Pakistan continues to face recurrent, healthcare-associated pediatric HIV outbreaks, highlighting persistent deficiencies in infection prevention and control (IPC). In the 2019 pediatric HIV outbreak in Larkana, over three-quarters of newly diagnosed HIV cases occurred among children. Over the following year, the outbreak expanded to more than 1,300 cases. ^{Reference Rabold, Shaikh and Schenkel1} More recently, a 2026 BBC investigation reported 331 HIV infections among children in Taunsa, Punjab, between November 2024 and October 2025. ^{Reference Abbasi, Mirodan and Zubair Khan2} As of July 2026, Dawn reported a pediatric HIV outbreak at Karachi’s Kulsum Bai Valika Hospital, with nearly 100 cases. ^{Reference Ilyas3}

Evidence from investigations into these outbreaks suggests a repeated pattern of breaches in IPC protocols. Following the 2019 Larkana HIV outbreak, a matched case-control study conducted at a children’s hospital in Larkana identified unsafe injection practices and deficiencies in blood safety measures as key contributors to HIV transmission among children. ^{Reference Mir, Nathwani and Simms4} Similarly, the 2026 BBC undercover investigation into the HIV outbreak in Taunsa, Punjab, documented comparable lapses, including the reuse of disposable syringes, contamination of multi-dose medication vials, and other unsafe injection practices. ^{Reference Abbasi, Mirodan and Zubair Khan2} Official investigations into Karachi’s Kulsum Bai Valika Hospital outbreak highlighted systemic IPC failures, citing mishandling of single-use syringes, unmonitored sterilization practices, and improper biomedical waste disposal. ⁵

The repeated emergence of these healthcare-associated pediatric HIV outbreaks over a relatively short period suggests that existing preventive measures have not been sufficient to address persistent gaps. Since the major contributors to these events are identifiable and largely preventable, greater efforts should focus on strengthening IPC practices across healthcare settings. These recurring outbreaks highlight the need for long-term interventions aimed at preventing future outbreaks rather than relying on temporary responses after outbreaks have occurred. To achieve this, hospital administrators and public health authorities should ensure a reliable supply of disposable syringes and essential consumables to reduce the risk of unsafe reuse. Healthcare workers, including doctors and paramedics, should receive regular training on IPC protocols. Furthermore, mandatory competency assessments and routine IPC audits must be instituted to ensure effective implementation and sustained compliance. Additionally, IPC standards should be routinely monitored through robust regulatory mechanisms. Regulatory bodies must ensure that breaches of IPC standards do not go unchecked, with swift corrective actions taken when serious or persistent violations are identified.

The recurrence of these outbreaks across multiple provinces should serve as a call to strengthen IPC systems nationwide to protect children from preventable healthcare-associated HIV transmission.