ISLAMABAD – Pakistan was as soon as thought of a low-prevalence nation for HIV, however a sequence of outbreaks has contaminated lots of of kids and uncovered basic weaknesses in its healthcare system.
Southern Pakistan has been significantly affected, with HIV outbreaks linked to healthcare amenities documented at Taunsa in Punjab, Karachi’s Kulsim Bai Valika (KBV) Hospital, and beforehand in Larkana and different districts.
Some 331 youngsters are estimated to have been contaminated with HIV at Tehsil Headquarters (THQ) Hospital in Taunsa since final October, and investigators have blamed their infections on preventable lapses in an infection prevention and management (IPC).
Not like outbreaks in lots of international locations, the place HIV transmission is primarily pushed via sexual contact, repeated investigations in Pakistan have as an alternative pointed to unsafe medical injections, poorly regulated blood transfusions and failures in sterilisation practices.
Regardless of the alarm being raised concerning the rise in youngsters’s infections earlier within the 12 months, an undercover expose by the BBC in April confirmed that well being staff continued to make use of the identical needles and syringes on a number of youngsters on the facility.
Rise in new infections
Officers from the Widespread Administration Unit, the federal government division coping with HIV/AIDS, malaria and tuberculosis, reported to Parliament’s Standing Committee on Well being final month that roughly 14,000 new HIV infections had been detected throughout 2025, a determine far larger than earlier annual experiences.
Though the nation’s well being ministry attributes a lot of the rise to expanded screening, which rose from round 37,000 folks examined in 2020 to greater than 374,000 in 2025, the rise has intensified issues over persistent transmission in healthcare settings and amongst weak populations.
For a lot of well being specialists, HIV has turn out to be a barometer of Pakistan’s broader well being system, revealing broader weaknesses in regulation, governance, surveillance and first healthcare that stretch effectively past the virus itself.
“Each outbreak ought to have been a lesson,” says Professor Hasan Abbas Zaheer, a World Well being Group (WHO) adviser on blood security. “Related failures proceed to emerge in several provinces, indicating that the underlying issues haven’t been resolved.”
Zaheer believes that Pakistan is dealing with a broader collapse of an infection prevention and management. Until hospitals, laboratories and blood banks persistently adhere to internationally accepted requirements – and regulators implement these requirements – the nation is prone to proceed responding to outbreaks after they happen quite than stopping them, he argues.
Taunsa and Karachi outbreaks
The Taunsa outbreak illustrates the implications of those failures. Between late 2024 and early 2025, more than 330 children had been contaminated, with three-quarters of infections occurring in youngsters youthful than 5 years.
Investigators discovered little proof that their moms had been dwelling with HIV, making mother-to-child transmission unlikely. As an alternative, the investigation pointed in the direction of healthcare-associated transmission via unsafe injections, blood transfusions and insufficient an infection management.
As an alternative, the investigation documented a number of breaches of primary scientific apply. Normal an infection prevention protocols had been usually absent or ignored, whereas intravenous infusion units had been reportedly reused, waste disposal programs had been insufficient and acceptable paediatric auto-disable syringes had been unavailable.
Bigger syringes that had been designed for hospital procedures had been generally used repeatedly in paediatric care, growing the danger of cross-contamination.
In the meantime, a authorities investigation into an HIV outbreak involving 130 folks – largely youngsters – at Karachi’s government-run Kulsum Bai Valika Hospital reported back final month.
It blamed the rise in HIV instances documented from final October on failures in sterilisation procedures, improper dealing with of single-use syringes, insufficient supervision, poor biomedical waste administration and weak compliance with an infection prevention tips.
Provincial authorities have since suspended dozens of healthcare staff and directors whereas strengthening therapy companies for affected youngsters.
Ban on substandard syringes
Final month, following a high-level evaluate of the HIV outbreaks ordered by Prime Minister Shehbaz Sharif, officers really useful a number of reforms aimed toward strengthening an infection management, enhancing surveillance and tightening regulation of medical gadgets.
These embody a nationwide ban on the manufacture and use of substandard syringes. The Drug Regulatory Authority of Pakistan (DRAP) has additionally accepted the phase-out of standard disposable 1cc and 10cc syringes from January 2027, extending earlier rules that already required auto-disable syringes for smaller volumes.
