Pakistan's Children Keep Getting HIV in Hospitals

KARACHI – Ayesha Aftab brought her two children to Kulsoom Bai Valika Hospital in Karachi last spring because they had fevers she could not break. One had what she thought was typhoid. The other had tested positive for malaria. Both came home HIV-positive.

They are not alone. At least 140 people, the vast majority of them children under ten, have now tested positive for HIV in connection with the Kulsoom Bai Valika cluster, according to Sindh provincial health authorities. Pakistan’s national HIV tally for children under fifteen stands at approximately 7,500, a figure the Pakistan Medical Association considers a significant undercount. The Kulsoom Bai Valika outbreak is the country’s third major healthcare-associated HIV cluster since 2019, and the cycle has become grimly predictable: a provincial government hospital, a needle, a child who came in for something else.

The scale of what is happening inside Pakistan’s public health system is not hidden from officials. Sindh’s Infectious Diseases and HIV/AIDS Research Centre recorded its caseload rising from 10 confirmed pediatric HIV cases to more than 70 in under eight months in the Karachi district alone. The Indus Hospital, which tracks HIV in children across Sindh, reported its pediatric count rising from 144 to 176 confirmed cases in a single quarter. The Pakistan Medical Association reported in April 2026 that 329 of 894 newly registered HIV cases in Sindh for the first quarter of the year were children, 37 percent of new infections in a province where the disease is supposed to be concentrated in adult high-risk populations.

A joint investigation led by the World Health Organization and UNICEF found that 99 percent of HIV-positive children identified in the cluster investigations had received an injection or intravenous drip at a healthcare facility in the twelve months preceding their diagnosis. Investigators documented syringes being reused across patients, sometimes up to ten times, before being repacked in clean packaging and returned to circulation. The same syringes that delivered saline or antibiotics to one child were delivering HIV to the next.

Pakistani children affected by the HIV outbreak linked to unsafe injection practices at government hospitals in Karachi and Sindh — At least 140 people, the vast majority of them children, have tested HIV-positive in connection with the Kulsoom Bai Valika Hospital cluster in Karachi, Pakistan’s third major healthcare-associated outbreak since 2019. [Image Source: TRT World]

“Without major reforms in how injections are administered and sterile equipment is procured in public facilities, more hospitals in the country risk spreading HIV,” said Dr. Fatima Mir of the Aga Khan University Hospital in Karachi, one of the clinicians managing pediatric HIV cases from the cluster. Her warning is not speculative. In November 2024, a separate outbreak emerged in Taunsa in Punjab province, 600 kilometres north of Karachi. By October 2025, 331 children had tested HIV-positive in that cluster, also linked to unsafe injection practices at local government clinics.

The pattern behind both outbreaks is the same one that produced the 2019 Ratodero crisis, Pakistan’s first nationally reported mass pediatric HIV outbreak, in which more than 900 people, mostly children, were infected through unsafe medical injections in Larkana district, Sindh. Government inquiries followed. Pledges of reform followed the inquiries. Procurement audits were announced. And then the conditions that made Ratodero possible persisted into the next outbreak, and the one after that.

A Pakistani child receiving medical care in Sindh, where syringe reuse at government hospitals triggered repeated HIV outbreaks since 2019 — The 2019 Ratodero outbreak in Sindh, Pakistan’s first nationally reported mass pediatric HIV cluster, was caused by the same unsafe injection practices now implicated in the 2026 Karachi and Taunsa cases. [Image Source: AP Photo via Al Jazeera]

What has changed since 2019 is the drug supply. The Trump administration’s USAID cuts earlier this year froze critical health funding across South Asia. Researchers presenting at the AIDS 2026 conference documented shortages of antiretroviral drugs and anti-tuberculosis medications in Pakistan directly attributable to the USAID suspension. Tuberculosis is the most common opportunistic infection in HIV-positive patients; losing both the antiretroviral supply and the anti-TB supply simultaneously places newly diagnosed children at severe risk. Multiple clinicians at Karachi-area hospitals reported running out of paediatric antiretroviral formulations, the liquid and chewable forms children can actually take, in the months following the USAID funding freeze.

Sindh provincial authorities responded to the Kulsoom Bai Valika cluster by suspending twelve hospital staff members, promising compensation to affected families, and ordering emergency screening of more than 10,500 people in the surrounding area. The hospital remained open throughout. Official statements described the outbreak as an isolated incident under investigation, the same language used in 2019 and in 2024.

The gap between what international health bodies know and what Pakistan’s public health system enforces has widened with each cluster. WHO and UNICEF identified the core mechanism, reused syringes in under-resourced government facilities, after Ratodero. The 2022 national HIV strategic plan acknowledged unsafe injections as a primary transmission route. The assessments have been accurate. The enforcement has not followed. The Kulsoom Bai Valika cluster suggests that in at least some Sindh government facilities, the same procurement and sterilisation failures that produced Ratodero in 2019 remained institutionally intact in 2026.

Researchers presenting at AIDS 2026 in July noted that Pakistan’s HIV response infrastructure, already strained before the USAID suspension, was now operating with a significantly reduced supply of the drugs needed to keep people alive once diagnosed. Ebola and other infectious disease surveillance frameworks depend on similar international funding flows; the AIDS 2026 sessions on South Asia drew attention to a regional pattern of treatment disruption that Pakistan exemplifies most acutely.

Antiretroviral medication supplies affected by USAID funding cuts in Pakistan — A nurse holds a USAID-labeled box of antiretroviral drugs at a hospital in Kisumu, Kenya. The same US funding suspension has disrupted antiretroviral supply chains in Pakistan, where clinicians report running out of paediatric HIV formulations. [PHOTO Credit: Michel Lunanga/Getty Images]

What the official numbers do not capture is how many Pakistani children with HIV have never been counted. The 7,500 figure reflects registered cases at government screening facilities. Clinicians in Sindh describe families who test positive and then disappear from follow-up care, who cannot afford the transport to the treatment centre, or who do not return because the medicines are no longer reliably available. The true number, by the consistent assessment of physicians working in the province, is materially higher.

Ayesha Aftab is managing two HIV-positive children. The hospital where they were infected is still open. Pakistan has been asking itself how this keeps happening for seven years. The answer has not changed, and neither, apparently, has the practice.