THIS is with reference to the letter ‘Silence surrounds a serious health issue’ (April 27). Pakistan is once again confronting a deeply troubling public health crisis which is as preventable as it is devastating. The rising number of paediatric infections is rather troubling. The mechanics of transmission in such cases are both simple and deeply disturbing. In many under-resourced areas, healthcare providers, often unlicensed or poorly trained, reuse syringes to cut costs or due to lack of awareness. A single contaminated needle can transmit human immunodeficiency virus (HIV) to multiple patients within hours.

This crisis is not merely a failure of individual practitioners. It is a reflection of broader systemic negligence. Regulatory bodies have long struggled to enforce standards across a fragmented healthcare system. Clinics operate without proper licensing, inspections are infrequent, and violations often go unpunished.

The lack of a centralised monitoring mechanism allows unsafe practices to persist unchecked. Even when outbreaks occur and investigations are conducted, the response tends to be reactive rather than preventive. Temporary crackdowns may follow, but sustained enforcement is rarely achieved.

The human cost of this negligence is immense. Children diagnosed with HIV face lifelong medical challenges, including the need for continuous antiretroviral therapy. Beyond the physical impact, there is also a profound social burden. Stigma surrounding HIV remains deeply entrenched in society, often leading to discrimination and isolation. Families affected by such outbreaks not only grapple with the emotional toll of the diagnosis, but also face financial strain due to long-term treatment costs. In many cases, these are families that can least afford such burdens, further deepening existing inequalities.

The economic implications extend beyond individual households. Managing HIV requires sustained investment in healthcare infrastructure, medication and support services. Antiretroviral therapy, while increasingly accessible, represents a significant cost when scaled to thousands of patients. Preventing infections through safe practices is far more cost-effective than treating them after the fact.

Accountability remains one of the most critical and most lacking components in addressing the crisis. Strict legal conse-quences must be enforced against those found responsible, including revocation of licences, heavy fines and criminal prosecution. However, accountability must extend beyond individual practitioners to include regulatory authorities that fail to regulate and enforce standards.

Oshaz Fatima
Lahore

Published in Dawn, May 5th, 2026