A rather stark headline, “36 Inmates Test HIV+ in Lucknow,” in the news earlier this month, raised numerous questions regarding the alarming concentration of HIV cases among inmates. Did they contract the disease within the confines of the jail? What level of risk do they present to others? 

Health officials dismissed the nature of media reports, emphasising that there was no reason to panic. In fact, the administration is confident that their intensified efforts are yielding positive results in their battle against HIV.

This expansion of screening efforts has led to increased detections among a major vulnerable population—criminals and repeat offenders—who are particularly susceptible to HIV. Importantly, the intensified screening hasn’t just revealed more cases; it has also facilitated counselling and access to medication, thereby paving the way for these individuals to transition towards a better quality of life.

Health on Air spoke with organisations leading intensified screening initiatives within correctional facilities to explore the measures being taken to assist inmates in reclaiming their lives through medication and comprehensive counselling. 

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In tandem with jail screenings, the government has been executing a multifaceted strategy since 2017. This approach encompasses antiretroviral therapy (ART), counselling, and surveys, all aimed at effectively combating the spread of HIV.

The intensive screening was mandated by the National AIDS Control Organization (NACO) under the ISHTH campaign launched last year, covering all 74 district jails in the state.

“The jail intervention programme has been in place since 2017, owing to the higher prevalence among the jail inmates,” said an official at National AIDS Control Organisation (NACO).  

According to a NACO report, the prevalence of HIV/AIDS in India is 9-10 times higher in central prisons (1.93) compared to the general population (0.21), highlighting the imperative need for screening inmates.

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“NACO projected the number of people living with HIV (PLHIV) in Uttar Pradesh is 1.95 lakh. This is our target, and as of now over 1.3 lakh people are being provided antiretroviral therapy (ART) after the tests,” told Dr. Ramesh Srivastava, Joint Director of Uttar Pradesh State AIDS Control Society (UPSACS).

HIV (human immunodeficiency virus) weakens the body’s immune system, making it susceptible to infections. It spreads through bodily fluids, primarily during unprotected sex or sharing needles with an infected person. Left untreated, HIV can progress to AIDS, a severe immune system disorder.

“There is no cure for HIV, but antiretroviral therapy can slow the progress of the infection and reduce the chances of transmission to others, including expecting mothers,” emphasised Dr. Srivastava. “We mandatorily initiate ART in women in the early pregnancy stage to reduce the risk of perinatal transmission.”

Reportedly, the jail administration stated that the HIV+ cases found among inmates of Lucknow District Jail contracted HIV outside the prison, likely through the common practice of sharing needles among drug users.

“The spike observed in the number of positive cases was due to bulk testing of inmates as the arrival of testing kits was slightly delayed,” said the jail authority. 

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The total count of HIV-infected prisoners in Lucknow District Jail now stands at 63, all receiving free ART treatment.

Under the National AIDS Control Programme (NACP) phase-V, ISHTH (Integrated STI, HIV, TB, Hepatitis) campaign was launched to provide healthcare services to jail inmates and other closed setting populations like juvenile home, drug de addiction centres and swadhar greh. 

The HIV testing coverage among inmates in prisons in India had increased from 1.4 lakh in 2017 to 10.2 lakh in 2022 according to a government press release, leading to heightened awareness among inmates about their HIV status and enrollment of positive cases in ART.

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“An important aspect in our mission to curb HIV spread is raising awareness of individuals’ HIV status. Our efforts encompass not only HIV testing and ART but also sensitization through interpersonal communication and group discussions. A designated counsellor engages with inmates to monitor their behaviour. Even outside the jail, individuals are linked to agencies working on the ground for regular treatment and counselling,” explained Dr. Srivastava.

One such agency dedicatedly working in the AIDS control program is UPNP Plus, based in Lucknow, Uttar Pradesh. “Screening is necessary in jails as this group is identified as one of the vulnerable groups by NACO. These individuals often engage in activities like unsafe sex and intravenous drug injections, making them prone to HIV,” said Amruta Soni of UPNP Plus.

He added, “Most often convicts are lodged in Central prisons, while the under-trails are kept in the district jails. If a person is granted bail, our team keeps in touch with the individual to provide counselling and treatment.”

NACO remarks that the ‘incidence of both biomarkers: HIV sero-prevalence and Syphilis sero-positivity was higher among the undertrial inmates’, in its 2021 HSS technical report.

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The HIV and AIDS (Prevention & Control) Act, 2017 safeguards the rights of persons living with HIV and AIDS and combats stigma and discrimination. It mandates confidentiality in healthcare services to encourage PLHIV to seek medical care and counselling without fear of stigma. “We ensure confidentiality in all our activities, including counselling and treatment, withholding individuals’ identities from disclosure, even to their parents,” stated Dr. Srivastava.

It’s crucial to provide thorough counselling to individuals with HIV to educate them about the disease and its transmission. “Teaching them about safe sex, drug abuse risks, hygiene, and medical treatment is vital for reducing transmission. Fear may lead some to withdraw, but our agencies stay connected. We even test the partners, sometimes multiple partners, of inmates for HIV. This approach has raised awareness among inmates, helping to prevent HIV transmission,” stated Dr. Srivastava.

As of the end of 2022, Uttar Pradesh had a prison population exceeding 1.21 lakh individuals, consisting of 27,209 convicts and 94,131 under-trials (NCRB). 

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Dr. Srivastava adds, “This year, we identified approximately 370 HIV+ cases out of 94,000 inmates screened in jails across Uttar Pradesh. We’ve extended the scope of our efforts to reach a population confined within prison walls,.”

The bi-annual HIV Sentinel Surveillance (HSS) report by NACO surveys the inmates lodged in central prison sites across the country. Uttar Pradesh has a total of 64 district jails and 7 central jails. The HIV/AIDS prevalence in Uttar Pradesh’s central prisons is 0.13% (NACO, HSS 2021), significantly lower than in other states.

The highest HIV prevalence rates in Central prisons were noted in Mizoram (26.0%), Punjab (7.5%), Nagaland (4.6%), Chandigarh (3.5%), Andhra Pradesh (3.3%), Telangana (2.5%), Delhi (2.4%), Manipur (2.3%), and Assam (2.0%).