n the quiet corners of hospitals, in neglected rural clinics and on the margins of our cities, a silent epidemic continues to unfold. It is a breaking out not only of a virus, but also of ignorance, stigma and systemic failure. HIV/ AIDS, once associated with distant lands and foreign headlines, is now carving its presence deep into the fabric of Pakistan’s public health crisis. For many, it remains an unspoken tragedy, shrouded in taboo and tangled in bureaucracy. Behind the silence, lie lives—fractured, forgotten, and fighting. As the world edges closer to scientific breakthroughs and policy innovations to curb the disease, Pakistan teeters on the brink of a preventable disaster. The virus is not just a test of our medical infrastructure; it is a litmus test of our empathy, our political priorities and our societal maturity.

Prevention cannot be reduced to a clinical checklist. It must be envisioned as a moral, structural and cultural imperative—a chain we must break not just with syringes and slogans, but with courage, clarity and collective will.

More than four decades after the emergence of HIV/ AIDS, the virus remains a significant global public health challenge. According to the World Health Organisation, approximately 39.9 million people were living with HIV at the end of 2023. 1.3 million new infections and 630,000 AIDS-related deaths were recorded that year. While advancements in medical treatments, such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP), have transformed HIV from a fatal disease into a manageable chronic condition, the real battle is its prevention. This fight is often hindered by stigma, misinformation and policy weaknesses.

Pakistan, once a low-prevalence country, is now witnessing a concerning rise in HIV cases. The National AIDS Control Programme estimates that over 240,000 individuals are living with HIV in Pakistan. Only a fraction of them are enrolled for treatment. Despite international support and an established framework, Pakistan risks a generalised epidemic unless prevention is prioritised with sincerity, strategy and societal engagement. The mushrooming of infections in districts like Larkana, Gujrat, and Faisalabad signals systemic neglect and a lack of foresight in handling epidemiological threats. It is not merely a health failure—it is a reflection of broad institutional decay and social fragmentation.

Globally, HIV prevention has evolved through a combination of medical, behavioural and structural interventions. The initial ABC strategy—abstinence, be faithful, and condom use—proved insufficient. The rise of PrEP, post-exposure prophylaxis (PEP), harm reduction strategies for intravenous drug users, prevention of mother-to-child transmission and community-based education programmes have significantly reduced new infections in many countries. The sub-Saharan Africa, for instance, has achieved a 70 per cent reduction in new HIV infections since 1993. This is attributed to improved awareness, increased access to ART and effective locally-run HIV programmes. This decline illustrates that when public health is placed above political expediency and cultural taboos, even the gravest crises can be controlled. Pakistan, unfortunately, has yet to replicate such commitment.

Pakistan’s HIV crisis is not merely medical. It is deeply social, political and moral. Outbreaks in areas like Ratodero in Sindh underscore how structural vulnerabilities—such as unscreened blood transfusions and unsafe injection practices by unqualified practitioners—are fueling the epidemic. The 2019 outbreak in Ratodero resulted in 895 confirmed cases, 754 of them children, primarily due to the re-use of syringes. Key populations, including intravenous drug users (IDUs), transgender individuals, sex workers and men who have sex with men (MSM), remain at the epicentre of the epidemic. Criminalisation, moral policing, and state apathy have rendered these groups invisible in national policy discourse. The unwillingness of policymakers to address these realities has fostered a dangerous culture of denial—one where the virus is allowed to spread silently through social fault lines.

Prevention must be rooted not in policies and pills, but in empathy, dignity and the recognition of every citizen’s right to health. 

Several factors contribute to the failure of HIV prevention efforts in Pakistan. First, there is a lack of comprehensive surveillance and testing, especially in rural areas. Voluntary counselling and testing centres are limited and often inaccessible. Second, harm reduction programmes for IDUs, such as needle exchange programmes and opioid substitution therapies, are limited and underfunded. Third, despite laws requiring blood screening, unregulated blood banks and illegal transfusion centres continue to operate. Fourth, public discourse around sex remains taboo, and comprehensive sexual education is absent from curricula. This allows myths to shape public understanding. Fifth, only about 25 per cent of those diagnosed with HIV are on ART, with irregular medication supplies and stigma deterring adherence. Sixth, societal stigma leads to the ostracisation of people living with HIV, discouraging testing and pushing the epidemic underground.

These failures are compounded by institutional inertia and misplaced policy priorities. A state that readily censors discussions on reproductive health cannot feasibly tackle an epidemic grounded in sexual and drug-related transmission. It is paradoxical that while Pakistan has signed international conventions on the right to health, its domestic policies often contradict those principles. The absence of accountability and performance-based evaluation in health governance enables bureaucratic complacency. Awareness campaigns are reduced to check-box exercises and treatment access remains patchy at best. Moreover, donor dependency has hollowed out national ownership of HIV response programmes—leaving long-term sustainability in question.

A comprehensive prevention framework for Pakistan must go beyond piecemeal interventions. It demands a multi-pronged, coordinated and rights-based approach. Political commitment is essential. The governments need to fund HIV programmes consistently, update legal frameworks and integrate HIV response across ministries. Targeted interventions for key populations should ensure free testing, condoms, PrEP and counselling without fear of harassment or arrest. Community-based education campaigns must engage religious leaders, local health workers and the media to dispel myths. Healthcare regulation should crack down on quackery and incentivise safe medical practices.

Youth engagement through curriculum reform is vital. It must incorporate age-appropriate, scientifically accurate information about HIV and reproductive health. Universal access to testing and treatment should be normalised as part of routine health checks, with decentralised ART distribution and a steady supply chain. Investment in real-time data collection and epidemiological research is necessary to understand evolving trends and maintain effective prevention strategies.

Beyond all technical measures, the real shift must occur in the culture. HIV prevention in Pakistan will not succeed unless it is depoliticised and de-stigmatised. Civil society, religious institutions and local influencers must collaborate to redefine the narrative around HIV—one that replaces fear with facts and shame with solidarity. Instead of framing HIV as a sign of moral failing, it must be seen through the lens of structural injustice and health inequity.

It is vital to humanise the epidemic. Behind every statistic there is a person—a mother unable to breastfeed her child; a teenager contracting HIV through unsafe medical procedures; a transgender individual denied treatment. Prevention must be rooted not just in policies and pills, but also in empathy, dignity and the recognition of every citizen’s right to health. Societal resilience against disease does not rest solely on pharmaceutical advances but mostly on the ethical backbone of a society that values every human life.

The writer is a researcher based in Islamabad. He can be reached at zakiir9669@gmail.com