Dr Bilawal Kamran
Each year, World AIDS Day arrives with sobering statistics, yet the question persists: why does HIV/AIDS remain a critical global and national challenge? Despite decades of interventions, glaring inequalities, systemic neglect, and societal complacency continue to drive elevated infection rates. According to UNAIDS, 40.8 million people globally are living with HIV, of whom 9.2 million are not accessing antiretroviral therapy. In 2024 alone, there were 1.3 million new infections and 630,000 HIV-related deaths, underscoring that the world is far from eliminating the epidemic.
Pakistan remains particularly vulnerable. The country now has the second fastest rate of HIV increase in the Asia-Pacific region, with the virus spreading through sexual contact, contaminated medical equipment, and unsafe blood transfusions. The 2019 outbreak in Larkana should have served as a critical lesson, yet systemic failures persist. Modeling by UNICEF-UNAIDS warns that if HIV program coverage falls by half, an additional 1.1 million children could acquire HIV, and 820,000 could die from AIDS-related complications by 2040, potentially raising cumulative infections to 3 million and deaths to 1.8 million.
Recent events highlight the urgent crisis. A hospital in Karachi diagnosed over 15 children with HIV in a single incident, while Sindh now reports 3,995 registered HIV-positive children. In Balochistan, last year saw 462 new cases, bringing the total registered patients to 2,823, though the actual number may range between 7,000 and 9,000. Such figures indicate that the epidemic is both expanding and underreported.
Pakistan’s response remains fragmented. This year’s global theme, “Overcoming disruption, transforming the AIDS response”, emphasizes the need for committed political leadership, international cooperation, and human rights-based approaches to end AIDS by 2030. For Pakistan, however, the reality is stark: policies exist on paper but are undermined by absent databanks, fragile health infrastructure, and an overreliance on foreign donors. The departure of USAID and a $27 million reduction in Global Fund assistance have further strained the system, highlighting the need for sustainable domestic health financing.
The National AIDS Control Programme, vital for bridging public health data gaps and coordinating care, is at a standstill due to insufficient resources. Treatment centers remain too few to cover patients and at-risk populations. In such an environment, disruptions in timely diagnoses, prevention services, and antiretroviral distribution could exacerbate the crisis. Without expansion and reform, Pakistan risks repeated outbreaks and mounting mortality.
Addressing HIV/AIDS requires a multifaceted approach that integrates prevention, treatment, and community engagement. Public awareness campaigns must target stigma and misinformation, which remain significant barriers to testing and care. Education programs, particularly in schools and vulnerable communities, should highlight safe practices, blood screening, and the importance of early diagnosis. Meanwhile, healthcare professionals must be trained to provide non-discriminatory, confidential services that respect patient dignity and encourage adherence to treatment.
Policy reform is equally critical. Pakistan must invest in domestic healthcare infrastructure, ensuring that treatment centers are geographically accessible and adequately stocked. Data collection mechanisms should be strengthened to track prevalence, treatment coverage, and emerging hotspots. National strategies must link prevention with social services, addressing vulnerabilities such as poverty, gender inequality, and lack of access to education, which amplify the risk of infection.
International collaboration remains essential but cannot replace domestic accountability. While donor assistance has historically supported HIV programs, sustainable progress requires Pakistan to allocate sufficient budgetary resources and implement effective governance mechanisms. Investments in human capital, logistics, and public awareness are not optional; they are central to saving lives and containing the epidemic.
The science and societal understanding of HIV/AIDS have evolved over decades. Antiretroviral therapy has transformed HIV from a death sentence into a manageable condition, and global partnerships have demonstrated the effectiveness of coordinated public health strategies. Pakistan must leverage these lessons to create a humane, evidence-based response. Stigma must be confronted, and health must be equated with dignity, ensuring that prevention and treatment initiatives are accessible, inclusive, and responsive to the needs of the most vulnerable populations.
Ultimately, Pakistan stands at a crossroads. Without decisive political will, strengthened healthcare infrastructure, and active community engagement, the country risks repeating past failures and witnessing escalating infections and mortality. Conversely, a committed, data-driven, and humane approach can halt the spread of HIV, save lives, and demonstrate that health, rights, and development are intrinsically linked. The time to act is now; Pakistan cannot afford complacency in the face of an epidemic that continues to threaten its most vulnerable citizens.
Keywords: Pakistan HIV AIDS healthcare prevention antiretroviral treatment epidemic public health
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