Apart from other interventions, surveillance remains a major focus of the national response to HIV/AIDS. However, with a shift in the epidemic pattern, the existing surveillance strategies are barely insufficient and longterm structural changes are desirable. This article provides a conceptual framework for developing a scientific system for HIV surveillance in Pakistan. Second generation surveillance system including repeated crosssectional surveys in high risk population groups are suggested to collect behavioral and serological data at regular intervals on an annual basis to monitor the epidemic trend as well as the associated behaviors. In addition, multiple data resources have been highlighted, which could be coordinated to describe the epidemic pattern in the country. This information should form the basis for national prevention planning and ought to be used for making sensible choices through which prevention efforts are most likely to reduce new infections