The choice follows years of proof linking syringe reuse to HIV outbreaks. Investigations into latest clusters persistently recognized unsafe injections as one of many principal drivers of transmission.
In lots of amenities, significantly the place an infection prevention requirements are weak, single-use syringes and intravenous gear have reportedly been reused or dealt with improperly, permitting blood-borne viruses to unfold between sufferers.
Systemic issues
Consultants warning, nevertheless, that focusing solely on syringes dangers overlooking broader systemic points.
Unsafe injections are sometimes a symptom quite than the foundation explanation for the issue. Weak regulation of personal clinics, insufficient inspection programs, inconsistent enforcement of an infection management requirements and shortages of educated healthcare staff all contribute to an surroundings wherein unsafe practices can persist.
Former federal well being minister and WHO official Dr Zafar Mirza argues that the recurring outbreaks needs to be considered as proof of wider governance failures.
The Taunsa outbreak, he mentioned, uncovered shortcomings not solely in an infection prevention but additionally in blood security, healthcare regulation, illness surveillance and accountability.
Though a authorities process power has proposed reforms throughout these areas, implementation has remained sluggish at the same time as new clusters proceed to emerge.
Insufficient surveillance
Whereas unsafe medical practices have attracted the best public consideration, Pakistan’s surveillance system represents one other main vulnerability.
The Ministry of Well being estimates that greater than 84,000 individuals are at the moment registered as dwelling with HIV and receiving care via the nationwide programme. Nonetheless, officers acknowledge that the true burden is considerably larger – and the WHO and UNAIDS put the determine at over 350,000 folks.
Federal Well being Minister Mustafa Kamal lately mentioned that roughly 20,000 further infections stay unreported, regardless of a dramatic growth of HIV testing capability over the previous 5 years.
Well being authorities argue that the sharp improve in reported infections partly displays improved case discovering quite than an explosion of transmission. Screening capability has expanded tenfold since 2020, enabling well being staff to establish infections that beforehand remained undiagnosed.
However weak surveillance continues to restrict Pakistan’s capacity to detect rising hotspots earlier than they turn out to be full-scale outbreaks.
The Taunsa investigation additionally discovered that hospitals and clinics lacked dependable digital reporting programs, normal case notification procedures and mechanisms for sharing surveillance information between districts and provinces. These gaps delayed recognition of transmission patterns and slowed public well being responses.
Monitoring sufferers after prognosis additionally stays a serious problem. Parliamentary discussions highlighted the issue of “lacking sufferers”: people who register at antiretroviral remedy (ART) centres however subsequently discontinue therapy or are misplaced to follow-up.
With out efficient counselling and monitoring, these interruptions improve the danger of poorer well being outcomes and continued HIV transmission.
Public well being specialists argue that surveillance ought to prolong past merely counting new diagnoses. It must also establish transmission networks, monitor healthcare-associated infections, consider an infection prevention practices and quickly detect clusters earlier than they unfold.
Zaheer believes Pakistan might strengthen these efforts by integrating surveillance information throughout provinces and utilizing digital applied sciences, together with synthetic intelligence, to establish rising hotspots in actual time.
Stigma limits HIV response
Whereas Pakistan has expanded HIV testing and therapy companies in recent times, prevention has not stored tempo with the altering nature of the epidemic.
The variety of government-supported antiretroviral remedy (ART) centres has greater than doubled from 44 in 2020 to 97 in 2025, with plans to extend the community to round 166 amenities. However entry stays uneven, significantly outdoors main cities.
For a lot of Pakistanis, HIV testing remains to be not a part of routine main healthcare. As an alternative, individuals are usually examined solely after they develop signs, require surgical procedure, donate blood or are recognized throughout an outbreak investigation.
Stigma stays one of many biggest limitations. Well being officers informed the Parliamentary well being committee that concern of discrimination discourages many individuals from searching for testing or therapy, whereas misconceptions about HIV proceed to gas secrecy and delayed prognosis.
The Pakistan Medical Affiliation (PMA) has additionally warned that 1000’s of infections stay undetected as a result of individuals are reluctant to entry healthcare companies for concern of being ostracised by their households or communities.
