Your daily Selection of IRIN Africa PlusNews reports, 6/11/2003

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U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network

CONTENT:

1 - SOUTH AFRICA: Feeling the impact of HIV/AIDS in prisons

2 - SOUTHERN AFRICA: The challenge of HIV in prisons

3 - SWAZILAND: Condoms refused in prison, despite high-risk behaviour

1 - SOUTH AFRICA: Feeling the impact of HIV/AIDS in prisons

PRETORIA, 11 June (PLUSNEWS) - Sentenced and locked away, prisoners are

often a forgotten population, with little being done to prevent the spread

of HIV/AIDS in an environment where they are at a greater risk of

infection.

South African laws protect the rights of prisoners living with HIV/AIDS on

paper, and the government has a stated policy on the management of those

who are infected. But the reality is that the implementation of these

policies is proving an uphill battle.

The Pretoria Prison Reserve, a sprawling mass of buildings known locally

as " Pretoria Central " , contains four main facilities: Maximum Security;

Central, which houses sentenced prisoners; Female; and Local Prison, one

of the largest holding areas for awaiting-trial prisoners in the country.

As the heavy steel gate closes behind the Local Prison checkpoint, the

noise immediately hits you. Deep male voices singing in the background and

voices calling to each other across their cells.

Local Prison was " like a zoo " , Nico Baloyi the head of the prison, told

PlusNews. This is where juveniles, children, awaiting-trial prisoners, and

those awaiting further charges are held. The regional hospital is also

situated there.

So far this year, the four gaols have recorded only 354 known cases of

prisoners living with HIV/AIDS. But a report by the Institute for Security

Studies has found that 45.2 percent of the 17,5000 people in the country's

prisons are estimated to be HIV-positive.

Altogether, the prison facilities have a capacity for 4,500 inmates. " At

this stage we are overpopulated and have an occupancy level of 169

percent. We have over 8,000 [prisoners], " Area Manager Benny Ndebele

noted.

HOSPITAL FEELS IMPACT

Statistics aside, the impact of the disease is becoming evident in the

regional hospital. According to Ndebele, the 120-bed hospital is

constantly full and " running short " of nurses, as most of the patients are

HIV-positive.

HIV testing, along with pre- and post-test counselling, is also conducted

at the hospital and in the various prison clinics. Patients receive daily

treatment at their local clinics for most opportunistic infections and are

referred to the hospital when their condition deteriorates.

A maze of stairs eventually leads you to the hospital, behind another

entrance with heavy steel bars.

Ward Two looks like any other state hospital - high metal cots and the

regulation government-stamped sheets. The barred windows and nurses in

brown prison warder uniforms are the only telltale signs. It is a ward

specifically for HIV-positive patients.

A separate ward was " a necessity " , as most of the patients were also

chronically ill with tuberculosis (TB) and other " contagious infections " ,

Sister Lucia Maako, explained.

All the patients are asleep, emaciated and tired looking; they barely

register the stream of visitors. They have just been diagnosed with TB and

are undergoing the initial phase of treatment.

TB is the most common opportunistic infection among HIV-positive

prisoners. Poor living conditions, including inadequate sanitation and

overcrowding, are a major problem, but strict patient observation makes it

easier to monitor treatment adherence.

" MDR [multi-drug resistant TB] is not such an issue here because we watch

them when they are taking their medicine, " Maako said.

Up to six of the hospital's TB patients have been moved upstairs to an

extension of Ward Two and are about to complete their treatment.

The ward upstairs is buzzing with activity, " these [patients] are the

'up-and-abouts', they are getting ready to join the rest of the prison

population, " she added.

HIV-positive patients receive a high-protein diet, " sometimes with extra

fruit, raisins and peanut butter " , as well as multivitamins to boost their

immune systems.

When discharged into prison, they are required to receive the same diet,

but whether this actually happened was difficult to determine, Maako

admitted.

In line with the national AIDS policy, antiretrovirals are not yet

available.

ACCESS TO CONDOMS

Government policy states that condoms are to be distributed to the

prisoners " on the same basis as condoms are provided in the community. "

But the policy document also adds: " A prisoner may not receive condoms

before having undergone education/counselling regarding AIDS, the use of

condoms and the dangers of 'high risk behaviour'. The fact that a prisoner

has received counselling must be recorded on his/her medical file. "

At Local Prison, this meant an inmate had to have a " private discussion "

with a medical officer called , one of the prisoners told PlusNews.

