Whether for a minor injury or a life-saving procedure, hospitals are where sick people rush to in the hopes of getting better. However, when proper infection control protocols are not followed, a patient walking in for a simple blood test might leave the hospital unknowingly carrying HIV-AIDS.
According to the Better Health Channel, basic infection control protocols for HIV-AIDS at hospitals involve the disposal of single-use syringes in approved sharps containers, decontamination and sterilization of reusable medical devices after each use, disposal of single use medical devices, provision of personal protective equipment (PPE) gowns, gloves and eyewear for healthcare workers, and cleaning of spilled body fluids and laundry as per strict guidelines.
Although hospital officials in Pakistan assure the presence of infection control departments at government hospitals, in reality, these bodies remain non-functional and adherence to standard operating procedures (SOPs) is highly unsatisfactory. The human immunodeficiency virus (HIV) living in the bloodstream is easily transmitted through contact with an infected person’s bodily fluids, which could be present on unsterilized medical apparatus and work surfaces. Pakistan’s lack of an effective strategy to prevent diseases is one reason why the number of HIV-AIDS patients, currently around 290,000, continues to grow.
A patient’s family at the Civil Hospital’s Infection Unit revealed that their brother, diagnosed with HIV in 2020, fled the hospital due to unhygienic conditions. After persuasion, the family got him re-registered at the Lyari General Hospital, where he now receives monthly medication. “The appalling condition of hygiene at public hospitals worsens the patient’s mental and physical health, burdening their families. Medical neglect and lack of sanitation are major contributors to the spread of infections in these healthcare facilities,” claimed the family.
Similarly, Asghar, whose elder brother acquired HIV-AIDS during the 2023 outbreak, recounted his family’s tough journey. “My completely healthy brother used to work as a lab technician at a large private hospital in Karachi. Suddenly, his health started deteriorating and it was revealed that he had contracted HIV. Once his treatment started, my brother had to quit his job,” shared Asghar.
Dr Pir Ghulam Nabi Shah Jilani, Deputy Director at the Karachi Health Department, claimed that infection prevention committees were functional in government hospitals. “These committees, comprising qualified doctors and pathologists, are tasked with ensuring sterilization and proper disposal of medical waste. However, their effectiveness remains questionable,” noted Dr Jilani, while speaking of Sindh, where HIV transmission has increased by 139.6 per cent over the past five years, with 1,438 cases reported in 2020 and 3,446 cases recorded in 2024.
Professor Dr Faisal Mahmood, an infectious disease specialist at the Aga Khan University Hospital, emphasized the urgent need to implement infection control protocols at hospitals and clinics. “Patients can be carriers, and hospitals must treat every patient as potentially infectious,” said Dr Mahmood, while mentioning medical protocols, which were clearly ignored in Punjab, where healthcare facilities’ lamentable adherence to infection control dragged multiple patients towards sickness and death.
In October 2024, over 24 nephrology patients acquired the HIV virus at the Nishtar Hospital in Multan, which is the largest facility offering dialysis to over 200 registered patients from South Punjab. During the investigation, it was revealed that a patient with HIV was dialyzed without proper sterilization protocols, which led to the spread of the virus to other patients due to the negligence of hospital staff.
Sources revealed that inspections of other government hospitals also found similar lapses in infection control protocols for HIV. Health Minister Salman Rafiq handed the matter over to the Punjab Healthcare Commission for further investigation. However, doctors at the Nishtar Hospital did not cooperate, and when summoned to the Lahore office, they presented excuses and resisted.
When contacted, the Punjab Healthcare Commission declined to provide further details on the grounds that it was investigating the matter and monitoring adherence to infection control SOPs. Dr Zahid Ansari, former Head of the Sindh Blood Transfusion Authority, clarified the difference between HIV-positive individuals and AIDS patients.
“HIV-positive individuals should not donate blood, and their used medical tools like syringes or razors must not be reused. The virus can be identified through specific blood tests and viral load analysis. Four key diseases — HIV, Hepatitis B, Hepatitis C, and malaria — must be screened in blood tests before transfusions,” emphasized Dr Ansari.
In the Nishtar Hospital incident, it was clear that screening procedures were completely ignored. Despite the gravity of the situation, the issue has once again disappeared into the background in Punjab, where more than 7,000 HIV cases were reported last year.
Shehzad, a 60-year-old dialysis patient at the Jinnah Hospital in Lahore, conveyed his worries after the Multan hospital outbreak. “After hearing about what happened at the Nishtar Hospital, I live in fear. Even routine procedures now feel dangerous. Patients are constantly worried that they may contract a serious illness at any time due to medical negligence,” revealed Shehzad.
Similar concerns have mounted over the poor performance of the Infection Prevention Committee and the Healthcare Commission in Khyber-Pakhtunkhwa, which has observed an 888.1 per cent increase in the incidence of HIV-AIDS over the past three years, with 816 cases reported in 2022, 5,543 cases reported in 2023, and an alarming 8,063 cases recorded in 2024.
Major medical teaching institutions (MTIs) in Peshawar, including the Lady Reading Hospital, Khyber Teaching Hospital, and Hayatabad Medical Complex, along with district-level Tehsil Headquarter Hospitals (THQs) are failing to maintain effective infection control and sterilization systems. Instead of preventing diseases, these hospitals are allegedly turning into hotbeds of infectious outbreaks.
A technician at the Hayatabad Medical Complex, speaking on the condition of anonymity, revealed that standard operating procedures (SOPs) for infection control were not being followed at all. “We have repeatedly requested the administration to provide basic supplies for infection control. However, now we do not even have spirit or syringes available, let alone anything else for infection prevention,” informed the technician.
Dr Amir Taj, an infection control expert, told The Express Tribune that it was unfortunate that both the Infection Control Committee and the Healthcare Commission, which were created for the very purpose of controlling the spread of transmissible infections, were failing to do their job.
“Instead of controlling infections, the Healthcare Commission seems more focused on collecting hospital fees and registration charges. Infections like HIV, Hepatitis, and others are rapidly spreading, costing the government billions of rupees each year. If proper infection control systems were in place at hospitals, patients would recover faster, and the national treasury would also benefit,” opined Dr Taj.
On the other hand, Dr Tariq Hayat, Director of the HIV Control Programme, stated that SOPs for infection control were strictly followed at HIV and Hepatitis control centers operating within hospitals. However, he also acknowledged the fact that awareness sessions on infection control were urgently needed at both public and private hospitals.
Dr Muhammad Naeem, former Director of the Sindh AIDS Control Program, recalled that Larkana faced major HIV outbreaks in 2019 and 2023. “After the Rato Dero outbreak, the Sindh Health Department screened 37,272 people in Larkana. HIV-AIDS was confirmed in 1,811 cases. Contributing factors included reused syringes, abundance of unqualified healthcare providers and unregulated blood transfusion practices,” revealed Dr Naeem.
Speaking to the Express Tribune on the matter, Azam Rehman, spokesperson for the Healthcare Commission, claimed that the commission strictly enforced SOPs for infection control, fining both private and public hospitals found violating the guidelines.
Despite official claims, the current poor adherence to infection control protocols at hospitals across the country demands urgent government intervention, including strict regulation of medical practices, enforcement of hygiene protocols, and establishment of a trace-and-track system for HIV-positive patients. Without swift action, the spread of HIV-AIDS may spiral out of control.