In Pakistan, routine medical care is spreading HIV

[KARACHI, SciDev.Net] Pakistan’s HIV epidemic is increasingly being driven by unsafe medical care, rather than traditional transmission routes, warn doctors and public health experts urging action after a public scandal around reused syringes.

Poor infection control, syringe reuse, unsafe blood management, and unregulated clinics are pushing the virus into the general population, including children and women with no known exposure risks, according to the WHO and health professionals on the ground.

HIV in Pakistan was traditionally concentrated among key populations such as intravenous drug users and sex workers, but this is changing.

“We are increasingly seeing infections among people outside traditional high-risk groups, including women and children, which points toward broader systemic healthcare failures,” said Baseer Achakzai, national technical advisor for HIV/AIDS at Pakistan’s Common Management Unit for AIDS, Tuberculosis and Malaria.

The issue came to the fore in an undercover investigation by Britain’s BBC that linked local outbreaks of hundreds of HIV cases to unsafe injection practices in some health facilities in Punjab’s Taunsa district. Healthcare workers were filmed apparently reusing syringes, improperly handling multi-dose medicine vials, and failing to follow sterilisation procedures.

Pakistan has one of the fastest growing HIV epidemics in the Eastern Mediterranean region, with new infections rising by 200 per cent over the last 15 years, from 16,000 in 2010 to 48,000 in 2024, according to the WHO.

An estimated 350, 000 people in the country are living with HIV, but almost eight in ten affected do not know their status, the WHO says.

Health experts warn that a growing number of infections are linked to unsafe healthcare practices, particularly in poorer districts where infection-control standards remain weak and informal medical providers operate with limited oversight.

Naveed Akram, former professor at the University of Health Sciences Lahore and a physician involved in infection-control advocacy, told SciDev.Net that Pakistan’s high rate of therapeutic injections and weak monitoring systems have created dangerous conditions for the spread of blood-borne diseases.

“In many communities, injections are still perceived as more effective treatment, while poor regulation allows unsafe practices to continue in both public and private healthcare settings,” Akram said.

Children infected

Medics on the ground say the crisis is largely preventable.

Amina Khan, a doctor working in Sindh province who treats HIV-positive children, says many infections are linked directly to unsafe healthcare practices.

As in other provinces, pediatric HIV clusters in Sindh have raised fears of widespread contamination through routine medical care rather than traditional transmission routes, she says.

“These children come to hospitals with fever, diarrhoea, or routine illnesses and leave infected with a lifelong virus,” Khan told SciDev.Net.

“The infection is often iatrogenic, acquired during medical care. A reused syringe can destroy an entire family’s future.”

For affected families, the impact extends far beyond health complications.

One father from southern Punjab, whose son contracted HIV after treatment at a local clinic, described the social isolation his family now faces. He did not want to be named due to the stigma surrounding HIV.

“We trusted the doctor with our child,” he told SciDev.Net via video call. “Now people avoid us because they think HIV is shameful.

“My son needs medicines for life but even reaching the treatment centre costs more than we can afford.”

Pakistan’s healthcare infrastructure has struggled for years with underfunding, poor oversight, and unequal access between urban and rural areas.

Public hospitals are often overcrowded, short-staffed, and have limited medical supplies, while in low-income communities, patients often seek treatment from unlicensed clinics or informal healthcare providers because qualified medical care is inaccessible or too expensive.

The country also has one of the highest rates of injecting drug use in the world.

Syringe crackdown urged

Activists and healthcare professionals are calling for urgent reforms, including strict enforcement of single-use syringe policies, nationwide infection-control monitoring, mandatory screening of all blood products, and crackdowns on unlicensed practitioners operating without oversight.

The government has officially banned used and reusable syringes, but reusable syringes continue to remain widely available in markets and are still used in many places due to weak enforcement and poor regulation.

Javed Akram, a leading healthcare expert in Pakistan says the country cannot control its surging HIV crisis without cracking down on “unregulated clinics and quacks responsible for thousands of infections” as well as syringe reuse.

“The government must enforce auto-disposable syringes nationwide, strengthen blood screening, mandate testing, ensure strict penalties, and run aggressive awareness campaigns to halt silent community transmission,” Akram, a former professor at the University of Health Sciences Lahore, told SciDev.Net.

Pakistan’s national HIV taskforce has recommended stringent action against the sale and reuse of disposable syringes and called for mandatory HIV testing, regular inspections of clinics and pharmacies, and tougher penalties, according to local media reports.

SciDev.Net reached out to officials at the Ministry of Health for comment but received no response.

Sajid Abdullah, a government official who volunteers with an HIV awareness team working in the country, believes testing is improving.

“An increase in reported HIV cases is not only a sign of the spread of the disease, but also reflects that more people are now coming forward for testing and diagnosis,” he told SciDev.Net.

However, he warned that stigma, silence and fear surrounding HIV remain major challenges, particularly in conservative communities where many avoid testing until the disease has progressed.

Abdullah said the detection of HIV cases among children is especially alarming and underlines the urgent need for awareness campaigns, early screening and better public education on prevention and treatment across Pakistan.

This piece was produced by SciDev.Net’s Global desk.