Pakistan's HIV Surge Exposes Systemic Infection Control Failures in Healthcare Facilities
核心洞察
Pakistan recorded approximately 14,000 new HIV (搜索) infections in 2025, with outbreaks linked to unsafe injection practices and poor infection control at healthcare facilities.
Over 330 children were infected at Tehsil Headquarters Hospital in Taunsa, with three-quarters of cases occurring in children younger than five years.
Investigators identified reused syringes, contaminated saline bottles, and inadequate sterilization as principal drivers of healthcare-associated HIV (搜索) transmission.
Pakistan, once considered a low-prevalence country for HIV (搜索), is now confronting a series of outbreaks that have infected hundreds of children and exposed fundamental weaknesses in its healthcare system. Officials from the Common Management Unit, the government department dealing with HIV/AIDS, malaria and tuberculosis, reported to Parliament's Standing Committee on Health that approximately 14,000 new HIV infections were detected during 2025, a figure far higher than previous annual reports.
Southern Pakistan has been particularly affected, with HIV (搜索) outbreaks linked to healthcare facilities documented at Taunsa in Punjab, Karachi's Kulsim Bai Valika (KBV) Hospital, and previously in Larkana and other districts. Unlike outbreaks in many countries where HIV transmission is primarily driven through sexual contact, repeated investigations in Pakistan have instead pointed to unsafe medical injections, poorly regulated blood transfusions, and failures in sterilisation practices.
The Taunsa Outbreak: A Preventable Tragedy
Some 331 children are estimated to have been infected with HIV (搜索) at Tehsil Headquarters (THQ) Hospital in Taunsa since October 2024, and investigators have blamed their infections on preventable lapses in infection prevention and control (IPC). Three-quarters of infections occurred in children younger than five years.
Investigators found little evidence that their mothers were living with HIV (搜索), making mother-to-child transmission unlikely. Instead, the investigation documented multiple breaches of basic clinical practice. Standard infection prevention protocols were often absent or ignored, while intravenous infusion sets were reportedly reused, waste disposal systems were inadequate, and appropriate paediatric auto-disable syringes were unavailable. Larger syringes designed for hospital procedures were sometimes used repeatedly in paediatric care, increasing the risk of cross-contamination.
Despite the alarm being raised earlier in the year, an undercover expose by the BBC in April showed that health workers continued to use the same needles and syringes on several children at the facility.
Karachi Outbreak and Systemic Weaknesses
A government investigation into an HIV (搜索) outbreak involving 130 people—mostly children—at Karachi's government-run Kulsum Bai Valika Hospital reported back last month. It blamed the increase in HIV cases documented from October 2024 on failures in sterilisation procedures, improper handling of single-use syringes, inadequate supervision, poor biomedical waste management, and weak compliance with infection prevention guidelines. Provincial authorities have since suspended dozens of healthcare workers and administrators while strengthening treatment services for affected children.
Dr Faisal Mahmood, Professor of Infectious Diseases, explained that unsafe injection practices are the most likely route of transmission. "A needle may be reused for more than one child. A saline bottle used to prepare medications may be used for multiple patients and become contaminated. Infection can also spread if medication from the same vial or syringe is shared between different children," he said.
Regulatory Response and Syringe Reform
Last month, following a high-level review of the HIV (搜索) outbreaks ordered by Prime Minister Shehbaz Sharif, officials recommended several reforms aimed at strengthening infection control, improving surveillance, and tightening regulation of medical devices. These include a nationwide ban on the manufacture and use of substandard syringes.
The Drug Regulatory Authority of Pakistan (搜索) (DRAP) has also approved the phase-out of conventional disposable 1cc and 10cc syringes from January 2027, extending earlier regulations that already required auto-disable syringes for smaller volumes. The decision follows years of evidence linking syringe reuse to HIV (搜索) outbreaks.
However, experts caution that focusing solely on syringes risks overlooking broader systemic issues. Former federal health minister and WHO official Dr Zafar Mirza argues that the recurring outbreaks should be viewed as evidence of wider governance failures. The Taunsa outbreak, he said, exposed shortcomings not only in infection prevention but also in blood safety, healthcare regulation, disease surveillance, and accountability.
Surveillance Gaps and Hidden Burden
Pakistan's surveillance system represents another major vulnerability. The Ministry of Health estimates that more than 84,000 people are currently registered as living with HIV (搜索) and receiving care through the national programme. However, the WHO and UNAIDS (搜索) put the true figure at over 350,000 people. Federal Health Minister Mustafa Kamal recently said that approximately 20,000 additional infections remain unreported.
Screening capacity has expanded tenfold since 2020, from around 37,000 people tested to more than 374,000 in 2025. Yet weak surveillance continues to limit Pakistan's ability to detect emerging hotspots before they become full-scale outbreaks. The Taunsa investigation found that hospitals and clinics lacked reliable digital reporting systems, standard case notification procedures, and mechanisms for sharing surveillance data between districts and provinces.
Dr Mahmood noted that "although HIV (搜索) is a notifiable disease, many healthcare facilities do not consistently report cases. Even when cases are reported, the data are often not analyzed in real time. In addition, because people with newly acquired HIV infection usually do not have symptoms, an outbreak may become quite widespread before it is detected."
Stigma and Access to Care
The number of government-supported antiretroviral therapy (ART) centres has more than doubled from 44 in 2020 to 97 in 2025, with plans to increase the network to around 166 facilities. But access remains uneven, particularly outside major cities. Stigma remains one of the greatest barriers, with health officials telling the Parliamentary health committee that fear of discrimination discourages many people from seeking testing or treatment.
The Pakistan Medical Association (搜索) (PMA) has warned that thousands of infections remain undetected because people are reluctant to access healthcare services for fear of being ostracised by their families or communities. The PMA has urged the government to make confidential, rapid HIV (搜索) testing available free of charge across primary and secondary healthcare facilities.
Broader Implications Beyond HIV (搜索)
Dr Mahmood emphasized that these outbreaks should not be viewed solely as an HIV (搜索) problem. "Pakistan also has one of the highest burdens of hepatitis C (搜索), which has spread through many of the same unsafe healthcare practices. Similarly, inadequate infection prevention and control measures have contributed to the growing problem of infections caused by antimicrobial-resistant bacteria and other difficult-to-treat organisms," he said.
Professor Hasan Abbas Zaheer, a WHO adviser on blood safety, captured the recurring nature of the crisis: "Every outbreak should have been a lesson. Similar failures continue to emerge in different provinces, indicating that the underlying problems have not been resolved."
The Promise of Long-Acting Prevention
While Pakistan struggles to contain healthcare-associated outbreaks, the global HIV (搜索) response is entering a new era defined by long-acting prevention technologies. Lenacapavir, a long-acting injectable medicine administered only twice a year, has demonstrated almost total prevention of HIV transmission in clinical trials. However, Pakistan has yet to establish broad access to conventional HIV prevention services, with oral PrEP remaining available only through limited pilot initiatives and donor-supported programmes.
Experts argue that Pakistan should begin preparing now rather than waiting for these medicines to become widely available globally. Planning for procurement, regulatory approval, healthcare worker training, and financing could enable the country to introduce new prevention technologies more rapidly once prices fall and generic versions become available.