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Islamabad, Pakistan At least 130 people, many of them children, have tested positive for HIV in an outbreak at a government-run hospital in Karachi, Pakistan’s largest city, with officials adding that the number has risen sharply in recent weeks.
Sindh Minister of Labour, Saeed Ghani, said earlier this week that more than 10,500 people were screened at the Kulsum Bai Valika (KBV) hospital, which is home to the Sindh Employees’ Social Security Institution (SESSI), where 120 were tested.
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Another monitoring station at another SESSI facility in Karachi’s Landhi found 10 additional cases.
SESSI is an independent organization that provides medical, medical and financial assistance to industrial and commercial workers and their dependents across Sindh.
The problem at the KBV hospital first came to light in November 2025, when residents of Karachi’s SITE Town noticed an increase in infections among children treated there.
Officials, however, tracked the outbreak back to October 2025, when the first six cases of HIV were reported to the provincial health department.
So what happened, what caused the outbreak, and why does Sindh continue to see such incidents?
What happened this month?
Prime Minister Murad Ali Shah was told on July 14 that two internal inquiries had found serious lapses, including failure to follow infection control measures, failure to use personal protective equipment and improper handling of single-use syringes.
The first questionnaire, which was given in November last year, found 16 children with HIV, all related to the children’s department of the KBV.
Second, a comprehensive investigation, which was presented to the regional ombudsman on June 19, has confirmed that 78 people are sick and six have died, implicating hospital workers who are responsible for failing to monitor and control.
The number has risen, the latest infections have been confirmed at SESSI sites.
Minister Ghani said all the cases came to light in October 2025 and that the investigation will continue “even though he fears that additional cases may arise”.
The 37 doctors and hospital staff were served with show-cause notices on July 3 and given 14 days to respond.
Ghani said prosecution and dismissal will follow those found guilty. When asked about his response, he said he “accepted indirect responsibility” and would not refuse to resign if it would help solve the problem.
Is the spread of Sindh a special problem?
Responding to questions after a petition by the Sindh High Court that said the outbreak was caused by reused syringes, Ghani told reporters on July 4 that the disease was not caused by the reuse of syringes. He said the KBV clinic uses self-contained syringes that cannot be reused.
The officials’ questions revealed a serious breakdown in infection prevention, citing failures that included poor adherence to safety regulations, inadequate use of personal protective equipment and poor handling of single-use syringes.
The Sindh High Court petition says that the number of infections is higher than what is acceptable.
This is not the first outbreak of HIV in Sindh.
Last December, the World Health Organization (WHO) and UNAIDS recognized the problem of Pakistan as one of the fastest growing HIV epidemics in the WHO Eastern Mediterranean Region, made up of 21 countries, with annual infections increasing 200 percent in 15 years, from 16,000 in 2010 to 48,000 in 2024.
In a joint statement on World AIDS Day issued on December 1, the organizations said that about 350,000 people in Pakistan are living with HIV, and about 80 percent do not know their status.
The statement also showed that HIV infection among children aged 0 to 14 increased from 530 in 2010 to 1,800 in 2023.
Only 38 percent of HIV-infected children are receiving treatment, while 14 percent of pregnant women need treatment to prevent mother-to-child transmission of HIV.
In June, doctors writing in the British medical journal The Lancet HIV said that the epidemic in Pakistan is now controlled “in large part, by the health care itself”, referring to repeated outbreaks related to unsafe medical procedures.
This assessment, however, was not confirmed.
Although repeated outbreaks have highlighted unsafe medical practices, researchers say Pakistan still lacks sufficient data to determine how much of the country’s HIV infections come from health care settings compared to transmission, mother-to-child transmission or intravenous drug use.
Syed Faisal Mahmood, a professor of infectious diseases at the Aga Khan University Hospital in Karachi, urged caution.
“At the moment, it is not possible to say which of the two is driving the disease,” he told Al Jazeera.
In the case of sexually transmitted diseases, mother-to-child transmission and intravenous drug use, he said, “the numbers are quite reliable, because a lot of work has been done” through a permanent registry.
“There is no systematic review that looks at the number of people who become infected with HIV through visits to hospitals, clinics, or traditional health care providers,” he said.
The route continues to the KBV Hospital.
Three other hospitals in Karachi also reported an increase in HIV patients, including one facility where admissions rose from 10 in 2024 to 70 in 2025.
The Pakistan Medical Association warned in April that 329 of the 894 HIV cases recorded in Sindh in the first quarter of 2026 involved children, describing the figures as “just a tip”.
For Mahmood, this spread represents an even bigger problem.
“For many of us who work in this field, this is a systemic problem,” he said. “It has nothing to do with any hospital or health care system. The practice of injecting drugs is widespread across the country and in all healthcare settings.”
He also said that children are not the only ones who are affected, referring to the spread of dialysis centers related to unsafe blood transfusions.
Pakistan also has one of the highest rates of hepatitis C in the world, he said, “driven by the same process and the same factors” as the HIV epidemic.
What is being done?
The Sindh High Court has given the provincial government until July 20 to respond to the petition alleging violation of the provincial law on the administration and disposal of syringes.
At the federal level, Prime Minister Shehbaz Sharif ordered a nationwide ban on cheap syringes on July 3.
The Drug Regulatory Authority of Pakistan later announced that the sale of ordinary reusable syringes, as opposed to self-dissolving syringes that clog or break the plunger after one use, will be banned from January 2027.
Federal Health Minister Mustafa Kamal also said pre-operative HIV testing should be made mandatory nationwide, warning against labeling the problem as a “epidemic”.
Meanwhile, the Sindh government has approved a fund worth 2 billion dollars ($7.2m) to support the long-term care of affected children, along with an isolation ward and a third-party audit of procurement and infection control measures at KBV Hospital after the provincial ombudsman took notice of the issue.
Al Jazeera contacted Sindh Health Department officials for comment but they did not respond.
Mahmood, however, said measures such as banning syringes only address one part of the problem.
About 60 percent of Pakistan’s health care is provided by the private sector, which he said is very difficult to manage.
“Independent institutions are very difficult to control. It is not only hospitals but also hospitals, dispensaries and similar, which are controlled by medical institutions that do not have the power to monitor everything,” he said.
Mahmood said unsafe injections remain entrenched in Pakistan’s medical culture, driven not only by weak laws but also by patient expectations.
“Patients coming to the doctor expect an injection because they believe it will help them recover faster, and medical staff often feel the same way,” he said. “It’s a perfect storm in many ways: more injecting, more illegal injecting, less knowledge of safe injecting practices, no monitoring of whether injections are being given correctly, and no consequences for unsafe practices.”
