[This story is supported by CFLI]
December 1, 2025
By Rehan Piracha
LAHORE
As Pakistan marks World AIDS Day on December 1, concern must extend beyond the rising number of HIV cases in the general population. The situation inside the country’s prisons is equally alarming, where a growing and often overlooked group of HIV-positive inmates faces inadequate screening, poor treatment access, and systemic neglect. The spread of HIV behind bars is emerging as yet another urgent public health challenge.
Health campaigners say social stigma remains one of the most significant challenge in the prevention and treatment of HIV/AIDS in the country. In prisons however there are other reasons – inadequacies and other systemic inefficiencies.
Dr Munir Malik, former head of the Punjab AIDS Control Programme, says that health authorities aim to keep the HIV/AIDS epidemic at its current low level—below 0.1% among the general adult population in Pakistan. According to the National AIDS Control Programme (NACP), an estimated 330,000 people are living with HIV in Pakistan. Of this population, NACP has registered 81,847 HIV cases, with 58,622 receiving antiretroviral therapy at 96 centers across the country as of September 2025.
HIV behind bars
The available data on HIV screening and treatment across prisons in Punjab – released by the Punjab Prisons website – reveals significant inconsistencies in testing practices, reporting quality, and medical follow-up for HIV-positive inmates. While certain facilities demonstrate relatively structured screening and treatment protocols, the majority show major gaps that undermine both prisoner health and broader public health objectives.
The data reveals systemic deficiencies in Punjab’s prison HIV response. Major challenges include inconsistent screening practices, significant reporting gaps, confirmed cases left untreated, and unreliable or incomplete data from several facilities. The uneven standards across the prison system leave many HIV-positive inmates without essential medical care and undermine the accuracy of provincial HIV surveillance.
Addressing these issues will require coordinated action across prison authorities, health departments, and the Punjab AIDS Control Program, with a focus on standardized screening protocols, improved data management, guaranteed continuity of care, and accountability mechanisms to ensure timely treatment.
Screening rates vary dramatically between prisons. Some facilities, such as District Jail Multan (3,246 screened) and District Jail Lahore (2,434 screened), report high coverage. In contrast, several large jails—including Central Jail Faisalabad, Central Jail Mianwali, Women Jail Multan, and Sub Jail Chakwal—report zero screening. Others report screening only a handful of individuals despite large inmate populations.
The unevenness of screening suggests the absence of a standardized province-wide HIV testing policy, poor compliance where such policies exist, or systemic issues in resource allocation and staff capacity.
Numerous entries in the Punjab Prisons’ data include “Nil,” “Not available,” “Awaited,” or entirely missing data, indicating persistent weaknesses in health information management. Some prisons, such as District Jail Kasur and Central Jail Sahiwal, report either incomplete data or note that results were not received from the Punjab AIDS Control Program or local DHQ hospitals. This raises concerns about delays in diagnostic processing, poor inter-agency coordination, and the lack of accountability in reporting mechanisms.
Reliable data is essential for any meaningful response, and its absence prevents accurate assessment of HIV prevalence and risk inside prisons.
A critical trend in the released data is the presence of confirmed HIV-positive cases with no evidence of CD4 testing or treatment initiation. For example in District Jail Layyah there are 4 confirmed cases, but zero on treatment. Same is the case with District Jail Gujranwala: there are two confirmed cases, zero CD4 tests, and zero on treatment. In District Jail DG Khan, there is one known HIV prisoner, but zero screening or follow-up.
Failure to provide CD4 tests and antiretroviral therapy (ART) constitutes a serious lapse in medical care. It places prisoners at higher risk of opportunistic infections, accelerates disease progression, and increases the likelihood of HIV transmission inside the facilities.
Several jails report the presence of HIV-positive inmates but no recent screening activities (e.g., Central Jail Rawalpindi, Central Jail Mianwali). These cases may be transfers or previously identified patients, but the absence of updated testing or treatment data indicates poor continuity of care.
Continuity is particularly important in prisons, where transfers, overcrowding, and limited medical infrastructure already pose barriers to consistent HIV management. Some large facilities report thousands screened, but zero HIV-positive cases, which is statistically unlikely in such populations. Examples include, Central Jail Bahawalpur, where 1,039 screened but zero positive cases, and District Jail Jhelum where 802 were screened, but zero positive.
This may reflect poor test sensitivity, selective screening, or under-reporting rather than an actual absence of HIV.
However a few prisons demonstrate complete screening-to-treatment pathways. In District Jail Sargodha there were four confirmed cases, all four case underwent CD4 and all four were also given treatment. In District Jail Faisalabad there were 2 confirmed cases, with CD4 tests for both carried out – subsequently, according to the data sheet, both were provided treatment.
These facilities show that structured systems can function effectively when properly implemented.
HIV breakout in Adiala Prison
Meanwhile earlier on, in August, the highest number of infected inmates – 148 – reported from Adiala Jail caused serious concern. At the time, PACP reported that 645 HIV-positive inmates are housed in Punjab’s 43 prisons at the time.
