EVERY few years, HIV returns to the national conversation in Pakistan.
There is outrage on television, emotional headlines, a few raids on clinics, promises of action and then silence. The cycle repeats itself so predictably that one almost wonders whether we are fighting the disease or simply performing concern for a few news cycles. For a long time, we convinced ourselves that Pakistan was following the so-called Asian epidemic model. The belief was comforting. HIV would remain confined to specific high risk populations and would not significantly enter the wider population. Unfortunately, reality has not cooperated with our theories.
Cases are now emerging in different pockets of the country and among populations that were never expected to be at the center of the discussion. Larkana should have forced us to rethink everything. Then came Jalalpur Jattan, Sargodha, Dera Ghazi Khan, Taunsa, Turbat, Bannu and several other districts quietly reporting cases that rarely remain in the headlines for long. Each outbreak is treated like a separate incident. A few individuals are blamed, temporary outrage follows and then the country moves on as if the underlying conditions never existed in the first place.
During my doctoral research on HIV in Pakistan, one uncomfortable conclusion became impossible to ignore. HIV in Pakistan is not simply a behavioral problem. It is a systems problem. The virus is spreading through the cracks of a fragile healthcare system that struggles to protect people from preventable harm. Unsafe injections, reused syringes, poor sterilization practices, unregulated blood transfusions, unsafe dental procedures and weak infection prevention measures continue to exist far more commonly than we would like to admit.
We often speak about the healthcare system in Pakistan as if it is a single organized structure. It is not. It is a crowded marketplace of public hospitals, private clinics, informal practitioners, roadside injection providers, faith healers and small diagnostic centers all functioning side by side. The easy response is to blame quacks for everything. That certainly makes for good television. The harder truth is that millions of Pakistanis depend on these providers because the formal health sector cannot absorb the needs of the population. In many areas, people go to whoever is available, affordable and willing to see them quickly.
This is where our response becomes deeply frustrating. Instead of strengthening systems, we prefer dramatic crackdowns after every outbreak. Clinics are sealed. Arrests are made. Statements are issued. Everyone appears decisive for a few days. Then the cameras disappear and the same unsafe practices quietly return. Punishment alone has never fixed a public health crisis. It may create headlines, but it does not create safer healthcare.
What Pakistan desperately needs is a proactive approach rather than a reactive one. Infection prevention and control should not be treated as luxury standards reserved for large hospitals in major cities. Safe injections, sterilized equipment and proper disposal of medical waste should be the bare minimum everywhere. Another issue that receives surprisingly little attention is HIV screening. In most hospitals, patients are routinely screened for hepatitis B and hepatitis C before surgeries or invasive procedures. Yet HIV screening is often missing from the process altogether.
The logic is difficult to understand. If blood is already being drawn and testing systems already exist, why is HIV still treated differently. Adding HIV screening alongside hepatitis screening would not require reinventing the system. It would simply require acknowledging reality. Early detection protects patients, healthcare workers and families. More importantly, it prevents silent transmission that only becomes visible once an outbreak appears and television channels rediscover public health for a week.
There is also a larger lesson here. HIV is not the only problem exposing weaknesses in our healthcare system. The same failures contributing to HIV transmission are also linked to hepatitis outbreaks, antimicrobial resistance, unsafe maternal care and countless preventable infections. Yet we continue to chase temporary attention instead of building durable systems. Resources are redirected toward whichever issue dominates headlines at a given moment, while long term planning quietly disappears into committee meetings and forgotten policy documents.
Pakistan still has time to prevent a much larger HIV crisis. But that will require honesty more than outrage. It will require investment in safer healthcare rather than symbolic reactions. Most of all, it will require accepting that HIV in Pakistan is not appearing out of nowhere. It is emerging from the weaknesses we have ignored for years.
—The writer is Associate Professor, Health Services Academy, Islamabad.
