Islamabad: Medical experts, public health professionals and civil society representatives have warned that Pakistan’s HIV situation is worsening, with official estimates showing 369,000 people living with the virus while only about 84,400 cases have been formally registered.
The concern was raised at a National Dialogue on HIV and AIDS organised by Lok Sehat, where doctors, medical bodies, civil society groups and representatives of communities affected by HIV discussed the rising number of infections, particularly among children and people outside groups traditionally considered at higher risk.
According to a government Task Force report, nearly 60,789 registered patients are receiving antiretroviral treatment. The report says the appearance of HIV among children in low-risk rural communities points to serious gaps in infection control, blood safety, healthcare regulation and medical management.
Lok Sehat Convener Dr Zafar Mirza said the government must stop trying to control disease by controlling or hiding data. He called for reliable information on HIV and other blood-borne diseases to be made available, and urged the government to assume greater financial responsibility for HIV, tuberculosis and malaria instead of relying heavily on international donors.
Dr Mirza said around 90 percent of spending on HIV, tuberculosis and malaria over the previous five years had come through the Global Fund. He said Pakistan should gradually take full financial responsibility for these programmes rather than treating donor support as a permanent arrangement.
The Task Force report has raised particular alarm over Taunsa Tehsil of Dera Ghazi Khan, where 127 children were confirmed to have HIV during a five-month period between December 2024 and April 2025. Around 79 percent of the infected children were below five years of age, with a median age of only three years. Investigations largely ruled out mother-to-child transmission as 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 in blood donor screening, unregulated healthcare providers, reuse of disposable syringes, excessive use of injections, poor sterilisation and weak infection prevention systems.
Dr 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 where oral medicines are medically suitable.
Former National AIDS Control Programme and Islamabad Healthcare Regulatory Authority chief Dr Quaid Saeed said 13 HIV outbreaks had been reported in Pakistan during the last 18 years, but only two, including Jalalpur Jattan and Ratodero, had been extensively investigated. He called for complete epidemiological investigations into every reported outbreak.
The Task Force report 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 expressed concern over stigma faced by people living with HIV. Dr Mirza said discrimination remained a serious problem, including within parts of the medical profession, and that there had been cases where doctors refused to treat patients after learning they had HIV.
He said 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 misconceptions and reduce discrimination.
In Islamabad, infectious diseases expert Dr Naseem Akhtar said many 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 due to 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 a major part of the problem. Dr Mirza called for stronger healthcare commissions, blood transfusion authorities and other regulators, supported by 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 key recommendation is the creation of a national real-time HIV surveillance dashboard. The proposed 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 outbreak-hit areas. It has recommended social protection for children living with HIV, including support for medicines, nutrition, education, transport and psychological care.
The proposed reforms 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 also proposes a high-level National HIV Technical Working Group 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.
The 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.
Participants said Pakistan now needed action beyond statements and meetings, including 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 underline that the HIV challenge is not only about treating patients, but also about ensuring that people seeking care at hospitals and clinics are not exposed to preventable risks caused by unsafe medical practices, weak monitoring or poor regulation.
