December 26, 2008	Friday	Zilhaj 27, 1429

KARACHI, Dec 25: Following reports that prisons across the province are housing individuals who are HIV positive, health managers and HIV/Aids controllers in the province are now pondering whether to introduce mandatory screening for inmates and treatment facilities for those who are infected by the virus as well as follow up visits for after they are released.

Health workers believe the government should introduce an exclusive protocol to ensure the timely detection of HIV/Aids and to provide antiretroviral drugs and a special diet to infected inmates. They also want a provision for pre-release services and a reduction of the risk of being infected within prison.

Jail authorities recently reported that out of 7,094 prisoners screened in prisons across the 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 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, a relevant official at CHK said that the samples of HIV-suspected inmates had been passed on to the Sindh Aids control programme. Responding to a query, the official clarified that all those tested were convicted prisoners and had volunteered under no duress for the tests.

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 due to their behaviour include injecting drug users, male and female sex-workers, transvestite sex workers and Pakistanis returning from abroad.

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.

Referring to high-risk behaviours, 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 hiding of the infections.

He said that jails in the province needed to focus mainly on unsafe same-sex relations and the use of injectable drugs, which had also been a challenge for health managers and policy makers working outside the jails. “The real picture about the prevalence of HIV cases in our prisons is still awaited but I personally feel that it was 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,” the doctor noted. He added that apart from those convicted for long terms, there are also undertrial 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 for 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 owned by jailers in Pakistan, where the prison population has already reached record numbers.

The provincial programme manager of SACP, Dr M Nasir Jalbani, said that any mandatory screening of jail inmates against HIV and placement of those detected positive in any isolation could not be ensured for the time being as under the guidelines of the international health agency and policies of the federal health ministry, those practices are discouraged.

“Similarly, in view of the increasing number of HIV cases in any ward of a jail, we cannot create exclusive spaces for Aids patients, as that will cause stigma and bias against them,” he said.

However, he agreed 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 prolonged lives. After a well-thought-out exercise, the government may pilot a research project seeking for all jail entrants, including the undertrial and convicted prisoners, to undergo screening against HIV and other diseases, he added.

In reply to another question, Dr Jalbani said that he had already asked an NGO working on an Aids project meant for the inmates to acquire data pertaining to the prisoners who were released from the jails 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 behaviours, he said.