THE EPIDEMIC IS SHIFTING

Pakistan is often described as having a “concentrated HIV epidemic,” meaning HIV is mostly found within key population groups such as people who inject drugs, sex workers, and transgender communities. But that definition, while technically correct, no longer captures the full picture.

The virus is spreading, and spreading faster than many acknowledge.

With recent reports of 64 children becoming infected in Pakistan’s Taunsa district, it is clear that the disease is on the move. This was not an isolated cluster in a high-risk group; it was an outbreak among ordinary families. Increasingly, women like Ayesha, and men like her husband, are becoming infected through everyday marital relationships. These are not people society considers “at risk.” And that is precisely the point: HIV is crossing over into the general population. 

In other countries where I have worked, this story of the disease “bridging” over to the general population has led to untold suffering and death. In Sub-Saharan Africa where HIV has ravaged populations in countries like Eswatini and Botswana, entire communities were hollowed out before governments fully understood the scale of the threat. Only when testing and treatment became widespread, and when medicines like ARVs and preventive tools like Pre-Exposure Prophylaxis (PrEP), which prevents infection of HIV in those who are not yet exposed to the virus, became easily accessible did those countries begin to turn the tide.

Pakistan is at a crossroads. The future does not have to mirror the worst-case scenarios of the past. But ignoring the warning signs would be a mistake we cannot afford.
 

THE PATH FORWARD

Ending HIV is not complicated from a technical point of view. We know exactly what works:

• early testing
• consistent access to treatment
• prevention tools like condoms and PrEP
• and, critically, reducing stigma so people feel safe enough to seek support.

The challenge is not science. It is commitment. 

Political will is essential. HIV has a better chance to be controlled if people can access testing, stay on treatment, and rely on a consistent supply of lifesaving ARVs. Just as crucial is breaking the silence and stigma surrounding the disease through education, open dialogue, and community engagement so that people living with HIV are treated with understanding, not fear.

But a newer risk to addressing the disease is now looming on the horizon: reductions in international financing for HIV and other infectious diseases like Tuberculosis. Global funding cycles are shifting, and donor priorities are evolving. These reductions are not theoretical; they are already happening.

This brings us back to Ayesha. Her fear represents the fear of thousands of men, women, and children across Pakistan whose lives are dependent on uninterrupted supplies of antiretroviral medicines.

If international support declines, there is only one feasible way forward: domestic investment must rise. Federal and Provincial Governments now hold both the responsibility and the opportunity to pick up the financing gaps and take full ownership of the HIV response. The choice is clear - act now to protect millions, or pay a far heavier price in lives, resources, and stability later.

The time has come for national leadership to be at the centre of this fight and UNDP stands ready to support this transition, with technical expertise, capacity-building, and continued partnership, so that Pakistan can build a resilient, fully domestically owned HIV response.

*The names of individuals in the blog have been changed to protect their privacy.

UNDP is implementing a Global Fund grant for HIV which is procuring the lifesaving ARVs, diagnostic kits, opportunistic infection medicines and prevention tools like condoms and Pre-Exposure Prophylaxis (PrEP) for the National HIV Response in Pakistan. The grant also funds community-based prevention activities across the country.