According to Dialogue Earth, the aftermath of the severe floods in 2025 has heightened the risks for individuals living with HIV in Pakistan.
As floodwaters filled their home in Buner, located in north-western Pakistan, Khalid (a pseudonym) and his wife focused on rescuing their three children by moving them to higher ground. Yet, amid the chaos, they realized they must also save their essential HIV medications.
Determined, they waded through the flooding, prioritizing their antiretroviral therapy pills over all else. “The waist-deep mud caused by the floods isolated our village for over eight days,” Khalid recalls. Fortunately, he and his wife managed to keep their HIV medications safe. Khalid, who has lived with the virus since contracting it abroad five years ago, reflects on the challenges posed during last year’s devastating monsoon season.
In August 2025, torrential rains resulted in catastrophic flooding across Pakistan. Areas like Buner in Khyber Pakhtunkhwa and parts of Punjab were particularly affected. The floods led to over a thousand fatalities, with many more displaced, damaging nearly 230,000 homes.
For those living with HIV and AIDS, the floods exacerbated their health vulnerabilities. Many individuals faced health complications due to being cut off from access to antiretroviral therapy centers and medications, as noted by Asma Nasim, head of the Infectious Diseases Department at the Sindh Institute for Urology and Transplantation.
In Pakistan, antiretroviral treatments are offered free at specific locations, enabling those with HIV to lead healthier lives by controlling the virus and maintaining immune function, explains Asghar Ilyas Satti from the Association of People Living with HIV-Pakistan. With this year’s monsoon season looming, Pakistan is on high alert, having already issued warnings for heavy rainfall and urban flooding.
In early July, the National Disaster Management Authority (NDMA) reported potential glacier lake outburst floods in two valleys of Gilgit-Baltistan, affecting various roads and bridges. Shortly after, heavy rainfall across the country resulted in at least 14 fatalities, underscoring the urgent need for preparedness in light of rising water levels.
This timely warning follows a troubling rise in HIV cases throughout Pakistan. Waheed (another pseudonym), a teacher living with HIV in Swat, expresses his concerns about the current monsoon season based on his previous experiences. While leading his family to safety during last year’s floods, he found it challenging to return home alone to retrieve his medication.
“The stigma of my illness means I’ve kept it hidden from everyone, including my spouse,” he confides. He barely had enough medicine left and feared missing out on crucial treatment due to restricted access to the healthcare center.
In the end, he was able to brave the rising water and secure his antiretroviral drugs from their hiding place. “Missing doses can lead to serious health ramifications, including viral rebound and progress toward AIDS,” Satti emphasizes.
Increase in HIV During Floods
By December 2025, the WHO reported that new HIV infections in Pakistan surged by 200 percent over fifteen years, from 16,000 in 2010 to 48,000 in 2024. Recently, hospitals in Karachi have noted a significant uptick in pediatric HIV cases. “In the last three months alone, I’ve seen more HIV-positive children than in the last decade,” Nasim observes.
The rise in incidents is largely attributed to unsafe medical practices, according to Samreen Sarfaraz, an expert in infectious disease control. A BBC report highlighted cases where children in Taunsa, Punjab, contracted HIV due to reused syringes in a local hospital.
Waheed suspects he contracted the virus during a dental procedure using non-sterilized equipment. Following a previous outbreak in 2019, auto-disable syringes were introduced to prevent reuse, but in recent instances, such syringes have been found to be subpar. “This virus has reached epidemic levels here,” notes Nasim.
With the monsoon upon Pakistan again, concerns are rising regarding the increased flooding potential. At a recent press event, NDMA Chairperson Inam Haider Malik warned that the 2026 monsoon could bring significantly more rainfall than the previous year.
During the same session, Prime Minister Shehbaz Sharif announced a five-year initiative aimed at improving flood preparedness. This is crucial for a nation that has historically struggled to secure formal disaster relief funds, as noted by climate expert Ali Tauqeer Sheikh.
Moreover, the government is emphasizing enhanced monsoon preparedness and comprehensive screenings in public health facilities for HIV and hepatitis. The memories of the catastrophic 2022 floods still resonate; they caused extensive damages, affecting over 33 million individuals and disconnecting many from treatment services.
“The floods in 2022 severely limited our ability to connect with numerous HIV patients,” states Robina, who leads the Association of People Living with HIV-Pakistan in Sindh. As communication lines are often disrupted during such disasters, delays in treatment become all too common, as experienced by volunteers like Pulwasha, who provides at-home medication deliveries to patients looking to avoid stigma.
Robina has spent the last six months working to re-engage patients lost to follow-up, many of whom had drifted from care due to trauma and economic hardships exacerbated by the floods. Unfortunately, some individuals are reported missing or presumed dead due to drowning or interrupted treatment access.
By May 2026, roughly 20,000 patients were deemed missing from the treatment network, raising pressing concerns about outreach and support for individuals needing continuous care.
Who Can Help?
Aware of the health risks faced by HIV patients amid last year’s floods, APLHIV activated an Emergency Response Cell to ensure ongoing treatment for affected populations in Khyber Pakhtunkhwa. By consulting their national registry of 25,000 HIV-positive individuals, they identified about 1,000 people living in flood-impacted regions.
Working closely with healthcare centers and case managers allowed for the swift replenishment of medications to those most in need. Sobo Malik, an activist associated with the Khawaja Sira Society, emphasizes that while the government provides medication, follow-up services like confidential counseling often fall to community organizations.
“Unfortunately, erratic weather, intense heat, and last year’s flooding have adversely affected medication access in rural areas,” Malik states.
In the event of further floods this year, APLHIV plans to extend its Emergency Response Cell to Punjab and Sindh provinces, according to Satti. The Punjab government has committed to various flood preparedness efforts, but attempts to reach the Punjab AIDS Control Program have gone unanswered.
Meanwhile, APLHIV staff remain vigilant, ready to provide necessary support to individuals living with HIV during any disaster. International organizations are also pledging support for disaster preparedness in Pakistan, although skepticism remains regarding whether these promises will lead to tangible assistance on the ground.
Nasim warns that those with advanced HIV face far greater risks during extreme weather events. “After floods, areas are often overrun with mosquitoes, increasing the chances of diseases like malaria and dengue. Plus, contaminated water can exacerbate health issues; how can AIDS patients endure that?”
