Islamabad: Pakistan has officially recorded more than 25,000 deaths from HIV infection and AIDS-related illnesses since its first AIDS case was reported in Lahore in 1987, but health officials and experts fear the real death toll is far higher because thousands die undiagnosed or without HIV being mentioned in hospital records.
Globally, HIV/AIDS remains one of the world’s most severe public health challenges, having claimed an estimated 44.2 million lives worldwide since the start of the epidemic.
The documented deaths include hundreds of children, many of whom acquired the virus during outbreaks linked to unsafe injections, reused syringes, poor infection-control practices, unsafe blood transfusions and unregulated healthcare providers over the last six to seven years.
Worldwide, despite significant advancements in treatment accessibility, approximately 570,000 people still die annually from AIDS-related illnesses, largely due to under-diagnosis and delayed treatment access in low- and middle-income health systems.
Data compiled by federal and provincial health departments show Punjab has suffered the largest documented loss, with more than 15,000 HIV/AIDS-related deaths.
Sindh has reported 6,373 deaths, including several hundred children, followed by Khyber Pakhtunkhwa with 1,950 deaths.
Islamabad Capital Territory alone has recorded 1,132 HIV/AIDS-related deaths, underlining that the crisis is not confined to rural or underserved areas.
Balochistan has reported 656 deaths, Azad Jammu and Kashmir 13 and Gilgit-Baltistan one.
The combined reported deaths from Sindh, KP, Islamabad, Balochistan, AJK and Gilgit-Baltistan stand at 10,125. With Punjab’s toll exceeding 15,000, Pakistan’s officially recorded HIV/AIDS death count has crossed 25,000.
But officials said the numbers tell only part of the story.
“HIV is frequently not recorded as the underlying cause of death. A patient may die of tuberculosis, pneumonia, meningitis, chronic diarrhoea, cancer or another opportunistic infection after the immune system has collapsed,” a health official said.
In many cases, hospitals record the immediate cause as cardiopulmonary arrest, meaning the heart and breathing stopped, without identifying the underlying disease that brought the patient to that stage. Others are never tested for HIV, while some families avoid disclosure because of the stigma still attached to the infection.
Pakistan is estimated to have around 370,000 people living with HIV, although rights activists, infectious diseases specialists and public health experts believe the actual number may be much higher. The reason is simple: a large number of infected people do not know their status.
Only around 62,000 people are currently receiving antiretroviral therapy in Pakistan, including approximately 7,500 children. This means that a vast majority of the estimated HIV-positive population is either undiagnosed, untreated or not consistently linked with care.
The gap between estimated infections and treatment coverage is particularly alarming because HIV is now a manageable chronic illness for people who are diagnosed early and receive uninterrupted antiretroviral medicines. With regular treatment, people living with HIV can survive for decades and lead productive lives.
However, late diagnosis remains a major reason behind preventable deaths. Many patients reach treatment centres only after developing severe tuberculosis, recurrent pneumonia, meningitis, persistent fever, weight loss or chronic diarrhoea, when the virus has already badly weakened their immune systems.
The mortality burden has become more visible since 2024, when reported HIV infections began rising sharply in different parts of the country. Punjab has the highest burden of people living with HIV and reported deaths, followed by Sindh, where repeated outbreaks among children have exposed deep failures in infection control and healthcare regulation.
The 2019 outbreak in Ratodero and Larkana first drew international attention to the scale of paediatric HIV infections in Sindh. Subsequent clusters in other districts and more recently Karachi have reinforced warnings that children remain at risk when syringes are reused, blood safety is compromised and informal practitioners operate without effective oversight.
Infectious diseases specialists say fear and misinformation are still keeping people away from testing and treatment. Many continue to believe that HIV has no treatment or that a positive diagnosis would permanently destroy their social and family life.
Experts say this silence is deadly. People who do not know their HIV status cannot start treatment, and people who begin treatment late face a far greater risk of dying from infections that could otherwise be prevented or treated.
Public health experts have called for expanded voluntary HIV testing, confidential counselling, uninterrupted availability of antiretroviral medicines and treatment services closer to communities. They have also demanded strict action against unsafe injections, reused medical equipment, unlicensed clinics and unsafe blood transfusion practices.
They warned that Pakistan cannot reduce HIV deaths through medicines alone. Unless stigma is confronted and testing is made routine, accessible and confidential, thousands more people may continue to die from a disease that can now be controlled.
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