is hiv preventable in prison?

By Godwin Muhwezi-Bonge (Source: The monitor)

 July 20, 2006: When Benjamin Buloba entered the gates of Luzira Prisons on charges of “conspiracy to commit a felony”, he looked forward to the day he would regain his freedom.

But that was not to be.

A few days after he was imprisoned, he developed a stomach upset, which eventually degenerated into terrible diarrhoea. After an agonising night of endless visits to the toilet, Buloba finally succumbed to death. On the night he died, “he kept putting toilet paper in his anus,” one prisoner was quoted, in The Monitor in October 2004.

Buloba’s death however has since remained a controversy. Though some reports attributed his death to homosexual rape, post-mortem reports done by the prison’s medical staff attributed his death to respiratory failure and secondary tuberculosis. On the other hand, reports from Mulago revealed “trauma of the rectum”, validating earlier claims of homosexuality.

Same situation

Almost two years later, the situation has not changed much. Homosexuality is still rife in Ugandan prisons though prison authorities remain elusive about the matter.

Ms Mary Kaddu, the assistant commissioner for social support Uganda Prisons said, “We are carrying out a study to ascertain whether homosexuality is a myth or reality in Uganda prisons”.

While homosexuality is still a point of contention, it has emerged as the leading spread of HIV among male prisoners. A United Nations Aids (UNAIDS) Best Practice report noted that prisons are ideal environments for HIV transmission, since they are often overcrowded, full of violence, tension, and fear.

Susceptible: Aids in prisons is a big threat as lack of information and proper medical care can lead to faster death of HIV patients. Net photo

“Release from these tensions, and from the boredom of prison life, is often found in the consumption of drugs or in illicit sexual acts such as homosexuality,” the report said. HIV first became prevalent in Ugandan prisons in 1987 at a time when the country was still wrestling with the disease in the general population.

At such a time, control and treatment of HIV among prisoners was not a priority. But in all this, Kaddu says, “We realised that prisoners could not be forgotten”.

Reduced incidence

The national Aids policy was later adopted and widened to cater for HIV positive prisoners. As a result of the effort, HIV incidence has reduced from 30 percent in the1990s to 8 percent today, slightly above the national average of 6.8 percent.

Even so, HIV is still a problem prison authorities have to deal with. Lack of information, and proper medical care can lead to faster death of HIV patients. However, Kaddu says that like any other HIV positive citizen, “HIV positive prisoners are put on medication and special diet.”

She dismissed as “falsehoods”, reports which suggest that prison staff take advantage of the situation to benefit themselves at the prisoners expense.

Although HIV treatment in prisons is done in accordance with the national Aids policy, which prescribes accessibility of condoms to sexually active persons, Kaddu concedes that prisoners are not provided with condoms.

“We do not expect any sexual contact between male and female prisoners because they are separated,” suggesting that in case it happens, inmates are then exposed to HIV.

In contrast, the UNAIDS report confirmed that sexual contact occurs in prisons and cannot be entirely stopped in prison settings. Given the high risk of HIV transmission amongst prisoners, UNAIDS recommends that it is vital that condoms are readily available to prisoners to counter the risk. But this is still a fact prison authorities are not ready to deal with.

According to press reports, prison authorities in Jamaica rejected the idea of providing condoms to prisoners, saying it is a way of encouraging them to have sex. What is even worse is the fact that prisons are not as accessible to health workers as other institutions. Kaddu says, “Most of the work is done by our staff.” Staff are trained on how to take care of Aids patients. “Our staff are also involved in Aids awareness campaigns.”

Besides, the approach has changed. By involving prisoners in what directly affects them, Kaddu says, “Aids stigma has significantly reduced”. The approach is to use prison staff to train a selected number of inmates in the prevention and control of HIV, and care for those living with Aids who in turn act as counsellors to their peers.

“This has proven to be the most effective approach,” She says. Besides, prisoners often take on roles staff play once they are off duty. “We are all working together to reduce HIV prevalence in prison to levels even lower than the national prevalence rates,” she says.

As prison authorities get to terms with HIV prevalence amongst prison inmates, overcrowding and illicit sexual behaviour still remain issues they have to contend with. Though sex is outlawed in prisons, Buloba’s case and many such cases that go unreported serve as a reminder that prisons are not immune to sexual activity. Whether condoms reduce the spread of HIV or whether they encourage sex among prisoners is something prison authorities have to address sooner rather than later.