PAKISTAN’S HIV surge is no longer a slow-burning public health concern. It is now a system failure unfolding in real time. What makes the crisis particularly alarming is not just the rising numbers — estimated at over 350,000 people living with the disease — but the profile of those newly infected. Increasingly, they are children and low-risk individuals, infected not through behaviour but through the healthcare system meant to protect them. Two converging failures are behind this trajectory. The first is the collapse of basic infection control across large parts of our healthcare network. The second is the persistence of syringe reuse, despite a nationwide ban on conventional disposable syringes in 2021. Together, they have created what experts describe as a “man-made epidemic”. The trail of evidence is troubling. Outbreaks linked to healthcare facilities have surfaced in Karachi, Larkana, Multan and Taunsa. In some cases, children as young as one year have been diagnosed with HIV after visiting clinics. Experts have pointed to contaminated injections and unsafe medical practices as the primary drivers — both entirely preventable. Yet enforcement remains lacking, and accountability absent.

The Pakistan Medical Association’s warning of falsely labelled “auto-disable” syringes entering the supply chain should trigger outrage. Instead, the Drug Regulatory Authority of Pakistan and provincial health bodies stand accused of a “catastrophic failure”. Equally troubling is the state’s indifference to data and transparency. As clinicians note, outbreak investigations are conducted but buried, depriving policymakers and the public of crucial lessons. Without a credible national dashboard and expert-led analysis, responses remain reactive. This is not merely a question of resources, though chronic underfunding — with health spending still below 1pc of GDP — has left hospitals struggling. It is a question of governance. Infection control protocols are basic: single-use syringes, sterilisation, clean water, trained staff. Their absence points to neglect. The way forward is clear, if politically inconvenient. First, declare a national health emergency. Next, audit syringe manufacturing and supply chains, seizing non-compliant stock and prosecuting offenders. Then, enforce infection control standards across all facilities with zero tolerance for violations. Finally, invest in real-time disease surveillance that informs policy. Pakistan cannot treat this as another outbreak. When children contract HIV in clinics, the very system meant to protect them has let them down.

Published in Dawn, May 5th, 2026