Dr Malik clarified that the inmates did not contract the infection in jail and most were already registered with health authorities. He explained that overcrowding in jails does not pose a significant threat for the spread of HIV, as it is mostly transmitted through sex, blood transfusion, or sharing of injectable drugs—scenarios unlikely in prisons.
According to Dr Malik, the PACP provides antiretroviral drugs to HIV-positive prisoners across Punjab jails.
Drug users most affected
Dr Malik tells Voicepk that most of those infected were actually drug users.
“The major infected groups are injecting drug users (IDUs), female sex workers (FSWs), male and transgender sex workers (MSWs/TRSWs), and men who have sex with men (MSMs),” Dr Malik says. “Injecting drug users comprise 50 percent of the registered HIV patients in Pakistan.”
Dr Malik notes that social stigma prevents many HIV patients from coming forward for testing and subsequent treatment, which is provided free of cost under government initiatives.
“People associate AIDS/HIV with sexual relations, but the truth is that most HIV patients in the country contract the disease by sharing needles with other drug users,” he said.
However studies by the UNODC (UN Office of Drugs and Crime) have shown that prison overcrowding has further put a strain on existing antiquated structures, worsening sanitary facilities and leaving no room for privacy. These conditions, make prisons conducive for spreading communicable disease like tuberculosis, including HIV/AIDS, as sex becomes a currency for the most basic of needs e.g. soap, sugar, cigarettes etc . Prisoners also become prone to hepatitis B and C, and other sexually transmitted infections.
High risk sexual and other behaviour such as injecting drug use and blood mixing rituals (gang-related) in prison are a problem. The failure for most countries to provide prevention commodities e.g. condoms, safe tattooing and injecting equipment and the absence of intimate/private visits (conjugal visits) further increases the risk of contracting HIV in prison. The lack of knowledge and education among prisoners about the risks of contracting and transmitting HIV further derails progress in the HIV response in prison settings.
According to the data released by the Punjab Prisons, there are 2,234 male inmates who are drug users, and 23 female inmates, currently behind bars across Punjab. These include inmates from all categories including undertrial, convicted and condemned.
Dispelling myths
Dr Malik emphasized that the media should raise awareness among the general population to dispel the erroneous notion that AIDS/HIV is incurable and that infected patients are doomed to death.
“In fact, HIV patients can lead normal lives—even sexually active ones—if they take antiretroviral therapy and their viral load remains within a threshold,” he explained.
He said that health authorities have developed a network with hospitals, clinics, blood banks, and laboratories to ensure all blood donors are tested for HIV infection prior to transfusion.
“Any HIV infection detected in blood donors is reported to the AIDS control programmes in the provinces, who contact the infected person and register them for treatment,” he said.
Another positive development is that single-use disposable syringes have become the norm. Even poor people now insist that injections given to children, women, and other patients be administered with fresh needles at clinics and private hospitals, Dr Malik noted.
Comprehensive screening and treatment
According to the Punjab Home Department, every new prisoner in the province is screened for HIV and hepatitis at the time of admission. This process has helped uncover hidden cases and ensured early treatment.
“At present, 673 inmates diagnosed with HIV/AIDS are being treated in collaboration with the Punjab AIDS Control Program. These prisoners are housed in specially designated barracks to ensure proper monitoring and care,” the Punjab Home Department said in a statement.
Officials clarified that no inmate has contracted HIV while serving time in jail; rather, most tested positive during entry screenings. The majority of these cases involve individuals imprisoned on drug-related charges, with their addiction history linked to the infection.
To manage the disease effectively, each diagnosed prisoner receives a month’s supply of antiretroviral drugs along with regular follow-up checkups. Testing is carried out with rapid diagnostic kits, followed by confirmatory PCR tests. Once confirmed, patients are counseled, monitored, and provided with psychological support in addition to medical treatment.
Doctors also conduct baseline tests, including blood work, liver and kidney function tests, urine analysis, and tuberculosis screening before starting therapy.
The Home Department spokesperson highlighted that specialists visit prisons every 15 days to review patient progress, with PCR and CD4 tests conducted periodically to track health changes.
Currently, 145 patients are being treated at Central Jail Rawalpindi, 83 at District Jail Lahore, 39 at Central Jail Faisalabad, 35 at Central Jail Lahore, 27 at Central Jail Gujranwala, and 27 at District Jail Faisalabad, among others.
Prevention and Awareness
The authorities stressed that along with treatment, preventive steps are being taken to curb the spread of HIV, hepatitis, and other infectious diseases inside prisons.
“Our first priority is to protect lives, and through consistent screening, treatment, and counselling, we are ensuring that no inmate is left untreated or unaware of their condition,” the spokesperson said.
This year, the Common Management Unit for AIDS, TB & Malaria (CMU)—National AIDS Control Program (NACP), Ministry of National Health Services, Regulations & Coordination—in collaboration with UNAIDS launched a social media campaign to raise awareness about AIDS/HIV prevention in the country.
Health officials emphasized the crucial role of strategic communication in combating stigma, promoting testing and treatment, and engaging communities. They highlighted the government’s ongoing commitment to strengthening HIV prevention and control measures nationwide.
The social media campaign aims to amplify public awareness, focusing on empowering communities, promoting early testing, and encouraging adherence to treatment for people living with HIV.