akistan is on course to add around 48,000 new HIV infections in a single year if current trends continue, even as authorities concede only 10,000 newly reported cases up to October 2025, official estimates shared with The News on Sunday show.

The 2025 HIV estimates data sheet for Pakistan, prepared for national HIV planners and technical partners including UNAIDS, puts new infections at 48,000 in 2024, showing a steep, uninterrupted rise over the last decade.

According to the same sheet, new HIV infections in Pakistan have more than doubled in less than ten years, rising from 22,000 in 2015 to 34,000 in 2020 and 48,000 in 2024. The estimated number of people living with HIV has climbed from about 150,000 in 2015 to 350,000 in 2024.

In 2000, Pakistan had fewer than 200 new HIV infections a year. The number did not cross the 10,000 mark until 2005. But since then the curve has bent sharply upwards, with an additional 4,000 to 5,000 new infections being added almost every year since 2018.

Around 10,000 new HIV cases were officially reported across Pakistan between January and October 2025, but experts involved in the estimation say this figure captures only a fraction of actual transmission.

If new infections in 2025 match the estimated 48,000 in 2024, four out of five people newly infected this year may still be undiagnosed, untreated and capable of passing on the virus to others, further aggravating a trend that has already turned Pakistan into one of the few countries in Asia with a growing HIV epidemic.

The estimates, which cover the period from 1990 to 2024, also shows how HIV has steadily moved from a low level, concentrated epidemic to a more widespread one over the last two decades.

New infections remained below 500 per year until the early 2000s, jumped to 6,000 in 2004 and 10,000 in 2005. These rose almost every year after that to reach 16,000 in 2010, 20,000 in 2014 and 31,000 in 2019, before touching 44,000 in 2023 and 48,000 in 2024.

Children have been increasingly pulled into this pattern. Modelled new infections among children aged 0 to 14 rose from about 530 in 2010 to 1,000 in 2015, peaking around 2,300 in 2019 and remaining between 1,800 and 2,100 a year since 2020, according to the same national estimates file.

Pakistan’s HIV response is still several steps behind the epidemic, especially outside its major cities. 

These numbers are mirrored in real world outbreaks among children, including the Ratodero tragedy of 2019 and more recent clusters reported from Nawabshah, Mirpurkhas and SITE Town in Karachi in Sindh, as well as Taunsa in the Punjab, where dozens of children have tested positive in short spans of time.
Experts warn that if Pakistan adds another 48,000 new infections in 2025, the country could be looking at nearly 400,000 people living with HIV within a few years, putting immense pressure on an the already stretched treatment programme.

Antiretroviral therapy, laboratory monitoring, prevention of mother-to-child transmission and harm reduction services will all need rapid expansion. Provincial health systems that are already struggling with shortages of staff, diagnostics and drugs will be forced to cope with thousands of additional patients every year.

National and provincial authorities, as well as international agencies working on HIV, including UNAIDS and the World Health Organisation, rarely share disaggregated surveillance data with the public and the medical community.

Officials often cite confidentiality laws, stigma and discrimination as reasons for withholding district wise or key population specific numbers, but public health experts argue that hiding data results in new outbreaks and fresh transmission networks grow unchecked until they explode into full blown crises.

Epidemiologists say that numbers and granular data are essential to spot unusual trends, such as sudden spikes in infections among children in a particular town or among dialysis patients, and to link them to unsafe medical practices, contaminated equipment or sexual and injecting networks.
In Ratodero, Nawabshah, Mirpurkhas, SITE Town Karachi and Taunsa, for example, delayed recognition and delayed public disclosure of rising case counts meant that unsafe injections, reuse of drips and poor infection control in local clinics continued for months, exposing more children and adults to HIV after some cases had been confirmed.

The same estimates sheet shows that AIDS-related deaths have not fallen fast enough, indicating gaps in diagnosis and treatment. With about 350,000 people already living with HIV in 2024 and tens of thousands more being infected each year, every undiagnosed person is a missed opportunity not only to save a life but also to prevent further transmission to spouses, babies and sexual or injecting partners.

Officials and technical partners involved in the 2025 estimates exercise acknowledge privately that Pakistan’s HIV response is still behind the epidemic, especially outside major cities. However, they do not publicly comment on the gravity of the matter. They say that unless surveillance data is shared transparently; prevention services, testing and treatment are scaled up aggressively; and lessons are learnt from recent paediatric outbreaks in Sindh and the Punjab, the projected 48,000 new infections a year could become a grim new normal rather than a peak.

The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International