Public health activists in Pakistan are urging an exclusive protocol to ensure timely detection of HIV/AIDS among prisoners.
Detection should be followed by regular monitoring, provision of antiretroviral drugs and also special diets, they further say.
Jail authorities recently reported that out of 7,094 prisoners screened in prisons across the Sindh province, 885 were found to be suffering from hepatitis. In Malir jail alone, according to reports, 422 were tested, out of whom 19 were HIV positive, eight had hepatitis B and 138 had hepatitis C.
During recent screenings provided by the Civil Hospital Karachi (CHK) to the inmates of the Karachi Central Prison, 455 inmates were tested for hepatitis, of whom 16 had hepatitis B and 26 hepatitis C. At least 273 inmates were tested for HIV, and 10 of them may have the virus (conclusive tests had not occurred till Dec 25).
While confirming the figures, an official at the Karachi hospital said that the samples of HIV-suspected inmates had been passed on to the Sindh AIDS Control Programme (SICP) authorities. The official also noted that all those tested were convicted prisoners and they had all volunteered for the tests.
Implicit is the point that many have not come forward for the check-up and that some among them could indeed be infected. It is such a state of affairs that is demanding mandatory screening, some contend.
Another source said provincial AIDS officials had worked further on the samples collected from Karachi jail, and confirmed the 'positive' result with regard to two samples. More follow-ups, including the determination of viral load in the affected inmates, are also being carried out, the source added.
It is said that there are between 35,000 and 40,000 cases of HIV in the province, and 80 per cent of those infected are believed to be living in Karachi. The groups which are considered highly vulnerable to HIV include injecting drug users, male and female sex-workers, transvestite sex workers and Pakistanis returning from abroad, Dawn newspaper reported.
According to SACP data, as many as 2,354 cases have been reported, including 2,186 of HIV and 167 of AIDS, and about 136 patients are on antiretroviral drugs.
Dr Agha Umer Daraz Khan, in-charge of Central Clinico Pathological Laboratory at the CHK, said that the considered reasons behind the spread of viral diseases like hepatitis B and C and HIV included needle pricks and unsafe injections, unsafe blood transfusions, needles and syringe sharing by addicts and drug users, unsafe sex. And there could be many who could hide their infection out of a sense of shame.
"The real picture about the prevalence of HIV cases in our prisons is still awaited, but I personally feel that it is high time the authorities moved for the establishment of some special wards for education, training and treatment of the infected inmates on a priority basis," Dr.Khan said.
He also warned that apart from those convicted for long terms, there were also under-trial prisoners of all ages who could become infected with the virus and then return to the general population.
A public health expert recommended a package of HIV counselling, testing practices, medical care, and prerelease services in prisons.
Internationally followed guidelines and approaches adopted in several Western European countries and in Australia, Canada, Kyrgyzstan, Indonesia and Iran should be followed by jailers in Pakistan, where the prison population has already reached record numbers, it is stressed..
However, the provincial programme manager of SACP, Dr M Nasir Jalbani, ruled out mandatory screening of jail inmates at the moment as, under the guidelines of the international health agency and policies of the federal health ministry, such practices are discouraged.
"We cannot create exclusive spaces for AIDS patients either, as doing so could invite stigma and bias against them," he said.
But he also conceded that efforts should be made for swift detection of HIV viral loads in the suspected inmates, as they have the right to safe treatment and longer life. After a well-thought-out exercise, the government may launch a pilot research project and call up inmates to volunteer for screening for HIV and other diseases, he added.
Already an NGO has been authorized to collect data pertaining to the prisoners released and then carry out post-release follow-ups. There is a need to monitor the released infected prisoners for the purpose of treatment and to advise them against adopting high risk behaviour, Dr.Jalbani added.