No statute currently mandates HIV-specific healthcare within custodial settings, nor does the existing legal architecture—including instruments like the Juvenile Justice System Act of 2018—adequately safeguard the health rights of inmates living with the virus. These frameworks, though nominally aligned with international human rights standards, operate with a dangerous blind spot: the systemic exclusion of communicable disease management, particularly in carceral environments where vulnerability is most acute. The state’s failure to legislate on this front reflects a deeper institutional reluctance to reckon with the health consequences of incarceration.
Instead, sporadic public health campaigns, often underwritten by foreign donors or operated by provincial health authorities, constitute the primary line of response. In Punjab, the government has recently undertaken large-scale screening initiatives, beginning with Adiala Jail, which now holds the province’s highest number of HIV-positive inmates. As of mid-2025, 148 prisoners in this single facility were confirmed HIV-positive—out of 645 across Punjab’s 43 jails—underscoring the extent of the outbreak. Screenings, though semi-annual in theory, remain irregular in practice and are undermined by logistical inertia and institutional overcrowding. The linkage of diagnosed individuals to external antiretroviral therapy centres offers some measure of recourse, yet the absence of integrated, on-site medical infrastructure renders treatment timelines dangerously protracted. Oversight by the Punjab AIDS Control Programme is nominal, while actual service delivery depends on the fragmented capacities of district-level bureaucracies.
A marginally more coherent model exists in Sindh, where assistance from the United Nations Office on Drugs and Crime facilitated the incorporation of an HIV, TB, and hepatitis tracking module into the Prison Management Information System. This digital intervention allows for some continuity of care by enabling coordination between prison officials, public health departments, and national identity services. However, its application is geographically myopic, confined to select facilities like Karachi’s Malir Jail, and has yet to be institutionalised at a national level. The result is a patchwork of policies and protocols, varying wildly in their efficacy and reach.
International agencies have attempted to intervene in the vacuum left by the state. UNODC’s programming in juvenile detention centres, which includes peer-led HIV education and staff sensitisation training, reveals a latent awareness of the prison system’s role in disease transmission. Yet these efforts are disproportionately focused on juvenile facilities, with adult prisons remaining largely unaddressed—despite bearing the highest burden of infections. The disparity illustrates the broader incoherence of Pakistan’s response: isolated interventions, dependent on donor interest and limited in both scope and duration, stand in for systemic reform.
In public discourse, the critique has grown sharper. Editorial and academic voices now frame the prison HIV crisis not merely as a health failure but as a symptom of a larger legal and institutional dereliction. The convergence of overcrowding, infrastructural neglect, and the state’s legislative indifference has produced a viral reservoir within the prison system, with potential epidemiological consequences extending far beyond its walls. Inmates, upon release, return to their communities with untreated infections, transforming what should be a contained public health challenge into a broader societal risk.
Ultimately, Pakistan’s current strategy—fragmented, donor-dependent, and lacking legislative grounding—is insufficient to confront a crisis of this scale. The continued spread of HIV in facilities such as Adiala Jail is not merely the result of biological transmission but the byproduct of political inertia and policy failure. The recognition of prisoner health as a non-negotiable human right remains absent from both legal texts and institutional priorities. Without codified protections and a system-wide commitment to integrated care, the country’s prison health apparatus will remain an open conduit for preventable suffering—and a silent catalyst for the epidemic’s acceleration.
