Islamabad: A task force constituted on the directives of Prime Minister Shehbaz Sharif has recommended an independent evaluation and restructuring of Pakistan’s National and Provincial AIDS Control Programs along with a nationwide HIV spill-over survey, warning that the country’s true HIV burden remains uncertain and that transmission may no longer be confined to traditional high-risk groups.
The recommendations have been made in a report prepared by the Task Force on Reported HIV Mishandling, which was established by the Ministry of National Health Services, Regulations and Coordination on May 5, 2026 following reports of pediatric HIV infections linked to unsafe healthcare practices, particularly the alleged reuse of contaminated syringes and lapses in infection prevention and control.
The task force was chaired by Minister of State for National Health Services Dr Malik Mukhtar Ahmad Bharath, with Maj Gen (R) Dr Azhar Mahmood Kayani serving as co-chair. Its members included former health minister Dr Zafar Mirza, Special Secretary Interior Dawood Muhammad Bareach, Additional Secretary Health Laiq Ahmed, DRAP CEO Dr Obaidullah, Dean IPH Lahore Dr Saira Afzal, infectious diseases expert Dr Sobia Qazi, and senior representatives of NIH, CMU, provincial health departments and UNAIDS.
It was mandated to investigate the reported HIV surge, review operational and management issues related to HIV prevention and treatment, identify systemic weaknesses and recommend measures to strengthen national mechanisms for the prevention and control of infectious diseases.
At the heart of the report is a recommendation for an independent third-party evaluation of the National AIDS Control Programme (NACP) and Provincial AIDS Control Programmes (PACPs), focusing on governance structures, financing arrangements, coordination mechanisms and operational effectiveness.
The review, the report says, should form the basis for comprehensive reforms, including new standard operating procedures, operational manuals, accountability frameworks, escalation mechanisms and confidentiality safeguards for antiretroviral treatment centres, surveillance units and HIV prevention programmes across the country.
The task force also proposed a comprehensive nationwide epidemiological assessment to determine the actual burden of HIV in Pakistan and evaluate whether infections have spilled over from traditionally high-risk groups into the general population.
According to the report, the survey should investigate healthcare-associated transmission linked to unsafe injections, blood transfusions and infection control failures; estimate the number of undiagnosed and unreported HIV cases; assess HIV prevalence in prisons and other vulnerable settings; examine pediatric HIV clusters; and identify geographical hotspots and healthcare system vulnerabilities contributing to transmission.
The proposed survey is expected to generate what the task force describes as a realistic and evidence-based estimate of Pakistan’s HIV burden to guide future policy decisions, prevention strategies, resource allocation and outbreak preparedness.
Pakistan is currently estimated to have around 369,000 people living with HIV. However, only about 84,400 individuals are formally registered in the healthcare system, while approximately 60,789 are receiving antiretroviral treatment, indicating a substantial gap between estimated infections and diagnosed cases.
The report notes that Pakistan’s HIV epidemic has historically remained concentrated among people who inject drugs, sex workers, transgender persons and other key populations. However, recent outbreaks among children living in low-risk rural communities suggest a disturbing epidemiological shift and expose weaknesses in infection prevention, blood safety, healthcare regulation and clinical governance.
The task force’s recommendations were triggered by a pediatric HIV outbreak in Taunsa Tehsil of Dera Ghazi Khan district, where 127 children were diagnosed with HIV between December 2024 and April 2025.
Investigations found that nearly 79 percent of the infected children were below five years of age, with a median age of just three years. Most mothers of infected children tested HIV-negative, leading investigators to largely rule out mother-to-child transmission and instead point towards healthcare-associated infections.
According to the report, epidemiological investigations identified unsafe blood transfusions and contaminated injection practices as the two major drivers of the outbreak, each accounting for nearly half of the reported infections.
The inquiry documented widespread deficiencies in blood safety systems, including inadequate donor screening, use of non-validated rapid diagnostic kits, weak oversight of blood banks and inadequate regulation of informal healthcare providers.
Investigators also reported widespread reuse of disposable syringes, irrational use of therapeutic injections and intravenous drips, poor sterilization practices, weak infection prevention and control measures, and inadequate monitoring of private healthcare facilities and informal practitioners.
The report warns that the Taunsa outbreak is not an isolated event but part of a recurring pattern of healthcare-associated HIV outbreaks reported across Pakistan over the past two decades.
It recalls the 2019 HIV outbreak in Ratodero, Larkana, where more than 1,000 people, mostly children, tested positive for HIV. Similar outbreaks were also reported among dialysis patients at Nishtar Hospital Multan, while incidents in Jalalpur Jattan and Kot Imrana highlighted risks associated with unsafe injection practices, unlicensed healthcare providers and poor regulatory oversight.
According to the task force, these outbreaks collectively demonstrate persistent structural weaknesses in Pakistan’s healthcare system, including inadequate regulation of private healthcare facilities, weak infection prevention mechanisms, deficiencies in blood safety systems and ineffective enforcement against unsafe medical practices and quackery.
Among its major recommendations, the task force has proposed the establishment of a real-time national HIV surveillance dashboard integrating antiretroviral treatment centres, blood transfusion facilities, disease surveillance units and points of entry into a centralized national health data system.
It has also recommended a nationwide contact tracing and epidemiological investigation framework for newly diagnosed pediatric HIV cases, standardized digital case-linkage systems, cluster mapping protocols and stronger coordination between treatment centres, laboratories and disease surveillance authorities.
The report further calls for mandatory screening for HIV, hepatitis B and hepatitis C before surgical procedures and invasive medical interventions in both public and private healthcare facilities.
In a significant governance recommendation, the task force has urged the government to formally include HIV among Pakistan’s notifiable diseases and accelerate work on a National Public Health Law that would provide legal mechanisms for outbreak reporting, disease surveillance, accountability, inter-provincial data sharing and public health emergency response.
To oversee implementation of these reforms, the report proposes the immediate constitution of a National HIV Technical Working Group comprising epidemiologists, infectious disease experts, blood safety specialists, pediatric HIV experts and public health professionals.
The proposed body would provide technical guidance, review progress, identify implementation bottlenecks and submit regular reports to the Prime Minister’s Office and the Ministry of National Health Services.
The task force has also recommended stricter regulation of syringes and medical devices, nationwide market surveillance to eliminate unregistered products, expansion of auto-disable syringe use, stronger regulation of blood banks, improved hospital waste management systems and nationwide public awareness campaigns on injection safety and HIV prevention.
The task force warned that repeated HIV outbreaks among children and low-risk populations demonstrate that Pakistan’s HIV challenge extends beyond traditional high-risk groups and reflects deeper failures in healthcare regulation and infection control. Without coordinated national reforms, it warns, the country will remain vulnerable to recurring and preventable healthcare-associated HIV outbreaks affecting children and communities across Pakistan.
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