Sello Cornelius, the chairman of the Local HIV/AIDS Counsel - a

prisoner-run body conducting awareness and education campaigns, and

support groups - admitted that prisoners might find this " uncomfortable " .

Consequently, very few prisoners approach the health care workers for

condoms. " They are suspicious of the [lack of] privacy, " he said.

" We don't condone any vulgar practices, but we have to, of course, advise

them where to get them, if necessary, " Cornelius told PlusNews.

There were no easily accessible condom dispensers within the prison,

" because we are trying to prevent sodomy, " he added.

" We are caught in a dilemma. We are saying 'don't do sodomy, but if you're

going to do it, use condoms,' " prison head Nico Baloyi commented.

The policy on condom distribution in prisons, however, was applied on an

" ad hoc basis " , Gloria Lekubu, provincial prisons HIV/AIDS coordinator,

pointed out. " In some prisons, there are condom cans [dispensers] which

are easily accessible, " she added.

Baloyi argued that prisoners would " take advantage " by blowing up condoms

and " making a mess " .

" But part of the dilemma is that they could mess up their lives, and not

just the prison, if they don't receive condoms, " Lekubu noted.

VOLUNTARY COUNSELLING AND TESTING

Despite a proliferation of awareness and educational campaigns encouraging

voluntary HIV testing, most prisoners are reluctant to come forward.

" We comply with the policy that rules out mandatory testing - we only get

to know a prisoner's status when they are sick, " Ndebele said.

But Local's HIV/AIDS Counsel feels more can be done.

" When we have awareness functions, the other prisoners tell us they want

to go out and say they are HIV-positive. " But first they want to talk to

people from outside, like their pastor, " Mandla , a member of the

group, told PlusNews.

IMPACT ON STAFF

Problems such as these appear not to have evaded prison staff. According

to Ramanee Hira, who runs the employee assistance programme, the biggest

obstacle in workplace programmes remains stigma and discrimination.

" Its very difficult to introduce VCT, the environment is not geared for

it, " Hira said. It was also difficult to form support groups and talk

openly about the disease. " Everybody wants to keep it secret, " she added.

Although the number of AIDS-related illnesses among the workforce was

" still very low " , Hira raised concerns about how HIV-positive staff would

be supported when ill.

She called for " less of a demarcation " between programmes targeting

prisoners and staff. " There is still an 'us and them' attitude - people

are very nervous about things like this. "

" We have to work through all the barriers and create an environment

conducive to openness - for ourselves and the prisoners, " she added.

EARLY RELEASE

World Health Organisation (WHO) guidelines call for the early release of

prisoners in the advanced stages of AIDS, to allow the person to die in

dignity. An HIV-positive woman was recently released from the female

prison on medical grounds, after her eight-week old baby was taken by her

grandmother.

" She was very weak and suffering from diarrhoea, the doctor decided we had

to let her go, " Sister Maako said.

Last year, eight prisoners from the Pretoria Prison reserve were released

on medical grounds.

Addressing HIV/AIDS in prisons effectively was " not easy " provincial AIDS

coordinator, Gloria Lekubu noted. A spate of bad publicity surrounding

prisons has skewed the public's impression of what is being done in

prisons.

The Department of Correctional Services, which oversees all prison

facilities in South Africa, introduced their AIDS policy in September

2002. However, there has been little coordination to ensure proper

implementation, a prison official said.

Despite the bad press, prisons were upbeat about tackling the disease.

" Things are happening. We are lobbying for outside support as a show of

our commitment, " Lekubu said.

[ENDS]

2 - SOUTHERN AFRICA: The challenge of HIV in prisons

JOHANNESBURG, 11 June (PLUSNEWS) - The jail doors that slam behind a newly

arrived inmate are likely to open again at some point in the future and

release the ex-convict back into society. The problem of HIV/AIDS in

prison, and the wider issue of penal reform, are therefore questions that

should concern us all.

Prison conditions in most countries of the world are ideal for the

transmission of HIV. " They are frequently overcrowded. They commonly

operate in an atmosphere of violence and fear. Tensions abound, including

sexual tensions. Release from these tensions, and from the boredom of

prison life, is often found in the consumption of drugs or in sex, " a

UNAIDS " Best Practice " report noted.

These are conditions that some people face more than once during the

course of their lives, entering and leaving prison repeatedly. In South

Africa, over 40 percent of prisoners are incarcerated for less than a

year, with only two percent serving life sentences, according to a study

by the Pretoria-based Institute for Security Studies (ISS). On average,

25,000 people are released from South African prisons and jails each

month.

