As Pakistan’s monsoon arrives, people with HIV worry

AI Summary

Pakistan faces significant challenges amid monsoon floods, particularly for people living with HIV who are at risk due to disrupted access to essential antiretroviral treatment. The floods have caused widespread devastation, claiming over a thousand lives, displacing millions, and increasing health risks for vulnerable populations.

As contaminated floodwater gushed into their home in Buner, north-western Pakistan, Khalid (name changed) and his wife helped their three children up to higher ground. Amid the chaos, the couple had one more crucial thing to rescue: their life-saving HIV drugs. They trudged through neck-deep water inside their home to save their antiretroviral treatment pills from being swept away, ignoring all other valuables. “The waist-deep mud left behind by floodwaters had cut off our village for more than eight days,” Khalid recalls. “Thankfully, my wife and I still had our HIV medication with us,” says the daily wager, who contracted the virus while working abroad five years prior. This happened last monsoon, in August 2025, when the skies opened on Pakistan, causing widespread flooding. Devastating riverine floods affected places like Buner, a district in Khyber Pakhtunkhwa, and Punjab province. The floods claimed over a thousand lives, with 808 of these casualties reported in the two provinces alone. They displaced three million people and damaged nearly 230,000 houses. For people living with HIV and AIDS, their illness was an added risk factor. During last year’s floods, many people with HIV got sick because they were cut off from antiretroviral therapy centres and couldn’t access drugs, Asma Nasim tells Dialogue Earth. Nasim is head of the Department of Infectious Diseases at the Sindh Institute for Urology and Transplantation. In Pakistan, antiretroviral treatment for HIV/AIDS is provided free of cost at dedicated centres. Such therapy enables persons with HIV “to live healthy lives by suppressing the virus and preserving immune functions,” explains Asghar Ilyas Satti, national coordinator for the Association of People Living with HIV-Pakistan. This year, as monsoon rolls in, Pakistan is on high alert, and has warned citizens of heavy rainfall, urban flooding and more weather-related risks. On 1 July, the country’s National Disaster Management Authority (NDMA) issued a glacier lake outburst flood alert in two valleys in Gilgit-Baltistan, a region bordering Khyber Pakhtunkhwa. Rising river water levels damaged roads and bridges across several parts of the region, Dawn reported. Soon after, heavy rains lashed Pakistan, claiming at least 14 lives across the country, according to The Nation. These warnings and recurring floods coincide with Pakistan recording a dramatic increase in the incidence of HIV. Waheed (name changed), a teacher living with HIV in Khyber Pakhtunkhwa’s Swat district, worries about the impacts of this year’s monsoon on his health due to his experience last year. While guiding his elderly mother, wife and three children to safety during the floods, he had to return to the house, but struggled to explain why. “Due to the stigma associated with the disease, I have kept my illness a secret from everyone, even from my spouse,” Waheed tells Dialogue Earth. “I had only nine tablets left and was worried about facing a gap in treatment due to [loss of] access to [the antiretroviral] centre,” he recalls. Eventually, he managed to rush back to his submerged house to extract his antiretroviral drugs from a hidden spot. “Gaps in treatment have severe health consequences, including viral rebound, immune system damage and progression to AIDS,” Satti tells Dialogue Earth. “For HIV patients, who are already navigating stigma and fragile health systems, climate disasters are not only destroying their homes and livelihoods, but also endangering access to essential medication, a disruption that could have life-threatening consequences,” Satti notes. HIV spikes amid floods On World AIDS Day in December 2025, the World Health Organisation (WHO) reported that new infections in Pakistan had risen by 200 per cent in 15 years ­— from 16,000 in 2010 to 48,000 in 2024. Hospitals in Karachi recently reported a “dramatic increase” in the number of paediatric HIV cases over the last nine months alone, noted Dawn. “During the last three months, I have seen more children who are HIV positive than I have seen in the last ten years,” says Nasim. “It isn’t just that more people are being tested. It is that there are more people being infected,” she adds. Unsafe medical practices appear to have been the main cause of these spikes, Samreen Sarfaraz, chair of infection control services and consultant infectious diseases at Indus Hospital, told Dawn. In April, the BBC published a story on how 331 children had tested positive for HIV between November 2024 and October 2025 in the city of Taunsa, Punjab. Their story, confirmed via undercover filming, linked the outbreak to a hospital where children were being injected with reused syringes. Waheed believes he contracted the virus while getting dental treatment where non-sterile instruments were used. After the 2019 HIV outbreak in Larkana, auto-disable syringes were introduced, which lock or break the plunger after one use. But more recently, such syringes have been discovered to be