Seven years ago, Pakistan faced a startling medical tragedy. In the city of Larkana, in Sindh province, 494 children were diagnosed with HIV. Authorities were puzzled but eventually determined a leading cause. As NPR reported at the time: “the tragedy is … being linked to major failures in the health care system, including reuse of syringes and lack of standards for blood transfusions.” The public was in an uproar. “There was panic, hue and cry,” Masood Bangash, a district police officer, told NPR. Parents gathered outside clinics in Larkana to express their anger. The government pledged action, including a crackdown on unauthorized medical providers, to prevent more such infections.

This year, HIV cases among children are again being linked to unsafe medical practices. Here is a report from journalist Betsy Joles in Pakistan on the families affected –- and why the number of infections continues to rise in a country with an estimated 350,000 active HIV cases, according to the World Health Organization, and a surge among youngsters.  This story is the first in our annual series, “Whatever happened to …”

KARACHI — In August 2025, Ayesha Aftab took two of her four children to Kulsoom Bai Valika Hospital in Karachi for treatment for what she suspected was typhoid or malaria — diseases most common during Pakistan’s muggy monsoon season in late summer. She brought along her youngest, Muhammad Rehan, as well. The toddler sat on her lap while her other kids received treatment and spiked a fever while they waited. The doctor on duty suggested an antibiotic injection to knock out his symptoms faster than a pill or over-the-counter syrup. “I thought, okay, the doctor knows better,” Aftab said.

In the crowded ward, she saw hospital staff giving injections to child after child. Their methods were common practice, they insisted to Aftab, even in well-known hospitals in the city. “We had never been to these hospitals,” she said, “so we thought maybe things happened this way.”

But Rehan’s health did not improve after the injection and Aftab’s other two children remained ill even after weeks of treatment.

Laboratory tests provided a startling explanation: All three had contracted HIV, the bloodborne infection that causes AIDS and can be deadly if not treated quickly with the right mix of medicines.

Dozens of other parents who brought their children to government-run Valika Hospital say their kids got HIV after being treated there too. At least six later died. They blame the reuse of syringes and IV needles at the hospital — echoing some findings from the 2019 outbreak.