an estimated 369,000 people living with the virus while only about 84,400 cases are formally registered, according to a government Task Force report. Health experts and concerned citizens have warned that the real situation may be much worse because the country still lacks reliable and complete disease data.

The warning came during a National Dialogue on HIV and AIDS organised by Lok Sehat, where doctors, public health experts, medical organisations, civil society groups and representatives of communities affected by HIV discussed the growing problem.

Lok Sehat Convener Dr Zafar Mirza said the government must stop trying to control the disease by controlling or hiding data. He demanded that reliable information about HIV and other blood-borne diseases should be made available and that the government should take greater financial responsibility for HIV, tuberculosis, and malaria instead of depending heavily on international donors.

The issue has become more serious because HIV infections are increasingly being reported among children and people outside the groups traditionally considered at higher risk.

The Task Force report estimates that 369,000 people are living with HIV in Pakistan, but only around 84,400 cases are formally registered and about 60,789 people are receiving antiretroviral treatment. The report says the recent appearance of HIV among children in low-risk rural communities points to serious weaknesses in infection control, blood safety, healthcare regulation, and medical management.

The situation in Taunsa Tehsil of Dera Ghazi Khan has raised particular concern. The Task Force report says 127 children were confirmed to have HIV during a five-month period between December 2024 and April 2025. Around 79 percent of those children were below five years of age, with the median age only three years. Investigations largely ruled out transmission from mothers because nearly all mothers of the infected children tested negative for HIV.

The report identified unsafe blood transfusions and contaminated injection practices as major drivers of the Taunsa outbreak. It also found problems involving blood donor screening, unregulated healthcare providers, reuse of disposable syringes, excessive use of injections, poor sterilisation and weak infection prevention systems.

Dr Zafar Mirza said repeated use of syringes and needles was a major suspected route of HIV transmission among people receiving healthcare. He called for proper training of healthcare workers and public awareness so patients and families understand the importance of using new syringes and needles. He also urged doctors to avoid unnecessary injections when oral medicines are medically suitable.

The problem is not limited to one area. Former National AIDS Control Programme and IHRA chief Dr Quaid Saeed said 13 HIV outbreaks had been reported in Pakistan during the last 18 years, but only two, including the outbreaks in Jalalpur Jattan and Ratodero, had been extensively investigated. He called for proper investigations into every outbreak.

The Task Force report also says the Ratodero outbreak in Sindh in 2019 affected more than 1,000 people, most of them children under 12. Investigations linked the outbreak to contaminated syringes, unsafe injections, unregulated blood transfusions, quackery and serious weaknesses in infection prevention and control.

Experts also raised concerns about the treatment of people living with HIV. Dr Zafar Mirza said stigma remains a serious problem, including within parts of the medical profession. He said there had been cases where doctors refused to treat patients after learning that they had HIV.

He stressed that HIV does not spread through ordinary contact such as shaking hands or being near an infected person. He called for stronger public awareness through television, newspapers and social media to correct false beliefs and reduce discrimination against patients.

In Islamabad, infectious diseases expert Dr. Naseem Akhtar said many of the HIV cases seen at her centre involved people who inject drugs, deportees, transgender persons, men who have sex with men, and female sex workers. She said some cases had also been found among children.

Dr Asma Naseem said the situation in Karachi was also worrying, particularly because of a rise in HIV cases among children. She said children with HIV were being brought to the Sindh Institute of Urology and Transplantation with kidney failure, describing the trend as highly concerning.

The experts said weak regulation of healthcare facilities was another major part of the problem. Dr. Zafar Mirza called for stronger healthcare commissions, blood transfusion authorities, and other regulators, along with better funding, trained staff, and modern technology.

The government Task Force has recommended nationwide surveillance of syringes, stronger regulation of medical devices, and a phased move towards auto-disable syringes. It has also proposed tougher action against unsafe medical practices.

Another major recommendation is the creation of a national real-time HIV surveillance dashboard. The system would collect information from treatment centres, blood transfusion centres, provincial disease surveillance units and other health facilities so that new cases could be reported quickly at the national level.

The Task Force has also proposed stronger testing and care for children, including early infant diagnosis, trained counsellors and paediatric HIV specialists in areas facing outbreaks. It has recommended social protection for children living with HIV, including support for medicines, nutrition, education, transport and psychological care.

The proposed reforms also include stronger laws, mandatory reporting of HIV cases and outbreaks, better sharing of health data between provinces and agencies, and accountability for public and private healthcare providers where negligence contributes to disease transmission.

The government report says a high-level National HIV Technical Working Group is also proposed, with experts including Maj. Gen. (R) Dr. Azhar Mehmood Kayani, Dr. Zafar Mirza, Dr. Abdul Wali Khan, Dr. Amjad Mahmood, Dr. Adnan Khan, Dr. Huma Qureshi, Dr. Hasan Abbas Zaheer, Brig. Dr. Nuzhat Mushahid, Dr. Saira Afzal, Dr. Fatima Mir, Dr. Saba Jamal, Dr. Rana Jawad Asghar and Dr. Khalid Rehman.

Dr Zafar Mirza also raised concern over Pakistan’s dependence on international funding. During the briefing, he said that around 90 percent of spending on HIV, tuberculosis and malaria over the previous five years had come through the Global Fund. He argued that Pakistan should gradually take full financial responsibility for these programmes rather than treating donor support as a permanent solution.

The national dialogue was attended by representatives of the Pakistan Medical Association, Pakistan Paediatric Association, Pakistan Islamic Medical Association, Medical Microbiology and Infectious Diseases Society of Pakistan, Society of Obstetrics and Gynaecology of Pakistan, Association of People Living with HIV in Pakistan, Indus Hospital and Health Network, Nai Zindagi Trust, Wajood Society, Bridge Foundation, Dareecha Male Health Society and UNAIDS.

The experts said Pakistan now needs more than statements and meetings. They called for safe injections, properly screened blood, stronger hospital safety rules, reliable disease data, regular investigations of outbreaks, better regulation of clinics and sustained government funding.

The Task Force recommendations make clear that the HIV problem is not only about treating patients. It is also about making sure that people who go to a hospital or clinic for treatment do not face preventable risks because of unsafe medical practices, weak monitoring or poor regulation.