he rising prevalence of HIV and AIDS has highlighted deep-seated issues of social stigma, misinformation lack of awareness and inadequate healthcare infrastructure in Balochistan. The lack of awareness about sexual health remains a huge factor driving the spread of the virus that is often transmitted unknowingly within families. This has led to painful consequences: family rejection, social isolation and an entrenched stigma that hinders both prevention and treatment efforts. Despite the critical situation, initiatives remain heavily dependent on donor funds, making the sustainability of the fight against HIV/ AIDS uncertain.

Many misconceptions about the disease persist. The common belief that HIV affects only those deemed perverted or sinful discourages many from seeking screening as they fear both a positive diagnosis and a breach of privacy. The lack of awareness is so severe that many people living with HIV are unaware of their status. This often leads to transmission within families resulting in further rejection, isolation and intensified stigma.

Muhammad Sabzal*, a father of five from Awaran, one of Balochistan’s poorest districts, contracted HIV some time ago. Due to a lack of awareness, his young son and his wife also contracted the virus. It was only when the family experienced severe illness that they sought blood tests at a hospital in Karachi, where all three were diagnosed with HIV. They are now receiving treatment at Jam Ghulam Qadir Hospital in Hub Chowki under the Balochistan AIDS Control Programme, which currently provides care for over 90 HIV and AIDS patients.

Zain Ullah, the case manager at the AIDS Control Programme in Jam Gulam Qadir Hospital, notes that HIV infection rates and AIDS cases continue to rise, particularly in areas like Hub, adjacent to Karachi, and Lasbela, largely due to sexual transmission and the widespread use of narcotics and shared drug paraphernalia. “Many drug addicts, unaware of the risks of HIV and AIDS, share needles that further facilitate the transmission of the virus,” he says. According to the Excise, Taxation and Narcotics Department, over 300,000 people, approximately 1.7 per cent of Balochistan’s population, are addicted to narcotics.

Zain Ullah says the AIDS Control Programme, in collaboration with the Health Department, is working on prevention, enforcement and rehabilitation efforts to combat HIV/ AIDS while raising awareness among the local population. However, he notes that a major challenge remains, “by the time most patients arrive at the Hub Chowki centre, their HIV infection has already progressed to AIDS, which makes it harder to provide effective treatment.”

Balochistan, which makes up 42 per cent of Pakistan’s land area, contributes about three per cent to the country’s HIV burden, with an estimated 47,831 people living with HIV, according to the Ministry of National Health Services, Regulations and Coordination. However, some health officials believe that the number of people living with HIV may be higher, as identifying and bringing new patients into treatment remains a challenge due to the reluctance of many to visit hospitals or undergo screening.

Mahjabeen, a staff nurse with the Balochistan AIDS Control Programme at Jam Ghulam Qadir Hospital in Hub, points out the need for greater awareness and the removal of stigma surrounding HIV and AIDS. “Once we succeed in raising awareness and identifying more infected people, we will be able to bring the epidemic under control,” she says. “The real challenge is convincing people to get screened. Even when people come here for a regular check-up, and we spot symptoms of HIV or AIDS, we ask them to get screened, many refuse. There are many reasons for this reluctance, but the primary one is cultural shame.”

Zaratoon Bibi*, a woman from Lasbela now receiving treatment through the AIDS Control Programme at Jam Ghulam Qadir Hospital, recalls her initial reaction to her diagnosis. “When I first found out I had contracted HIV through sexual transmission, I was shocked. I thought I was going to die.

“For me, the biggest challenge was overcoming the shame. In our society, having HIV is considered a disgrace. I thought if people in my community found out the reason, I would die of shame before HIV could kill me. These thoughts disturbed me a lot,” she says.

The crisis in Balochistan is heightened by several challenges. Primary among them is a limited understanding of HIV/ AIDS and sexual health. With insufficient access to mental health services, those diagnosed with HIV often face emotional and psychological struggles in isolation. Family members, unaware of the disease, frequently blame and shun the infected, which further fuels social exclusion and discrimination.

Amid this bleak situation, there is a growing recognition of the need for mental health integration in HIV/ AIDS projects. Health officials say that introducing psychologists and counsellors into these programmes is essential to address the complex emotional toll on those living with HIV and their families. They say psychological counselling is crucial for managing feelings of anger, hopelessness and death anxiety, while also combating the negative self-perception that often accompanies a diagnosis.

Another challenge in combating AIDS in Balochistan is the lack of a consistent policy, health officials say. The Balochistan AIDS Control Programme had its most recent budget of Rs 188.4 million approved for the period from July 2016 to June 2019, with a no-cost extension granted until June 2020. However, a 2019 review of the National HIV Programme revealed that the BACP had managed to spend only 47.5 per cent of its allocated budget, primarily on salaries, procurement of equipment and advocacy and awareness sessions. The review highlighted that the BACP had failed to meet the 2017-2021 strategy targets for prevention and treatment programmes, mainly because contracting with NGOs and community-based organisations was not undertaken. Only Global Fund-supported services for people who inject drugs existed in some localities, leaving many districts without adequate HIV prevention programmes.

The current Balochistan AIDS Strategy, which runs from 2020 to 2025, was shortened by a year due to significant underperformance against targets. Health officials point out that the AIDS control programme relies heavily on global funds, and there is no clear strategy from the provincial government or health department for sustaining efforts if the foreign funding stops. “We need a proper local strategy and mechanisms to fight and maintain sustainability in our efforts,” a health official says. “We need to allocate sufficient resources and develop a long-term strategy, at least a 10-year plan, to create a roadmap for prevention.”

In Hub, Muheem Hassan*, a man infected with HIV through unsafe sex, expresses deep concern about the potential end of his treatment. “At first, I was terrified to continue treatment because I didn’t want to face the reality that I had AIDS. After a long struggle with myself, I accepted it. Now, my biggest fear is that one day I will no longer receive free treatment and medication,” he says.

Balochistan has a limited number of centres to combat HIV/ AIDS, leaving thousands of young men without adequate treatment. Facilities for treating patients from all 37 districts are available only in Quetta, Naseerabad, Hub Chowki, Loralai and Turbat.

“The most alarming aspect of HIV and AIDS in Balochistan is that we have limited facility centres. The disease is affecting the general population,” says Zainullah, the case manager. “Even where we have centres, adequate mental health counselling is missing. A majority of AIDS patients suffer from severe mental health issues due to a lack of awareness about HIV/ AIDS. It’s crucial to have psychologists, raise awareness and ensure sustainability and predictability in our efforts. How long can we continue relying on foreign funding to fight what is clearly a local issue?” says Zain.

The writer is a psychologist