Every few years, Pakistan is surprised by a crisis it has already met before. This week, the alarm is coming again from Punjab, where a BBC investigation reported in recent coverage that at least 331 children in Taunsa tested HIV-positive between November 2024 and October 2025, with staff at a government hospital filmed reusing syringes and breaking basic infection-control rules. Karachi, meanwhile, is seeing a sharp rise in paediatric HIV cases too: Dawn reported 159 patients admitted across three city hospitals this year, with most linked to unsafe healthcare practices.
Even more troubling, the epidemic is no longer confined to the peripheries: Islamabad recorded 618 new HIV cases between January 2025 and March 2026, with adult men making up most infections. That matters because when HIV is rising in the capital, the most posh of places, it stops being a distant local failure and becomes a federal warning about urban transmission, surveillance gaps, and a system that is failing in plain sight.
The first thing to say, plainly, is this: this is not a story that should be reduced to sexual panic, gossip, or the old reflex of blaming the “wrong” kind of people. WHO says HIV in the general population can spread through unsafe injections, unscreened blood, and poor infection control, and it specifically notes that the 2019 outbreak in Ratodero was attributed to reused syringes for therapeutic injections. In other words, the needle is not a side issue but the main plot.
Pakistan has been down this road before, and the road is ugly. Reuters reported in 2019 that nearly 700 HIV cases had emerged in Ratodero since April, most of them children. WHO’s later review of that outbreak found 876 people tested positive in Larkana district between late April and late June 2019, 719 of them children. Cross the border, and the pattern feels painfully familiar, where Reuters reported in 2018 that at least 33 people in Bangarmau, India, tested positive after an unqualified practitioner used an infected syringe.
Different place, same disease of the system. This repetition is institutional memory failing in real time. Public health, at its core, is about learning and making yesterday’s outbreak structurally impossible tomorrow. When the same mechanism of harm resurfaces across years and borders, what we are witnessing is a collapse of learning itself, rather than a mere health crisis. The state remembers on paper; the system forgets in practice.
Stigma does two things at once: it pushes families into silence, and it pushes public debate towards moral theatre instead of practical reform
The deeper problem is not just malpractice. It is the culture that makes malpractice feel normal. Studies in Pakistan have found that injections are overused, that many patients believe injections work faster than tablets, and that a large share think injections are less risky than oral medicine. WHO’s own review of syringe reuse in Pakistan says patients often expect injections for minor ailments, and providers comply with that demand. So yes, there is ignorance.
There is a habit. There is a kind of medical superstition, too, where the shot feels stronger than the prescription. But it is also a question of hierarchy and authority. In much of Pakistan’s medical culture, the doctor’s act is rarely questioned. The injection, then, is a symbol of expertise, of decisiveness, of ‘real’ medicine being administered. Patients do not demand safety as much as they defer to authority. In a so-called first-world country, this would be a moment of scrutiny, but here it becomes a moment of surrender for the third-world layperson.
Then comes the money. And not even big money at times. Often small, dirty savings. WHO’s 2020 review on syringe reuse in Pakistan notes that providers’ savings from reuse are hidden from patients, which is exactly why the practice survives in plain sight. The same review also warns that simply passing laws, or even making auto-disable syringes available, will not fix the problem unless patients are made aware and the system changes around them. In other words, the corruption here is not always cinematic. Sometimes it is a few rupees saved on a syringe, a shortcut taken because nobody is watching, and a chain of negligence long enough to infect a child and destroy his life before it has even started.
And there is stigma, which is its own second, deeper wound. HIV stigma in Pakistan is real and corrosive, especially around disclosure to family and other social contacts. That matters because stigma does two things at once: it pushes families into silence, and it pushes public debate towards moral theatre instead of practical reform. We start asking who should be ashamed, instead of asking why a hospital ward is reusing syringes on children. Shame is a terrible public-health policy.
If this story has any lesson at all, it is that Pakistan cannot keep treating HIV outbreaks as isolated scandals. They are symptoms of a larger failure where a health system is too comfortable with injection reuse, too tolerant of quacks, too weak on inspection, and too quick to turn each crisis into a moral debate. The answer to this is not another round of outrage. It is boring, relentless discipline: single-use equipment that is actually single-use, inspections that reach private clinics, blood screening, infection-control training, and public messaging that strips HIV of shame and puts the focus where it belongs — on unsafe practice, not character questioning. Pakistan already knows the diagnosis. The tragedy is that it keeps delaying the treatment.