HIGH RATES OF HIV

HIV prevalence in prisons is usually higher than in the population at

large. As a result of the poverty and deprivation that helps drive

criminality and HIV/AIDS, many of those inmates who are HIV-positive in

prison were already infected on the outside.

" Poverty is a defining characteristic of both prisoner and HIV-positive

populations alike, " the ISS report, " HIV/AIDS in Prison: Problems,

Policies and Potential " , points out. But rather than acceptance of the

problem, measures can be taken to reduce the transmission of HIV, and help

delay the emergence of AIDS-related illnesses.

" Policies to address HIV transmission in prison cannot be effective

without immediate and urgent prison reforms, " the report stressed.

" Overcrowding, corruption and gangs are the primary culprits behind rape,

assault and violence in prisons, and this environment is horrifying, even

without the risk of HIV infection. "

HIGH RISK BEHAVIOUR

The main types of high-risk behaviour in prisons are contaminated needles

used by injecting drug users - which is not a major problem in African

countries - and/or instruments used for tattooing. Unprotected sex between

men is another important factor.

" The extent of sexual activity in prisons is difficult to determine

because studies must rely on self-reporting, which is distorted by

embarrassment or fear of reprisal. Sex is prohibited in most prison

systems, leading inmates to deny their involvement in sexual activity. Sex

in prison usually takes place in situations of violence or intimidation,

thus both perpetrators and victims are disinclined to discuss its

occurrence, " the ISS study noted.

In women's prisons where there are male prison staff, sex between men and

women may also take place, UNAIDS pointed out, creating a risk of HIV

transmission.

Homosexual activity is illegal in every southern African country with the

exception of South Africa. However, according to UNAIDS, 8.4 percent of

men in the Zambian prison of Kamfinsa reported anal sex in a study in

1995, with the true figure likely to be higher. A 1999 Penal Reform

International study of Zomba prison in Malawi reported respondents as

estimating that between 10 to 60 percent of prisoners had participated in

homosexual activity at least once.

Three aspects of man-to-man sexual activity in prison make it a high risk

for HIV transmission: anal intercourse, rape and the presence of sexually

transmitted infections (STIs). Related problems in prisons across Southern

Africa include overcrowding, shortages, corruption, and the presence of

juveniles alongside adult prisoners.

The Zomba study noted that those who served as the " receptive partner "

were usually: " recently detained, either juveniles or young adults, who

have no blanket, soap, plates or food. They have no relatives from the

outside to help them and care for them, they are in physical need and

confused by their recent detention, and they turn to somebody to care for

them. The ones they usually turn to are those who have outside supplies.

The relationship between them was described as similar to that between a

poor prostitute and a rich client. "

The report also noted the existence of " prostitution rings " , in which

guards were involved in smuggling juveniles into the adult blocks,

sometimes for as little as 30 US cents. The practice was assisted by

inadequate supervision and segregation of juveniles from adult inmates.

The appalling physical conditions of most prisons in Southern Africa,

along with inadequate nutrition and health services, exacerbates the

incidence of AIDS. Particularly serious is tuberculosis (TB), which can

easily spread in overcrowded prison conditions. People with HIV are

especially vulnerable to TB, and HIV-positive people can transmit the

disease to those not infected with HIV, the UNAIDS report warned.

The potential for the spread of HIV is also increased by a lack of

information and education, and a lack of proper medical care. STIs, if

left untreated, can greatly increase a person's vulnerability to HIV

through sexual contact, UNAIDS noted.

WHAT TO DO?

Rather than accepting the reality of sexual activity and the attendant

risks, most prison authorities in Southern Africa refuse to provide

condoms for inmates in the belief that it will encourage homosexuality.

Attitudes of denial will have to change if societies want to see the rate

of HIV infection - inside prison and outside - decrease.

The UNAIDS position is clear. " Recognising the fact that sexual contact

does occur and cannot be stopped in prison settings, and given the high

risk of disease transmission that it carries, UNAIDS believes that it is

vital that condoms, together with lubricant, should be readily available

to prisoners. This should be done either using dispensing machines, or

supplies in the prison medical service. "

Even in South Africa where the provision of condoms is policy, in the

prisons themselves, access is still circumscribed by issues of shame and

censure.

" The impact of HIV/AIDS on prisoners is most visible in the rising number

of deaths in prison each year, " the ISS report cautioned. " What must be

envisioned is the positive impact prisoners can have on HIV/AIDS. "

The study recommends aggressive behavioural change interventions,

transforming cells into classrooms, in which gang leaders are co-opted as

peer educators. It also calls for better health education and health

services, enabling the prison authorities to make " significant

contributions towards an AIDS-free generation in South Africa " .

