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Prevalence and Associated Risk Factors of HIV in Prisons In F1000Research 2018, 7:1821 Last updated: 08 APR 2021 RESEARCH ARTICLE Prevalence and associated risk factors of HIV in prisons in Balochistan, Pakistan: a cross-sectional study [version 1; peer review: 1 approved, 2 approved with reservations] Muhammad Dawood Khan 1, Ahmad Wali2, Razia Fatima 3, Aashifa Yaqoob3, Shoaib Aziz 2 1Department of Health, Provincial AIDS Control Program, Quetta, Balochistan, 87300, Pakistan 2Department of Health, Provincial TB Control Program, Quetta, Balochistan, 87300, Pakistan 3Ministry of National Health Services, Regulation and Coordination, National TB Control Program, Islamabad, Pakistan v1 First published: 20 Nov 2018, 7:1821 Open Peer Review https://doi.org/10.12688/f1000research.16994.1 Latest published: 15 Mar 2019, 7:1821 https://doi.org/10.12688/f1000research.16994.2 Reviewer Status Invited Reviewers Abstract Background: The prevalence of HIV is 0.1% in Pakistan, with 1 2 3 epidemicity in high-risk groups. The infection is on verge of transmission from key populations to the general population through version 2 people who inject drugs and sexual transmission. Prisoners are (revision) report vulnerable to infectious diseases like HIV. This study was conducted in 15 Mar 2019 four prisons in Balochistan. Pakistan to determine the prevalence of HIV and associated risk factors. version 1 Methods: This cross sectional study was conducted from March to 20 Nov 2018 report report report June 2018, in the prisons of Balochistan. WHO-approved rapid diagnostic kits were used for determining the prevalence of HIV and structured interviews were conducted for the assessment of risk 1. Quaid Saeed , National AIDS Control factors. Programme, Islamabad, Pakistan Results: Out of 2084 screened prisoners, 33 (1.6%) were found to be positive. A subset of 104 interviews were analysed for risk factors of 2. Pamela Valera, Rutgers University School of HIV. Among HIV-infected prisoners 68.8% (OR 4.48; 95% CI 1.41-14.2) Public Health, New Brunswick, USA had extramarital sex, 43.8% (OR 2.09 95% CI 0.69-6.28) had homosexual experience, and 50% had history of needle sharing (OR 3. Laurent Getaz , Geneva University 43; 95% CI 7.77-237). About 94% (OR 16.42; 95% CI 2.09-129.81) of Hospitals & University of Geneva, Geneva, prisoners had history of drug addiction of any type while 50% (OR 13; 95% CI 2.82-60.01) of those infected with HIV had a history of using Switzerland injectable drugs. Around 75% of HIV-infected prisoners had spent 1-5 Geneva University Hospitals & University of years in prison, and 25% had spent more than 10 years. Geneva, Geneva, Switzerland Conclusion: The high prevalence of HIV in prisons of Balochistan demands that preventive and treatment strategies should be Any reports and responses or comments on the designed and implemented carefully, allowing early diagnosis and article can be found at the end of the article. treatment initiation to minimize the spread of infection among the prisons and ultimately their onward transmission into the community. Page 1 of 14 F1000Research 2018, 7:1821 Last updated: 08 APR 2021 Keywords Prison, HIV, AIDS, prevalence, risk-factors. This article is included in the TDR gateway. Corresponding author: Muhammad Dawood Khan ([email protected]) Author roles: Khan MD: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing; Wali A: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing; Fatima R: Formal Analysis, Funding Acquisition, Methodology, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing; Yaqoob A: Formal Analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing; Aziz S: Investigation, Methodology, Writing – Original Draft Preparation Competing interests: No competing interests were disclosed. Grant information: This research was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR). The training model is based on a course developed jointly by the International Union Against Tuberculosis and Lung Disease (The Union, Paris, France) and Médecins Sans Frontières (MSF, Geneva, Switzerland). The specific SORT IT programme that resulted in this publication was implemented by the National Tuberculosis Control Programme of Pakistan, through the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund, Geneva, Switzerland). The publication fee was covered by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2018 Khan MD et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite this article: Khan MD, Wali A, Fatima R et al. Prevalence and associated risk factors of HIV in prisons in Balochistan, Pakistan: a cross-sectional study [version 1; peer review: 1 approved, 