At a glance: HIV in Pakistan

• 210,000 people with HIV
• 0.2% adult HIV prevalence
• 25,000 new HIV infections (2020 data)
• 9,600 AIDS-related deaths
• 50,000 people on antiretroviral treatment

The current targets for HIV testing and treatment are called the 95-95-95 targets and must be reached by 2025 in order to end AIDS by 2030.

In 2021 in Pakistan:

Did you know?

Pakistan is experiencing a fast-growing HIV epidemic, with new infections rising by 84% between 2010 and 2020.

Preventing HIV in Pakistan focuses on:

• harm reduction (needle and syringe programmes)
• STI management
• male condoms and lubricants
• behaviour change communication
• information and education materials about how to prevent and treat HIV, how to use condoms and lubricants, and information about sexually transmitted infections
• psychosocial counselling, plus career and family counselling
• harm reduction (needle and syringe programme; opioid agonist therapy approved in 2021)
• preventing mother-to-child transmission.  

Did you know?  

In 2018, Pakistan began a new HIV prevention programme that works with community-based organisations to reach people who inject drugs, sex workers, transgender people (sometimes referred to as ‘hijra’), gay men and other men who have sex with men – the people most affected by HIV in the country.

Testing for HIV is:

• available through mobile testing vans, targeted at groups most at risk of HIV
• delivered by community-based organisations
• available for the partners of people who come to test, with a particular focus on the pregnant partners of men who use drugs and men who have sex with men
• more available in cities than in other areas.

Did you know?

Pakistan’s mobile testing services also provide counselling, information about what HIV is and how to prevent it, links to HIV treatment if needed, condoms, lubricants and STI treatment.

Treatment for HIV is:

• available immediately after diagnosis
• monitored by viral load testing in some clinics, but not all of them
• includes counselling to help people stay on treatment
• available alongside screening for other infections, such as tuberculosis.

Treatment coverage has been expanding in Pakistan in recent years, but around 85% of people with HIV are still not on treatment and there is a lack of data on viral suppression. This is helping to drive the country’s rapidly increasing HIV infection rate.

Pakistan’s HIV epidemic is concentrated among certain groups (known as ‘key populations’).

People who inject drugs were the first group to experience a high rate of HIV infections, which now appear to have stabilised (although they are still high). But new infections from sexual transmission are increasing, particularly among sex workers, transgender people, gay men and other men who have sex with men. Men are disproportionately affected.

Pakistan’s HIV epidemic could soon start to rise among the general population. In 2019, more than half of HIV infections occurred among people not classified as ‘high-risk’ – many are likely to be the sexual partners of people from key populations. The Punjab and Sindh is home to around 90% of people with HIV, particularly the cities of Karachi, Faisalabad and Lahore.

Although Pakistan’s HIV prevention, testing and treatment programmes are showing signs of success, coverage is still too low to have a significant impact. New infections, the number of people with HIV, and AIDS-related deaths are all increasing. New advances such as PrEP are yet to be introduced. Pakistan has limited data on viral suppression. This will need to be addressed to track the impact of the country’s treatment programme.

Pakistan’s programme to prevent parent-to-child transmission is struggling. Only 23% of pregnant women with HIV were on treatment in 2021 and only 4% of infants exposed to HIV were tested within 2 months of being born.

Criminalisation, violence, stigma and discrimination against people most affected by HIV stops people from accessing HIV services and hampers efforts to end the epidemic. Gay men and other men who have sex with men face fines and imprisonment. Sharia law also carries heavy penalties for homosexuality, including the death penalty. Sex work is illegal, as is drug use. Abortion is legal in limited circumstances on the basis of health grounds (for example, if the mother’s life is at risk). But, some progress is being made in regards to the law. Pakistan’s 2018 Transgender Persons Act means transgender people can now change their records, driver’s license and passport to reflect their gender.

Pakistan’s HIV programme depends on international donors, the largest of which is the Global Fund. In recent years, the domestic resources the Pakistan Government has provided to address HIV were lower than expected. This has left funding gaps in many programmes, including HIV treatment.