THE recent reports of a dramatic surge in paediatric human immunodeficiency virus (HIV) cases in Karachi and other parts of the country serve as a chilling wake-up call for a nation that has long remained in denial about the HIV issue. With 159 children admitted to three Karachi hospitals this year alone, the majority of whom contracted the incurable virus through unsafe healthcare practices, it is clear that we are no longer facing a hidden threat, but a full-blown public health emergency. This is not a new lesson; the Ratodero HIV outbreak of 2019 was one of the largest global paediatric out-breaks, but the glaring gaps in infection control remain rampant.

The horror is not confined to Sindh. An investigation at a government hospital in Taunsa, Punjab, revealed that serious malpractices continued months after the facility was linked to an outbreak that infected over a hundred children.

Undercover footage captured the un-thinkable: nurses injecting patients through their clothes, the reuse of dirty syringes, and unqualified volunteers injecting child after child from a single blood-contaminated vial.

Nationally, the statistics remain stag-gering. There are an estimated 350,000 people living with HIV in Pakistan, but only a few of them know of their status, or are registered for treatment. In 2024, new HIV infections reached 48,000 — a 200 per cent increase over 2010 — making Pakistan one of the fastest-growing areas with HIV epidemic in the larger Eastern Mediterranean Region of the World Health Organisation (WHO).

Deaths from acquired immunodeficiency syndrome (AIDS) exceeded 14,000 in 2024, and over 1,100 child deaths were reported in 2023 alone. Despite some progress, our antiretroviral therapy (ART) coverage stands at approximately 16pc, with only 55,500 people on treatment and just 7pc achieving viral load suppression.

The drivers of this epidemic are multi-faceted, but unsafe injection practices remain the primary cause of transmission. The epidemic, once concentrated among key populations, is now spreading rapidly to children, spouses and the wider com-munity through unsafe blood management, gaps in infection prevention and control, and inadequate HIV testing during antenatal care. New cases among children aged 0-14 surged from 530 in 2010 to 1,800 in 2023.

Social stigma and taboos remain the greatest barriers to effective intervention. HIV is often viewed solely through the prism of immoral activities, causing even educated citizens to conclude that infection is a mark of character rather than a medical condition. This silence is fatal. Many people avoid testing, and those diagnosed often keep their status secret from their own families.

Our legal and policy frameworks are also struggling to keep pace. The 18th Amendment, while a milestone for provincial autonomy, has created gaps in coordinated national response and international health commitments. As such, provinces often lack consistent central guidance, research support and sustained funding, leading to policy inconsistencies.

The path forward requires a holistic and indigenous strategy. We must enforce the National Action Plan for Injection Safety and mandate the use of auto-disable syringes in all healthcare settings. Making premarital blood screening mandatory for HIV, thalassemia and hepatitis is vital to protecting future generations. It is time to stop looking for excuses and start demanding accountability and trans-parency in our healthcare delivery system.

Muhammad Faizan Ali
Karachi

Published in Dawn, April 27th, 2026