Pakistan is once again forced to confront a public health story it has long managed to ignore. Last week, a parliamentary committee was apprised of how nearly 20,000 people who had begun antiretroviral therapy at government clinics have disappeared from follow-up registries. The gulf between the data and reality is shocking on its own, with new infections said to have climbed 200 per cent in fifteen years. What makes the picture grimmer is that only 16 per cent of those infected are receiving treatment, and a mere seven per cent have suppressed viral loads.
The government’s response, announced with much fanfare, is to screen every deported passenger at airports. A high-level task force has also proposed regular inspections of clinics and pharmacies, a national dashboard for real-time data, and a new public health law. In a separate briefing, the health minister declared that HIV screening would become compulsory before surgery and that the reuse of syringes would be banned.
These measures may create a veneer of action, but they are aimed at the symptom rather than the disease. HIV spreads here not because migrants slip through airports but because our healthcare system is riddled with unsafe practices. In the 2019 Ratodero outbreak in Larkana, 30,192 people were tested, and 876 were positive, while 82 per cent of the cases were children. Investigations by the World Health Organisation identified the reuse of needles and contaminated blood products as risk factors and noted that the Larkana district had experienced four HIV outbreaks since 2003.
The old stigma figures were damning, but the newer Pakistan HIV Stigma Index 2.0 makes the point sharper. The 2024 study found that stigmatisation still begins at home, as 17 per cent reported discrimination by family members after disclosure, including verbal harassment, blackmail and physical harassment. Lawmakers rarely address this side of the epidemic.
The proposals to screen deportees and surgical patients cannot fix a failing system. Airport testing risks creating a new class of scapegoats. Mandatory screening may be defensible in hospitals, but without safeguards, counselling and strict anti-discrimination enforcement, it could easily be misused to deny care in a country where people living with HIV have already learned to fear clinics. Pakistan should also pursue a tangible line of action to address the shortage of safe blood, enforce bans on reusable syringes, fund robust infection-control training, and expand community-based testing and counselling.
The health ministry told legislators that a $65 million grant from the Global Fund is being channelled to non-government organisations. Parliament would do well to demand transparency in how these funds are spent and ensure they reach the treatment centres that remain Pakistan’s thin red line against this epidemic. Above all, the discourse must shift from moral panic to human rights. Conflating HIV with crime and promiscuity would achieve nothing other than breeding discrimination and driving people away from care.
