BBC shows not much has changed. Syringes being reused on multiple children, injections administered through clothing, a nurse rummaging through medical waste without gloves — these malpractices have been linked to the outbreak. The video was complemented by parents’ confirmation of the reuse of syringes on their children.

In more than half of these cases, a “contaminated needle” was identified as the mode of transmission. With the health system a vortex of infection, and HIV no longer confined to certain high-risk groups, former SAPM on health, Dr Zafar Mirza, has waved a red flag in a recent tweet: “We are sitting on a generalised epidemic of AIDS in Pakistan”, adding that estimates by UNAIDS point to Pakistan as the country with the fastest-growing number of AIDS cases in Asia. The all-too-familiar cycle will unfold: eyebrows will rise, outrage will flare and the finger-pointing will begin, followed by inquiries.

The media will whip up a frenzy, the government will rap a few knuckles — and before long, it will all fade from our collective memory, until the next outbreak forces it back into view. This pattern has been observed across four major outbreaks: in 2019, Larkana reported over 1,000 cases, up to 90 per cent of them children; in 2023, Jacobabad and Shikarpur became hotspots; in 2024, alongside Taunsa, Mirpurkhas emerged as “another Larkana” after 150 children tested positive, while in south Punjab, Dera Ghazi Khan saw a surge in HIV cases linked to unsafe sexual practices and the reuse of syringes by unqualified practitioners.

In 2025, Hyderabad, Shaheed Benazirabad, Naushahro Feroze and Karachi’s Pathan Colony also made headlines for rising HIV cases. Parents took their sick children to those they trusted would heal them — only to return with a far more serious, lifelong infection. Yet, these criminal practices have failed to provoke the outrage they deserve from the public, health practitioners and even governments.

No­­bo­­dy seems to know who to hold accountable, otherwise, why would these outbreaks continue so frequently? And in the Taunsa hospital’s case, in par­ticular, it is clear that the irresponsible behaviour never stopped despite a change in leadership. Along with implementation gaps, the lack of public awareness remains a stumbling block.

Patients, especially in public hospitals, are not only poor, but often poorly informed. They have little reason to suspect that a routine injection could leave them or their child with a lifelong infection. In rural and peri-urban communities, this already vulnerable population is left at the mercy of practitioners who can be insensitive, unskilled — even cruel.

With little oversight or accountability, these health practitioners operate with near impunity. When senior officials dismiss the BBC’s evidence of “repeated and serious breaches of basic infection control” as “staged”, it raises a stark question: what real hope is there for accountability or recourse? Another question that comes to mind is: why are these outbreaks happening in the first place?

Is there an incentive to overuse injections and why is enforcement against syringe and needle reuse by the provincial health authorities weak, despite the various plans, policies and strategies? Four major policy responses — the National Injection Safety Policy (2004–05), the Prime Minister’s Programme for Prevention and Control of Hepatitis (launched in 2005), the National Action Plan to Address Unsafe Injection Practices (2019-2021) and the National Infection Prevention & Control Strategic Framework/Guidelines (2021–23; 2025–30) — were all born out of deadly hepatitis C and HIV outbreaks, with the explicit aim of ending unsafe injections and syringe reuse.

Yet, despite the urgency that produced them, these frameworks appear to have remained largely on paper, as can be seen by the upsurge (we have around 10 million people infected with hepatitis C, the largest burden in the world) in these diseases. Injection and transfusion safety are the health system’s “nemesis”, says Karachi-based paediatric infectious disease specialist Dr Fatima Mir — a basic standard that demands strict compliance at every level, yet remains stubbornly unenforced. What makes these outbreaks especially tragic is that over 80 per cent of those diagnosed are children — an anomaly in HIV epidemiology, since children are not engaged in high-risk behaviours such as unprotected sex or injecting drug use.

With most mothers testing negative, mother-to-child transmission has also been ruled out. Parents took their sick children to those they tr