To view a PlusNews web special on the issue:

http://www.irinnews.org/webspecials/hiv-in-prisons/default.asp

[ENDS]

3 - SWAZILAND: Condoms refused in prison, despite high-risk behaviour

MBABANE, 10 June (PLUSNEWS) - Swaziland's Correctional Services last month

finally admitted that sexual activity occurred among prison inmates.

But despite the risk of HIV transmission, the authorities are refusing to

provide condoms, in the belief that it would encourage homosexual

behaviour.

" This is not consensual sex, but rape. It is considered aggravated

assault, and perpetrators will be punished, " Noma Dlamini, public

relations officer for the Correctional Services, told a press conference

in May.

" These men-on-men rapes are not homosexual acts. They are done by men who

are away from their wives, and who are pretending that other men are

female. That is why the perpetrators prefer young men and boys, " a prison

warder told PlusNews.

Central Matsapha Maximum Security Prison for Men is 30 km east of the

capital, Mbabane. A former inmate, who asked to be known only as ,

told PlusNews that sexual exploitation was rife.

" There is cellblock G-7 that is supposed to keep minors separately from

adults, but they are free to join the men during the day. We meet in the

kitchen, in the dining hall, and we see each other outside because we

spend most of the day outside. It isn't difficult for men who want sex to

meet the kids. They carry blankets, and they take the kids to other

cellblocks, " he explained.

In Swaziland's penal system, he said, sex is a matter of negotiation

between inmates, but there is also sexual assault. " A grown man inmate can

negotiate to have it voluntarily done, or he can just go and rape somebody

if he wants to. "

Swaziland's prisons are overcrowded. Correctional Services, the authority

responsible for all the country's prisons, will not reveal the total

number of inmates, but food shortages have reportedly reduced meals to one

a day in some congested facilities like the Manzini Remand Centre, where

prisoners awaiting trail are kept.

A controversial decree by King Mswati III, denying bail to some categories

of accused, has worsened the problem.

Prison warders are underpaid, their ranks depleted by AIDS and, burdened

with a burgeoning prison population, they are hard-pressed to enforce good

behaviour among inmates.

" We call the prison wardens the bosses, " said . " They know what is

going on. But they leave prisoners to sort things out for ourselves. "

When first spoke of his prison experience a year ago in the local

press, Correctional Services authorities produced a dozen inmates then

serving time, and each one refuted his account. They said no sodomy

occurred in prison, and they challenged to shed his anonymity so

they could confront him face to face.

A year later, the prison authorities have reversed their position. Too

many former inmates had gone public, exposing prison conditions, and

confirming the dawning realisation that the general public was endangered

by the spread of AIDS among prisoners.

" We have always resisted issuing condoms to inmates because to do so would

be to tacitly condone sexual acts, " Correctional Services Commissioner

Mguni Simelane told PlusNews.

A warder, who asked to be named only as Simon, said he supported demands

by health NGOs for the provision of condoms in prison - a significant step

in this conservative kingdom, despite an HIV-prevalence rate of nearly 45

percent among Swazis in their twenties.

" There is too much sodomy. I wrote to my superiors about it. In my letter,

I said, 'You know, you get a three-month sentence in Swaziland, and it is

a death sentence, because of HIV', " Simon said.

" You get 60 guys in a cell, sodomy is going to happen. If a prisoner

complains to us, we punish the perpetrator. We are obliged to do this by

the rules, " he commented. " But then the others will go after the one who

complains, and they'll punish him. "

Simon, who has been a prison warder for 12 years, has seen enough to give

survival tips.

" If you have a friend in prison, the best thing you can do for him is give

him an unlimited supply of cigarettes. In prison, cigarettes are more

valuable than money [is] on the outside. You use cigarettes to buy

protection. Muscle isn't enough. How do you fight six other prisoners at

once? I tell these guys who are vulnerable to abuse, 'For God’s sake, get

someone you know on the outside to send you a package. It's your only

hope', " he said.

The position of UNAIDS, the joint UN agency programme on HIV/AIDS, is

clear. " Recognising the fact that sexual contact does occur and cannot be

stopped in prison settings, and given the high risk of disease

transmission that it carries, UNAIDS believes that it is vital that

condoms, together with lubricant, should be readily available to

prisoners. This should be done either using dispensing machines, or

supplies in the prison medical service. "

[ENDS]

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