Pakistan's HIV high-risk populations: Critical appraisal of failure to curtail spread beyond key populations

Abstract

Pakistan has been a hub of several HIV outbreaks over the last two decades, with four major outbreaks being registered since 2018. There has been a recent rise in HIV infections, especially in high-risk populations, mainly consisting of people who inject drugs, men who have sex with men, prisoners, the transgender women community and female sex workers. Consistently poor infection control practices, unregulated unsafe blood transfusion, questionable ethical practices by healthcare providers and a general lack of awareness are the main drivers of recent HIV outbreaks, with these issues exacerbated by the presence of untrained healthcare providers. In order to stop the spread of HIV systemically and sustainably, aggressive measures need to be taken at all levels by all concerned stakeholders that not only deal with building up testing, tracing and treatment capabilities but also address underlying grassroot problems that have largely been ignored to date.