Prevalence of human immunodeficiency virus in the inmates of district Jail Quetta , Balochistan

The human immunodeficiency virus (HIV) infection commonly known as acquired immunodeficiency syndrome (AIDS) is caused by a lentivirus (HIV). The prevalence of HIV is well documented globally but such statistics are sparse from Pakistan and there has been no such data from Balochistan at all. The current study was designed and conducted to assess the seroprevalence of HIV amongst jail inmates in Quetta, Pakistan. A total of 200 out of 350 male prisoners were selected randomly for HIV testing. The prisoners included in the study, voluntarily completed a risk-factor questionnaire and blood samples were provided for unlinked anonymous testing for the presence of antibodies to HIV. All the subjects were above 18 years of age. Informed consent was obtained. We measured sero-prevalence and assessed the risk factors for HIV by using Abbot Determine® rapid screening kit (specificity 100%). Reactive specimens were further assessed for anti-HIV antibodies by enzyme linked immuno sorbent assay (ELISA). Of total 200 prisoners, 0.5%of the prisoners were found positive for HIV antibodies using ELISA which is equal to the HIV prevalence in world population. But being an Islamic country where extramarital sex and drugs are illegal and banned the resulted HIV prevalence in inmates of the District Jail Quetta, Pakistan is alarming and there is need to educate the prisoners to minimize the risk factors associated with HIV transmission.


Introduction
Despite the fact that the number of Immunodeficiency Virus (HIV) infections has decreased worldwide, this trend is not uniform and varies significantly from region to region [1].Due to this reason, HIV pandemic continues to remain a major health problem throughout the world.In an annual report on HIV/AIDS of the World Health Organization (WHO) approximately 2.7 million new cases were identified with HIV in 2010 and this number was about 15% less than HIV infection in 2001 (3.3 million infected), which was less than HIV infected people in 1997 (3.4

million affected) [2].
However, in the low-income countries where HIV/AIDS remains an epidemic, one in every five adults is infected with HIV.Some African's countries are at the worst end of HIV/AIDS epidemic and over 22.9 million people are infected with HIV/AIDS.In terms of prevalence, countries such as Afghanistan and Saudi Arabia are reported to have the lowest prevalence (0.01% of total population) rate amongst the reported nations [2-4].In Indonesia, Pakistan and Vietnam the number of HIV/AIDS infected people or the rate of incidence of HIV/AIDS infection has been increased [5, 6] but there is an immense variation between and within these countries.HIV is not currently an overriding epidemic in Pakistan, because Pakistan is an Islamic state and the majority of the population is Muslim, where by law and religion the extramarital sex is banned.However, the number of HIV/AIDS cases has increased in the recent years The prevalence of HIV infection has been reported in different jails of Pakistan.For example, in Sind province, out of 4987 prisoners in different jails, the distribution of HIV positive cases were 32 from Karachi Jails, 07 from Sukkur Jails, 03 from Hyderabad Jails, 04 from Larkana Jails and 02 from Shikarpur Jails [14].In Punjab province of Pakistan, 1000 male prisoners of different jails were screened for HIV and 44 prisoners (4.4%) were found positive for HIV [15].Balochistan is the largest province of the country and Quetta is its capital and serves as the only metropolitan city of the province.Here people belong to different castes with many refugees who migrated from war affected country of Afghanistan during the early 1980s and 1990s [16].
No Study has been conducted yet to report the HIV prevalence and risk factors in the Jail inmates of Balochistan province of Pakistan.Therefore, the aim of this study was to provide the preliminary information about HIV prevalence and its risk factors amongst Jail inmates of Quetta, Balochistan.This study will be useful to formulate the public health strategy for the prevention of risk factors associated with spreading of HIV in prisons of Balochistan.

Study location
This study analyzed HIV prevalence and associated high risk behaviors connected with the transmission of HIV amongst the adult males incarcerated in the largest prison of the city, the Central Jail, Hudda, situated in Quetta, the capital of Balochistan province of Pakistan.Quetta has a population of about 896,090 people, according to 2001 censuses.

Study design
This study was designed to determine the prevalence and associated risks of HIV among the inmates of the Central Jail Quetta.For this purpose, a structured questionnaire consisting of 12 variables was designed to collect the demographic data and related clinical information regarding age, weight, educational level, profession, marital status, occupation, duration of incarceration, extramarital sex before incarceration, Injected Drug Addict, homosexuality, sharing of syringes, sharing razors and Blood transfusion.The total incarcerated population at the time of this study was approximately (n=350) with different duration of incarceration.Informed consents were obtained before filling the questionnaire and those who did not consent to participate were excluded from the study.A total of 200 HIV suspected adult male prisoners out of 350, between 18-60 years, were tested for HIV in the District Central Jail of Quetta, Balochistan.

Data collection
A team of Medical Doctor, a laboratory technician and phlebotomist was organized to collect the blood samples.Blood samples (about 5ml) were collected aseptically according to standard protocols.All collected sample sera were tested in Biosafet y Level III (BS L III) laborator y at Provincial Reference Laboratory (PRL), Fatima Jinnah General & chest Hospital, a tertiary care hospital in the city of Quetta, Balochistan to detect the HIV antibodies.HIV antibodies' testing was done using rapid Immuno-chromatographic (ICT) Abbot Determine® rapid screening kit.Reactive specimens were assayed by immunosorbent assay (ELISA) strip reader, Read well DOT diagnostic according enzyme linked to the manufacturer instruction.Funding restrictions did not allow to conduct the molecular base study.

Results
A total of 200 inmates were included in the study.Table 1 outlines the basic Sociodemographic characteristics of the inmates.All the participating prisoners were male with the mean age of 39 (18-60 years).Sixty eight per cent of prisoners were having weight of > 60 kg and rests of the prisoners were less than 60 kg.60% were not married, 89.5% had no extramarital sex history and homosexuality was reported to be 2.5% (Table 1).More than half of the prisoners 69% (n=138) were illiterate and literacy rate was only 31% (n=62).Before the beginning of their current confinement, 34(17%) were unemployed, 39 (19.5%) were employed, and the number of prisoners working on daily wages were 127 (63.5%) (Table 1).The number of prisoners with more than 4 years of incarceration were 15 (7.5%), 43 (21.5%) were of the duration of 2-3 years, 68 (34%) were of 1-2 years and 74 (37%) were of the period < 1 year.Altogether, 27 (13.5%)prisoners were sharing needles and 20 (10%) prisoners were engaged in sharing of razors during incarceration as well as before incarceration; while other 180 (90%) prisoners did not have such habit (Table 1).
When tested for HIV Positivity, among 200 prisoners, one person (0.5%) was having anti HIV antibodies (Table 2).In this study, we also found prevalence of HIV positive cases in the jail community of Quetta.The prevalence of HIV positive in this community was 0.5% which is equal to prevalence of HIV in world population.However this infection was significantly lower than that reported from other prisons of the Pakistan and world such as United State 6.6%, Italy 7.5%, Ghana 19.2% and South Africa 41.4% [18].

Conclusions and recommendations
Despite of low prevalence of HIV compared to other prisons of Pakistan, it is important to plan future strategies to prevent its possible spread to other prisoners and jails of the province and subsequently in the country.We strongly recommend the following: 1.Further research is needed to determine the extent of HIV infection and the occurrence of co-infections in other jails of the Balochistan province.2. Introduction of comprehensive preventive measures and data management of HIV.