Three decades ago, a silent epidemic began moving through Pakistan’s veins, quite literally. Hepatitis C, a blood-borne virus, started spreading through reused syringes, unscreened blood transfusions and unsterilized medical equipment. By the time the state finally measured the damage in the 2007-08 National Hepatitis Survey, the numbers were staggering: 4.8 percent of the general population was infected, translating into millions of chronic cases. Later analyses put the toll even higher, at nearly 9.8 million people living with hepatitis C, enough to make Pakistan one of the worst-affected countries in the world.
The tragedy is not that Pakistan became infected. It is that Pakistan knew, in black and white, through a government-commissioned survey, exactly how and why the infection was spreading, yet did remarkably little about it. The 2008 survey left little room for guesswork. It pointed squarely to syringe reuse, unsafe blood transfusions and poor infection control in healthcare settings as the primary drivers of transmission. People who inject drugs and multi-transfused patients bore the heaviest burden, with prevalence rates exceeding 50 percent in these groups. Genotype 3a, the dominant strain in Pakistan, became almost a national signature of medical neglect. Crucially, hepatitis C is curable. Effective treatment exists. Yet national data show little evidence that the epidemic has declined over the years, not because science failed, but because policy did, and because the government failed to protect its people.
Here is the uncomfortable truth: the very practices that fuelled the hepatitis C epidemic, dirty syringes, unscreened blood and poor infection control, never actually stopped. They simply found a new virus to carry. Pakistan is now living through the consequences in the form of a rapidly accelerating HIV epidemic that is, by several accounts, among the fastest-growing in the Asia-Pacific region.
The trajectory is chilling. UNAIDS-linked estimates suggest the number of people living with HIV in Pakistan rose from around 97,000 in 2009 to roughly 210,000 adults by 2022, an 84 percent increase in a little over a decade. Since 2008, ten distinct HIV outbreaks have been investigated by the government, the United Nations and international partners. Every one of them pointed to the same preventable causes: unsafe blood transfusions, needle reuse and poor infection control. Every time, however, the remedial action that should have followed simply failed to materialize. Who is to blame for this sheer negligence?
The human cost of this inertia is now most visible among children. The 2019 outbreak in Larkana led to the screening of more than 26,000 people and the detection of 751 HIV cases, nearly 80 percent of them children. The World Health Organization classified it as a Grade 2 emergency. In Kot Imrana, a small town in Punjab, HIV prevalence reportedly jumped from 1.29 percent to 13.38 percent in just six months. This year, in Taunsa, more than 150 children between six months and 10 years of age tested positive for HIV within roughly three months. More recently, children have also been diagnosed with HIV at a hospital in Karachi. These are not isolated accidents. They are the predictable result of a healthcare system that was warned decades ago and chose not to listen.
Unlike hepatitis C, HIV has no cure. It demands lifelong treatment, lifelong stigma and, for children infected through no fault of their own, a lifetime shaped by the failures of the healthcare system. The epidemic has now spread beyond major cities into smaller towns and rural districts, with Punjab and Sindh carrying the heaviest burden, while key populations, including people who inject drugs, transgender communities and sex workers, continue to face disproportionately high prevalence.
What makes this story so damning is its circularity. In 2008, the state was handed a roadmap through a rigorous, government-sponsored survey identifying exactly which unsafe practices were driving a curable epidemic. Had that roadmap been acted upon through genuine investment in blood screening, safe injection practices and infection control in clinics and hospitals, the pipeline that later carried HIV into the general population, and ultimately into the bloodstream of children, might never have existed.
Instead, Pakistan is now paying twice for the same failure. First, through millions of hepatitis C infections that continue to course through the population. Second, through a faster-moving, incurable epidemic that is stealing childhoods in towns most Pakistanis had never heard of before an outbreak made the news.
The question the state must now answer is not merely how HIV entered the bodies of more than 150 children in Taunsa. It is why, seventeen years after being told precisely how blood-borne infections were spreading, the same reused syringes, the same unscreened blood and the same broken infection-control systems remained in place long enough for it to happen again.
(Writer is Dr Quaid Saeed Akhunzada, former CEO of Islamabad Healthcare Regulatory Authority.)