Pakistan's child HIV crisis highlights dangers of unsafe injections
Pakistan is facing a severe HIV epidemic, with children disproportionately affected due to unsafe medical practices like syringe reuse. Outbreaks in various regions, notably Larkana in 2019, have exposed systemic failures in healthcare, leading to thousands of infections. Urgent public health action is needed to address this crisis.
Key Highlights
- Unsafe injection practices are a primary driver of Pakistan's HIV outbreak.
- Children are significantly impacted, with many contracting HIV through routine medical care.
- Past outbreaks in Larkana and other areas reveal recurring systemic failures.
- Pakistan's healthcare system struggles with accountability and enforcement of safety standards.
- Urgent public health interventions are required to curb the escalating crisis.
Pakistan is grappling with a severe and escalating HIV epidemic, characterized by alarming outbreaks that have disproportionately affected children. The root cause of this crisis has been identified as a widespread culture of unsafe medical practices, particularly the reuse of syringes and needles, and poor infection control in healthcare facilities across the country [3, 11].
The gravity of the situation was starkly highlighted by a major HIV outbreak in Larkana district, Sindh province, in April 2019. Investigations revealed that hundreds of children, many of whom had HIV-negative parents, contracted the virus through therapeutic injections administered during routine medical care [5, 15]. Between April and June 2019, over 30,000 people were tested in Larkana, with 876 testing positive for HIV, of whom 82% were children under 15 years old [5, 7, 19]. This outbreak was reminiscent of similar pediatric HIV epidemics linked to needle and syringe reuse in other parts of the world [15].
Subsequent reports and ongoing monitoring have indicated that this is not an isolated incident, but rather a recurring problem across Pakistan. Outbreaks have been reported in various other locations, including Shaheed Benazirabad, Hyderabad, Naushahro Feroze, Pathan Colony (2025), Taunsa (2024), Mirpur Khas (2024), Jacobabad, and Shikarpur (2023) [6]. In many of these outbreaks, children constituted over 80% of the detected cases [6]. A recent BBC Eye investigation in Taunsa, Punjab, uncovered a similar scenario, where a government hospital was implicated in an outbreak affecting at least 331 children between November 2024 and October 2025, due to reused syringes and contaminated medical supplies [21].
Experts and health organizations, including the World Health Organization (WHO) and UNAIDS, have repeatedly warned about Pakistan's rapidly growing HIV epidemic. New infections have surged significantly, with an estimated 200% increase over the past 15 years [6, 13]. While HIV traditionally affected high-risk groups, it is now spreading to the general community, including children and spouses, due to a combination of factors: unsafe blood management and injection practices, gaps in infection prevention and control, insufficient HIV testing during antenatal care, unprotected sexual activity, pervasive stigma, and limited access to HIV services [6, 13].
The underlying issues point to systemic weaknesses within Pakistan's healthcare system. These include a lack of accountability, inadequate regulation of clinics, the prevalence of unlicensed practitioners (quacks), and a disregard for established infection control protocols [8, 11, 21]. Many healthcare providers, especially in rural and underserved areas, allegedly reuse syringes on multiple patients to cut costs, a practice that directly facilitates the transmission of blood-borne viruses like HIV, hepatitis B, and hepatitis C [3, 11].
Despite promises of reform and interventions by authorities following earlier outbreaks, unsafe practices appear to persist [21]. The scale of the problem is immense, with an estimated 350,000 people living with HIV in Pakistan, but a vast majority (nearly 80%) are unaware of their status, and only a fraction receive adequate treatment [6, 13]. This gap in awareness and treatment contributes to continued transmission.
Addressing this crisis requires a multi-faceted approach. This includes strengthening HIV surveillance, enhancing public awareness campaigns to reduce stigma and promote safe practices, improving infection prevention and control measures in all healthcare settings, ensuring the availability and accessibility of antiretroviral therapy (ART), and enforcing stricter regulations on medical practitioners and facilities [3, 4, 6]. The international community has also called for renewed commitment and resources to support Pakistan's efforts in combating this epidemic and ending AIDS as a public health threat by 2030 [4, 6]. The health and future of Pakistan's children are at stake, demanding urgent and comprehensive action.
Frequently Asked Questions
What is causing the HIV outbreak among children in Pakistan?
The primary cause of the HIV outbreak among children in Pakistan is the widespread practice of unsafe medical injections, including the reuse of syringes and needles, and poor infection control measures in healthcare facilities. This has led to the transmission of HIV and other blood-borne infections.
When and where did the major child HIV outbreak in Pakistan occur?
A significant HIV outbreak primarily affecting children occurred in Larkana district, Sindh province, in April 2019. Since then, similar outbreaks have been reported in other regions of Pakistan.
Are these unsafe medical practices unique to Pakistan?
While the scale of the problem in Pakistan is severe, unsafe injection practices and the reuse of medical equipment leading to disease transmission have been documented in various parts of the world, particularly in low-resource settings. However, Pakistan has been noted for having one of the highest rates of unsafe injections globally.
What is being done to address the HIV crisis in Pakistan?
Efforts are underway by the Pakistani government, WHO, UNAIDS, and other partners to increase HIV testing, provide treatment (antiretroviral therapy), improve infection prevention and control measures, and raise public awareness. However, these efforts are often hampered by systemic issues, funding gaps, and the vastness of the affected population.