2 approved with reservations] F1000Research 2018, 7:1821 https://doi.org/10.12688/f1000research.16994.1 First published: 20 Nov 2018, 7:1821 https://doi.org/10.12688/f1000research.16994.1 Page 2 of 14 F1000Research 2018, 7:1821 Last updated: 08 APR 2021 Introduction Methods Globally; about 36.7 million people were living with HIV. HIV Study design and setting infection causes AIDS and is epidemic throughout the world. In A descriptive cross-sectional study was carried out from March 2016; about 1.8 million were reported as newly infected and to June 2018 in four major prisons of Balochistan: Quetta, 1 million died from AIDS related illnesses in the same period Gaddani, Mach and Loralai. Balochistan is the most widely (http://www.unaids.org). In Pakistan, an estimated 0.13 mil- spread and less populated province of Pakistan with the popula- lion peoples are infected with HIV, out of which only 17% are tion of 12.3 million (http://www.pbs.gov.pk). Area wise it is the registered with the AIDS Control programme and 54% of total largest province and covers 347,190 km2 and comprises of 33 registered people currently living with HIV/AIDS are getting districts (http://www.balochistan.gov.pk). The province is bor- treatment from antiretroviral therapy (ART) centres (http://www. dered by Afghanistan in the north and north-west, Iran in the nacp.gov.pk). The prevalence rate of HIV is 0.1% in Pakistan south-west, Khyber Pakhtunkhwa province in the north-east and (http://www.unaids.org). AIDS in Pakistan was limited and epi- Punjab and Sindh provinces in the east. demic among key populations over the decades, but the latest evi- dence suggests that there is a shift from key populations through BACP is a vertical program of the health department, provid- transmission via needle-sharing by injecting drug users (IDUs) ing preventive and curative services to high risk population in to sexual transmission via multiple sexual partners, and further the province. The program has two treatment centres (ART Cen- transmission to their intimate partners is increasing1. According tres) located in one of the largest tertiary care hospitals (Bolan to Integrated Biological and Behavioural Survey (IBBS), HIV Medical Complex Hospital) at the provincial capital Quetta, and prevalence was 38.4% among people who inject drugs (PWIDs), District Headquarter (DHQ) hospital of Kech, in the city of Tur- about 7.1% among transgender (TG), 3.5% among men who bat. The program is also running 30 screening centres in DHQ have sex with men and 2.2% among female sex workers1–3. Hospitals. Patients with HIV are referred to ART centres for registration and treatment provision from all the screening Prisons are the easily approachable venues for health interven- centres and other health care facilities of the province. tions. Unfortunately, prisoners are among the most marginal- ized and restricted populations, whose access to health services, Specific settings. There are 11 prisons in Balochistan, of which interventions and surveys is very limited4. Prisoners are one of three are central prisons and remaining eight are district jails14. Jails the most vulnerable populations for acquiring infectious dis- are meant to keep the prisoners who are under trial or imprisoned eases, especially HIV, because people from diverse backgrounds, for short durations, whereas prisons are meant to keep the pris- communities and with diverse risk factors are kept together for oners who are imprisoned for long duration. In Balochistan, jails varying time5. The prevalence of HIV is alarmingly increas- may serve as prisons and prisons may serve as jails due to limited ing in PWIDs and an evidence through IBBS indicated that capacity for prisoners and long distances from the trial court. The 38.5% of PWIDs were arrested in past 12 months, which makes four prisons were selected on the basis of number of prisoners and the other prisoners also vulnerable as PWIDs have access to type of jail, as these prisons caters majority of the prisoners from drugs in the prisons2. A study of HIV-positive prisoners in five Balochistan. jails in Sindh, Pakistan indicated that 12.3% of prisoners in the jails had ever used drugs by injection in the jails6. The provincial program started 6-month-long service deliv- ery packages (SDPs) in four selected prisons of Balochistan The revised Pakistan AIDS Strategy III, developed in 2017 by from March to August 2018. In these SDPs, screening as well the National AIDS Control Program (NACP) to guide Pakistan’s as treatment and preventive services were provided to jail overall national response for HIV and AIDS till 2020, through prisoners.
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