Prison Aids deaths grow by 750%

The number of Aids-related deaths in South African prisons was estimated to have grown by 750% since 1995, an Institute for Security Studies (ISS) research consultant said on Tuesday.

Six times more prisoners died of natural causes last year than in 1995, and 90% to 95% of the deaths were believed to have been Aids-related, KC Goyer told an ISS seminar in Pretoria.

She estimated that 41,4% of the prison population was HIV-positive last year. The Department of Correctional Services (DCS) had acknowledged its estimate of three percent was unrealistically low, Goyer said.

Maria Mabena, acting director of health at the DCS, told the seminar there were 623 known HIV/Aids cases in October 1995, compared to 5 285 in the same month last year.

"According to departmental statistics there was a 40% increase in HIV/Aids between 1996 and 2000."

The department was planning to do a survey of HIV/Aids prevalence in prisons, Mabena said.

Goyer said researchers of the University of Natal and the Medical Research Council had done a prevalence study -- the first of its kind -- at Westville Medium B prison in 2001. However, the department would not allow its release; apparently because it was afraid its findings might be extrapolated on the country's whole prison population.

Both Goyer and Mabena believed mandatory HIV testing of prisoners and segregating those who tested positive from the rest was out of the question.

It was not done outside prison and should not be done inside either, Goyer said.

"In terms of the Constitution, everybody is equal before the law," said Mabena.

Mandatory testing would also be in contravention of the World Health Organisation's (WHO) guidelines.

"It doesn't serve any purpose ... What if you test 20 000 and all of them test positive? How do you deal with that?" Mabena asked.

Goyer said: "Mandatory testing doesn't help anything if you tell someone he is HIV-positive and he can't have the medicine to keep him alive."

She said many people were already HIV-positive when they arrived at prison.

"The socioeconomic indicators for crime and incarceration are similar to those for HIV/Aids."

These included poverty and unemployment. Most prisoners were between 18 and 35 years old -- the age group most likely to have unprotected sex, engage in commercial sex or be involved in sexual violence. They were also most likely to be using drugs -- which meant they could share needles and have sex in exchange for drugs.

Goyer added: "The conditions inside prison contribute to the progression of HIV and the onset of Aids and death."

According to her, the life expectancy of HIV-positive inmates was half of what it would have been if they were outside prison.

The high-risk factors inside prisons included overcrowding.

Mabena said South Africa presently had about 182 000 prisoners, but the capacity to handle only 90 000.

Overcrowding made it more difficult for warders to provide safety, resulting in more instances of rape and sexual assault. Injury increased the risk of HIV transmission, Goyer said.

Receptive anal intercourse was also likely to result in the spread of the virus.

Lack of ventilation increased the likelihood of the spread of pulmonary tuberculosis, one of the opportunistic infections associated with Aids.

Other risk factors included stress and inadequate nutrition.

All these factors had to be reduced before any meaningful HIV policies could be put in place, Goyer said.

"Prisons have been built to warehouse people, not to rehabilitate them. Health facilities in prisons have not been built to handle HIV/Aids."

Mabena said her department was unable to recruit and retain nurses, who left due to poor remuneration and because they could not cope any longer. It did not have its own doctors on the payroll either.

One of the principles of the DCS' new HIV/Aids policy, approved in October last year, was the early release of terminally ill patients. The processes in this regard were still very long and cumbersome though.

Goyer's recommendations included seeking alternatives to imprisonment for those awaiting trial and non-violent offenders.

Prison presented the ideal circumstances to maintain a treatment regime, she said.

"It is an intervention opportunity that should not be missed."

About 25 000 prisoners were released back into the community every month. That meant prisoners' health could not be seen in isolation, Goyer said.

"Prison health is public health." - Sapa