Silent AIDS epidemic

Pakistan now holds the unenviable distinction of being home to one of the fastest-growing HIV epidemics in the WHO Eastern Mediterranean Region, which covers 22 countries in West Asia, North Africa, the Horn of Africa and Central Asia. New infections have surged by an alarming 200 per cent over the last 15 years, rising from 16,000 in 2010 to 48,000 in 2024. But even worse is the fact that public awareness campaigns and harm reduction strategies have been almost completely ineffective. Just this week, the National Assembly's Standing Committee on Health was told that nearly 20,000 patients out of 84,000 registered have gone "missing" after initiating antiretroviral therapy. That means they are walking around with potentially contagious levels of the virus in their systems.

Meanwhile, even the 84,000 people registered are nothing compared to the estimated 369,000 people living with HIV nationwide. This large, mostly untreated population, makes it harder to even identify who should be included in 'high-risk' groups. While unsafe sexual practices and intravenous drug use with used needles are still the main transmission routes, other medical routes, such as unsafe injection practices, unsterile blood transfusions, weak infection control and unchecked quackery are driving transmission to children and spouses.

Children have been disproportionately affected, with new infections in the 0–14 age group climbing from 530 in 2010 to 1,800 in 2023. In several outbreak hotspots - including Larkana, Taunsa and Hyderabad - children comprised more than 80 per cent of new detected cases. And despite these outbreaks, banned reusable syringes are still available in the market, and blood bank regulation remains spotty.

Compounding the crisis are resource constraints forced by underfunding from rich countries, especially US President Donald Trump's decision to almost eliminate all American foreign aid. The aid-dependent National AIDS Control Programme is now severely underfunded and understaffed, while corrupt local elements managed to steal $800,000 worth of donated supplies from the programme.