Special Report on HIV in prisons
JOHANNESBURG, 10 June (IRIN) - 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
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
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
"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
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
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
number of deaths in prison each year," the ISS report
cautioned. "What must be
envisioned is the positive impact prisoners can have on
The study recommends aggressive behavioural change
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".
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