Ajmal Khan and Kulsoom Bibi (names changed at their request to protect their privacy) have been living as outcasts in the northwestern Pakistani province of Khyber Pakhtunkhwa since testing positive for HIV almost 10 years ago.

They live in a conservative community. Most of their neighbors believe that HIV can only be transmitted by illicit sex. The poor couple from Peshawar city deny involvement in extramarital practices and say they contracted the virus via an infected syringe, but most relatives and acquaintances reject this and refuse contact with them or subject them to discrimination.

Out of their four underage children, a girl and a boy have also tested HIV-positive. They are among the province's 394 HIV-positive children, who, if not treated, could develop acquired immunodeficiency syndrome (AIDS).

The couple is now increasingly worried about the future of their healthy kids.

"We're constantly living in fear of dying soon, so if this fear comes true, what will become of my little children not affected by this disease, especially the daughter, in this ruthless society? This thought gives us sleepless nights," Khan, 45, told DW.

Confirmed HIV infections on the rise

Alarmingly, more and more children are testing positive for the virus in the Pakistani province.

According to official figures shared with DW by Dr. Asghar Khan, the project director of the Khyber Pakhtunkhwa government's Integrated HIV, Hepatitis and Thalassemia Control Program, 168 children were diagnosed with HIV between 2020 and 2022. Of them, 112 were boys and 56 girls.

The program registered 22 such boys in 2020, 25 in 2021 and 65 in 2022. Also, 10 girls were recorded in 2020, 13 in 2021 and 33 in 2022. Together with previously known cases, the official number of HIV-positive children is now close to 400.

The rising incidence is not limited to children, as more and more men, women and transgender people are diagnosed with the virus. The province has recorded 6,064 HIV cases since 2005 — mostly from the Peshawar district (1,055), tribal areas bordering Afghanistan (903), and the Bannu district (722). A total of 864 people have lost their lives to the virus.

Officials attribute the recent rise in confirmed cases to mandatory HIV testing before surgeries as well as better public awareness.

"In 2018, our [Khyber Pakhtunkhwa] health department notified HIV testing as compulsory for people needing any surgical procedure. The initiative led to the reporting of high incidence," said Dr. Asghar of the HIV Control Program.

"Public awareness of HIV, easy access to testing and treatment as well as strong coordination among and collaboration of health facilities and bodies also contributed to it."

HIV patients forced to leave their homes

Ajmal Khan said that he, his wife, and his children used to live in a joint household with their extended family, but were evicted after an HIV diagnosis.

"We suffered social rejection, discrimination, and stigma and felt like pariahs among our own people but had to put up with all that for ourselves and our children. Though unwell, I work with a carpenter as a daily wager, while my wife stays indoors managing the household," he said.

A 34-year-old HIV-positive woman has moved, together with her infected 7-year-old child, to a village in Charsadda district, miles away from her family. She is under treatment, but hasn't told any other villagers about her disease to prevent eviction.

"Actually, my husband carried the virus and transmitted it to us but asked me to keep it a secret for the sake of his and his family's honor in society, which largely believes it spreads by unlawful [extramarital] sex only," she told DW on condition of anonymity. 

"I broke the news after his death six years ago but to my utter shock and despair, my in-laws forced me out of the village, while my real brothers didn't help me either, so I came here and make tea for a living."

To ensure her privacy, the woman travels alone to an HIV treatment center in the district to receive medication.

She is worried about her son and doesn't believe he would survive in the cruel society without her.

More people seek out treatment

The government has set up HIV centers across the province with outpatient departments. They counsel and treat patients, and give them anti-retroviral drugs free of charge. The complimentary medication is provided to people from distant areas for six months, and to locals for three months.

Dr. Saadia Khan, who heads the HIV center at the public sector Hayatabad Medical Complex in Peshawar, said that more and more HIV-positive people were approaching health centers in the province for treatment.

"Some patients are in such a bad condition that they're immediately admitted to the outpatient department, while others are sent home after examination and counseling with medicines. All that is free of charge for being funded by the government or donors," she said.

The doctor raised the alarm by disclosing that growing HIV cases are seen in children with thalassemia — a blood disorder characterized by a lack of hemoglobin — possibly due to poor blood screening.

She also warned that, in addition to HIV spreading from parents to unborn children, as well as via sexual contact, drug addicts are also at risk if they use discarded syringes. Even skin cuts by infected razors or blades can lead to an infection.

Edited by: Darko Janjevic