Karachi: Pakistan’s HIV epidemic has expanded almost 240 times in just a quarter century, increasing from fewer than 200 new infections in 2000 to an estimated 48,000 new infections in 2025, according to national estimates prepared for federal and provincial HIV planners.
Public health specialists say this explosive rise places Pakistan among the fastest-growing HIV epidemics in Asia at a time when most neighbouring countries have stabilised or reversed their trajectories.
The latest national estimates file, developed for the 2025 modelling round, shows an uninterrupted climb.
New infections remained below 500 a year until the early 2000s, then surged to 6,000 in 2004 and 10,000 in 2005. By 2010, the figure had crossed 16,000. In 2014, it reached 20,000, rising further to 31,000 in 2019, 44,000 in 2023 and 48,000 in 2024. Experts involved in the modelling say the 2025 tally is likely to mirror last year unless transmission slows significantly.
Officials have publicly confirmed around 10,000 newly reported HIV cases between January and October 2025, but they acknowledge privately that routine reporting captures only a small fraction of actual transmission.
With an estimated 48,000 new infections annually, it means four out of every five people infected each year may still be undiagnosed, untreated and capable of spreading the virus.
Alongside this rise, the number of people living with HIV has more than doubled in a decade, growing from around 150,000 in 2015 to nearly 350,000 in 2024. If current trends continue, Pakistan could approach 400,000 people living with HIV in the next few years, stretching provincial treatment programmes that are already struggling with shortages of staff, testing kits and antiretroviral medicines.
The character of the epidemic has also shifted. Once described as “low level and concentrated”, HIV has steadily moved towards the general population and, more alarmingly, into children. Modelled national data shows new infections among children aged 0 to 14 increasing from about 530 in 2010 to around 1,000 in 2015, peaking at nearly 2,300 in 2019 and remaining between 1,800 and 2,100 annually since.
These patterns match real outbreaks. The devastating Ratodero tragedy in 2019, where more than a thousand children tested positive, was followed by clusters in Nawabshah, Mirpurkhas, SITE Town Karachi and Taunsa in Punjab. Investigations in each location pointed to unsafe medical practices, including reused syringes, contaminated drips and poor infection control, exposing children and adults to avoidable risk.
Experts say detection of these outbreaks was delayed partly because district-level HIV data is not regularly shared with clinicians, media or the public. Authorities often cite stigma and confidentiality laws, but epidemiologists warn that withholding data allows hidden transmission to grow unchecked until it erupts into full-scale crises.
Antiretroviral therapy coverage has expanded steadily, but not fast enough to keep up with new infections. Thousands of patients start treatment every year, yet tens of thousands are newly infected, undermining progress. AIDS-related deaths have not fallen at the expected rate, signalling late diagnosis and inconsistent access to care, especially outside major urban centres.
Public health specialists say Pakistan is now at a critical juncture. They argue that only major, urgent shifts—large-scale expansion of testing, strict enforcement of infection control, stronger harm reduction services and transparent sharing of surveillance data—can prevent the country from normalising nearly 50,000 new infections annually.
For now, the numbers underline a stark reality: an epidemic that has grown almost 240 times since 2000, tens of thousands of new infections every year, and a health system still struggling to diagnose, treat and prevent HIV at the scale required to bring the crisis under control.