Pakistan’s HIV epidemic stays concentrated amongst individuals who inject medicine, males who’ve intercourse with males, transgender folks and intercourse staff. These teams ceaselessly encounter discrimination in healthcare settings and are sometimes excluded from mainstream well being programmes.
Group organisations have lengthy argued that HIV companies stay overly depending on donor-funded outreach initiatives quite than being built-in into routine main healthcare.
Hidden sexual networks?
Though the outbreak primarily affected youngsters contaminated via unsafe healthcare practices, investigators additionally warned of “hidden sexual networks” working largely outdoors current surveillance and prevention programmes.
With out confidential testing, neighborhood outreach and culturally acceptable prevention companies, these networks might maintain HIV transmission whereas remaining largely invisible to well being authorities.
Girls additionally face distinct limitations. Though Pakistan has made progress in stopping mother-to-child transmission, reproductive well being companies and HIV care are sometimes delivered individually, limiting alternatives for routine screening and counselling throughout being pregnant.
Many ladies are recognized solely after a partner or baby assessments constructive, reflecting broader gaps in sexual and reproductive healthcare.
The PMA has urged the federal government to make confidential, fast HIV testing obtainable freed from cost throughout main and secondary healthcare amenities, whereas investing in coaching for healthcare staff to scale back discrimination and enhance counselling. It has additionally referred to as for higher entry to fashionable biomedical prevention methods alongside expanded therapy companies.
Though antiretroviral medicines suppress the virus and dramatically cut back the danger of transmission, they depend upon early prognosis, uninterrupted drug provides and sustained affected person engagement.
With out addressing stigma, increasing community-based prevention and making certain equitable entry to care, many individuals will proceed to enter the well being system solely after they turn out to be critically in poor health—or after an outbreak has already occurred.
Might long-acting HIV prevention change the response?
Whereas Pakistan struggles to include healthcare-associated outbreaks, the worldwide HIV response is coming into a brand new period outlined by long-acting prevention applied sciences that might dramatically cut back new infections.
Lenacapavir, a long-acting injectable medication administered solely twice a 12 months, has demonstrated virtually complete prevention of HIV transmission in scientific trials.
Researchers additionally reported progress on different long-acting applied sciences, together with injectable mixtures that present each contraception and HIV prevention, three-month vaginal rings and real-world implementation of a month-to-month injectable cabotegravir in African international locations.
World well being specialists more and more view these medicines as potential game changers, significantly for individuals who battle to take every day oral pre-exposure prophylaxis (PrEP). Receiving two injections a 12 months might considerably enhance adherence whereas decreasing the danger of HIV transmission amongst folks at elevated danger of an infection.
However Pakistan has but to determine broad entry to traditional HIV prevention companies. Oral PrEP stays obtainable solely via restricted pilot initiatives and donor-supported programmes.
Lengthy-acting injectable prevention is due to this fact unlikely to turn out to be broadly accessible with out vital funding, regulatory approval and monetary help from worldwide companions.
Consultants however argue that Pakistan ought to start getting ready now quite than ready for the medicines to turn out to be broadly obtainable globally. Planning for procurement, regulatory approval, healthcare employee coaching and financing might allow the nation to introduce new prevention applied sciences extra quickly as soon as costs fall and generic variations turn out to be obtainable.
Mirza believes Pakistan’s response should transfer past emergency outbreak administration in the direction of a complete public well being technique that integrates an infection prevention, illness surveillance, blood security, governance and neighborhood engagement.
Zaheer additionally sees a chance to modernise Pakistan’s surveillance programs via digital applied sciences. Higher integration of laboratory information, hospital reporting and provincial surveillance might assist establish rising clusters earlier than they develop into massive outbreaks. Synthetic intelligence, he argues, might help well being authorities in recognising transmission patterns, predicting hotspots and directing scarce assets in the direction of areas of biggest want.
But specialists warning that new insurance policies and rules alone is not going to stop future outbreaks if enforcement stays weak. Earlier bans on standard syringes had been inconsistently applied, permitting unsafe merchandise to stay broadly obtainable. Likewise, investigations following successive HIV outbreaks have repeatedly recognized related failures in an infection prevention regardless of earlier suggestions.
Picture Credit: BBC, Wuestenigel/Flickr, Hamid Inam/ WHO Pakistan.
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