Why is Pakistan’s Sindh province facing a major child HIV outbreak?

Islamabad, Pakistan – At slightest 130 people, astir of them children, person tested HIV-positive successful transportation with an outbreak astatine a government-run infirmary successful Karachi, Pakistan’s largest city, with officials adding that the fig has risen sharply successful caller weeks.

Sindh Labour Minister Saeed Ghani said earlier this week that much than 10,500 radical were screened successful and astir Kulsum Bai Valika (KBV) Hospital, a Sindh Employees’ Social Security Institution (SESSI) tally facility, wherever 120 tested positive.

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A abstracted screening thrust astatine different SESSI installation successful Karachi’s Landhi country identified 10 further cases.

SESSI is an autonomous provincial organisation that provides healthcare, aesculapian facilities and fiscal assistance to concern and commercialized workers and their dependants crossed Sindh.

The situation astatine KBV Hospital archetypal came to nationalist attraction successful November 2025, erstwhile residents of Karachi’s SITE Town noticed a clump of infections among children treated there.

Officials, however, hint the outbreak to October 2025, erstwhile the archetypal six HIV-positive cases were reported to the provincial wellness department.

So what happened, what caused the outbreak, and wherefore does Sindh proceed to witnesser specified episodes?

What has happened this month?

Chief Minister Murad Ali Shah was briefed connected July 14 that 2 interior inquiries had recovered superior lapses, including mediocre adherence to corruption prevention protocols, inadequate usage of protective instrumentality and improper handling of single-use syringes.

The archetypal inquiry, submitted successful November past year, identified 16 HIV-positive children, each linked to the KBV’s paediatrics department.

A second, much broad inquiry, submitted to the provincial ombudsman connected June 19, confirmed 78 infections and six deaths, holding named infirmary unit liable for administrative and supervisory failures.

The fig has since increased, with the latest infections confirmed astatine the SESSI facilities.

Minister Ghani said each cases had been traced to vulnerability earlier October 2025 and that screening would proceed “despite fears that further cases whitethorn emerge”.

Thirty-seven doctors and infirmary unit were issued show-cause notices connected July 3 and fixed 14 days to respond.

Ghani said transgression cases and dismissals would travel for those recovered responsible. Asked astir his ain accountability, helium said helium had “accepted indirect responsibility” and would not entity to resigning if it helped resoluteness the crisis.

A HIV diligent displays a caller syringe and distilled h2o helium received astatine Pakistan Society, a nongovernmental organisation (NGO) Drop-In Centre successful Karachi, connected November 30, 2013 [Akhtar Soomro/Reuters]

Is Sindh’s outbreak an isolated case?

Responding to questions aft a Sindh High Court petition alleged the outbreak stemmed from reused syringes, Ghani told reporters connected July 4 that the infections were not caused by syringe reuse. He argued that KBV Hospital uses auto-disable syringes that cannot beryllium reused.

The authoritative inquiries, however, pointed to a broader breakdown successful corruption prevention, citing failures that included mediocre adherence to information protocols, inadequate usage of protective instrumentality and improper handling of single-use syringes.

The petition earlier the Sindh High Court alleges the fig of infections is importantly higher than officially acknowledged.

This is not the archetypal ample HIV outbreak reported successful Sindh.

Last December, the World Health Organization (WHO) and UNAIDS identified the situation successful Pakistan arsenic 1 of the fastest-growing HIV epidemics successful the WHO Eastern Mediterranean Region, comprising of 21 nations, with yearly infections rising 200 percent implicit 15 years, from 16,000 successful 2010 to 48,000 successful 2024.

In a associated World AIDS Day connection issued connected December 1, the agencies estimated that astir 350,000 radical successful Pakistan are surviving with HIV, with astir 80 percent unaware of their status.

The connection besides noted that HIV infections among children aged 0 to 14 accrued from 530 successful 2010 to 1,800 successful 2023.

Only 38 percent of children surviving with HIV are receiving treatment, portion conscionable 14 percent of large women requiring therapy to forestall mother-to-child transmission person it.

In June, physicians penning successful British aesculapian diary The Lancet HIV argued that Pakistan’s epidemic is present driven “in ample part, by the health-care strategy itself”, pointing to repeated outbreaks linked to unsafe aesculapian practices.

