In a revolutionary step towards national health security, the Sindh government has decided to make HIV, tuberculosis and hepatitis B and C screening mandatory for all deportees arriving at entry points in the province amid growing concern that undetected infections among returning Pakistanis are fuelling the spread of chronic diseases into the general population.
Health officials say that around 150 to 200 deportees land at the Jinnah International Airport in Karachi every day from various countries, many of whom are not screened on arrival and return to their communities without being linked to care.
Over the past few years, an estimated 50,000 Pakistanis have been deported from different parts of the world and entered the country through multiple points of entry, raising alarms among public health authorities about the risk of silent transmission of HIV, TB and viral hepatitis.
“This is a revolutionary step taken by Sindh Health Minister Dr Azra Pechuho,” said Dr Zafar Mehdi, focal person for communicable diseases at the Karachi airport. “The decision to make screening mandatory was taken because infected people were unknowingly spreading these diseases in society.”
Dr Mehdi said the provincial health department has provided rapid testing kits, X-ray facilities, personal protective equipment and specialised training to staff to ensure that deportees are screened with dignity and respect.
Under the new protocol, all deportees arriving in Sindh will be offered on-the-spot testing for HIV, TB and hepatitis B and C. Those who test positive will be asked to share basic personal details, medical history and contact information, and will then be allowed to proceed unless required by law enforcement agencies.
Importantly, they will be formally linked to treatment and counselling programmes so that they can begin care immediately and reduce the risk of passing infections on to others.
Officials involved in the programme said coordination has also been initiated with the Federal Investigation Agency and other relevant agencies at points of entry to ensure that no deportee leaves without mandatory screening.
They added that even non-deportee travellers would be encouraged to get themselves tested voluntarily, framing the initiative as a broader public health intervention rather than a punitive measure.
Health authorities acknowledged that the decision has not been without controversy. Officials said they faced pressure from some organisations opposing mandatory testing, arguing that it can lead to discrimination.
However, with HIV increasingly spilling over into the general population and the burden of TB and hepatitis in Sindh described as “out of control”, the provincial government decided that stronger preventive action is unavoidable.
Dr Mehdi said that strict confidentiality protocols would be followed. “The identities and details of those who test positive will be kept confidential to protect them from stigma and discrimination. Our aim is not to penalise anyone but to connect them with treatment centres and disease control programmes so these infections can be contained.”
Pakistan is already struggling with a fast growing HIV epidemic, as official figures show that thousands of new HIV cases are reported every year, with last year alone seeing a sharp rise in reported infections.
Once largely confined to key populations, HIV has now spread into the wider community, with repeated outbreaks reported among children in parts of Sindh, exposing serious gaps in infection control, unsafe medical practices and weak surveillance.
Public health experts say the decision to screen deportees addresses a blind spot in the country’s disease control efforts. With large numbers of Pakistanis moving abroad for work and many returning under difficult circumstances, airports and other entry points have become critical but largely neglected nodes in the prevention chain.
By bringing systematic screening and referral into this space, Sindh is attempting to plug one route through which HIV and other chronic infections may be entering communities unnoticed.
Officials warned that without similar measures at other entry points across the country, infected individuals can still slip through elsewhere. Even so, they believe the Sindh model can serve as a template for a national approach to disease surveillance at borders at a time when the country can ill afford further spread of HIV, TB and hepatitis.
