Authors: Shoaib Raza Butt and Rana Tassawar Ali, August 28 2014 - It is estimated that there are more than 100,000 people with HIV-positive status in Pakistan. Among them, injecting drug users (IDUs), general population and sex workers are included. It has been proved by many researches that IDUs are at the highest risk group of HIV transference. Many national and international organizations are providing services related to reducing the risks of HIV transference and also providing HIV treatment in different treatment centers all over Pakistan. These services include needle syringe exchange programs, protections for safer sex practices, HIV testing and counseling, detoxification and ART (anti-retroviral therapy).

Although all these efforts are focused on reduction the risks of HIV among IDUs and other people with related risks, still an essential population group, possibly missed by all these efforts, remains in need of advocacy for better reduction of HIV. “Prisons have been recognized worldwide as an important place for the transmission of blood-borne viruses (BBVs). There are two reasons why transmission risks in prison are higher than in the community. First, …many prison entrants have histories of injecting drug use thus already have high prevalence of BBVs. Second, scarcity of preventive measures (such as clean needle, syringes and condoms) in most prisons, combined with extreme social conditions, creates extra opportunities for BBV transmission.” - HIV in prison: what are the risks and what can be done? Hellard ME, Aitken CK.

PWID (people who inject drugs) are often arrested by the police because of drug pushing, theft or many other illicit behaviors, and they spend considerable time in prison. Although imprisoned, IDUs cannot use drugs with the same frequency that they use when they were not confined, they share the same syringes more often and sterilize them less because of scarce resources. Unfortunately, there is no health infrastructure for HIV transfer prevention in prison. IDUs often have to share the same syringes used by the HIV-positive people for injecting drugs that is the resulting in high risk circumstances of HIV virus prevalence. Sometime used syringes that have already been used on an HIV-positive person are stolen from the medical section of prison.

Many IDUs are also involved in other illicit activities like sex during the imprisonment. The frequency of homosexual rape in imprisonment is a dilemma in Pakistan. Drugs are also offered to other IDUs for sex. All sexual activities of males or females in prison are unprotected and are one of the main causes of spreading the HIV virus.

The concept of counseling, testing and treatment of prisoners regarding HIV is merely a dream as yet. There is no mechanism of initiation and adherence of ART for the prisoners. If somebody has just had his ART initiation during imprisonment, there is no medical support for tackling and managing the side effects of ART.

The governmental and non-governmental organizations should take steps to overcome these “nurseries” of HIV contagion. They should introduce some effective and applicable policies that should sustain, for the long term, the changing patterns of HIV treatment and stop drug use with the establishment of HIV counseling, testing and treatment centers in prisons.

Image credit: Visiting a Prisoner in Pakistan blog