That assessment, however, remains inconclusive.

While repeated outbreaks person highlighted unsafe aesculapian practices, researchers accidental Pakistan besides lacks broad surveillance to find however galore HIV infections nationwide originate successful healthcare settings compared with intersexual transmission, mother-to-child transmission oregon intravenous cause use.

Syed Faisal Mahmood, prof of infectious diseases astatine Aga Khan University Hospital successful Karachi, urged caution.

“At this constituent successful time, it is intolerable to accidental which of the 2 are the ascendant drivers of infection,” helium told Al Jazeera.

For intersexual transmission, mother-to-child transmission and intravenous cause use, helium said, “the numbers are somewhat much reliable, due to the fact that a large woody of enactment has been done” done established surveillance.

“There is nary systematic surveillance looking astatine however galore radical person acquired HIV from visiting clinics, hospitals, oregon informal attraction providers,” helium said.

The signifier extends beyond KBV Hospital.

Three different hospitals successful Karachi person besides reported expanding numbers of paediatric HIV patients, including 1 installation wherever admissions roseate from 10 cases successful 2024 to 70 successful 2025.

The Pakistan Medical Association warned successful April that 329 of the 894 HIV cases recorded successful Sindh during the archetypal 4th of 2026 progressive children, describing the figures arsenic “merely the extremity of the iceberg”.

For Mahmood, these outbreaks constituent to a overmuch broader problem.

“For galore of america moving successful this field, this is simply a systemic problem,” helium said. “It is not linked to immoderate 1 infirmary oregon healthcare system. Poor injection information protocols are pervasive passim the full state and crossed each levels of healthcare.”

He added that children are not the lone victims, pointing to outbreaks successful dialysis centres linked to unsafe humor transfusions.

Pakistan besides has 1 of the world’s highest hepatitis C burdens, helium said, “driven by the aforesaid mechanics and the aforesaid underlying reasons” arsenic the HIV cases present emerging.

What is being done?

The Sindh High Court has fixed the provincial authorities until July 20 to respond to a petition alleging violations of provincial laws governing the regularisation and disposal of syringes.

A Pakistani doc screens villagers for HIV astatine a infirmary successful a colony adjacent Ratodero, a tiny municipality successful the confederate state of Sindh, Pakistan, successful May 2019, wherever the outbreak of the deadly illness took spot earlier successful the twelvemonth [File: Fareed Khan/AP Photo]

At the national level, Prime Minister Shehbaz Sharif ordered a nationwide prohibition connected substandard syringes connected July 3.

The Drug Regulatory Authority of Pakistan aboriginal announced that retail income of accepted syringes that tin beryllium reused, dissimilar auto-disable syringes that artifact oregon interruption the plunger aft 1 use, volition beryllium banned from January 2027.

Federal Health Minister Mustafa Kamal has besides said HIV screening volition go mandatory earlier country nationwide, portion cautioning against describing the concern arsenic a broader “epidemic”.

Meanwhile, the Sindh authorities has approved a 2 billion-rupee ($7.2m) endowment money for the semipermanent attraction of affected children, alongside an isolation ward and a third-party audit of KBV Hospital’s procurement and corruption power systems aft the provincial ombudsman took announcement of the case.

Al Jazeera contacted Sindh Health Department officials for remark but did not person a response.

Mahmood, however, said measures specified arsenic banning syringes code lone portion of the problem.

About 60 percent of healthcare successful Pakistan is delivered by the backstage sector, which helium said is overmuch harder to regulate.

“The backstage assemblage is considerably much hard to regulate. It encompasses not conscionable hospitals but besides clinics, dispensaries and akin facilities, which are nominally overseen by healthcare commissions that simply bash not person the manpower to inspect each of them,” helium said.

Mahmood said unsafe injections stay profoundly embedded successful Pakistan’s healthcare culture, driven not lone by anemic regularisation but besides by diligent expectations.

“Patients coming to a doc expect an injection due to the fact that they judge it volition marque them retrieve faster, and healthcare workers often consciousness the aforesaid way,” helium said. “It is, successful galore ways, a cleanable storm: much injections being given, those injections going mostly unregulated, constricted cognition of harmless injection practice, nary surveillance connected whether injections are being administered correctly, and nary consequences for unsafe practice.”