Human immunodeficiency virus (HIV) was first reported in Pakistan in 1987. Initially believed to have a low HIV prevalence mainly confined to high-risk groups such as injection drug users (IDUs) and commercial sex workers. However, HIV prevalence has steadily increased, with Punjab and Sindh provinces reporting the highest rates. Heterosexual transmission is the most frequent transmission route. High-risk populations include IDUs, men having sex with men, commercial sex workers, as well as truck drivers and miners. Furthermore, HIV has spread from urban centers to rural areas. The World Health Organization has reported over 200,000 HIV cases in Pakistan, making it the second-largest HIV-positive nation in Asia after India. The proportion of undiagnosed individuals is high and antiretroviral coverage is suboptimal. Fear of societal discrimination often leads individuals with HIV to hide their status, further spreading the virus. Mother-to-child transmission is another significant concern. Challenges in patient adherence to antiretroviral therapy (ART) exist, with many patients missing follow-up appointments. ART access due to shortages is frequent stemming from the reliance on imports. To mitigate the growing burden of HIV in Pakistan, it is essential to prioritize prevention through awareness campaigns and robust screening and antiretroviral programs targeting high-risk populations.