PROVIDING access to HIV prevention and treatment services in closed settings, such as prisons, is crucial to curbing the transmission of HIV, particularly among women, say public health experts.
The UN Office on Drugs and Crime (UNODC) says global HIV prevalence among prisoners is up to 50 times higher than infection rates in the general population. The World Health Organization (WHO) estimates that 0.8 percent of people aged 15-49 globally are living with HIV.
“About 30 million people [worldwide] go through prison each year. People who inject drugs account for about 70 percent of the prison population,” said Fabienna Hariaga, a UNODC senior HIV advisor based in Austria.
“Drugs exist in prison… All modes of HIV transmission that are present in communities are present in prison.” HIV is transmitted in the body fluids – blood, semen, vaginal fluid and breast milk – of an HIV-positive person.
“In prisons, injecting drug use, tattooing, body piercing and modification are high-risk behaviours that allow for HIV transmission through blood. Consensual and forced sex, and vertical infection such as mother-to-child transmission, are all avenues for… [spreading] HIV,” said Anne Bergenstrom, the UNODC HIV/AIDS advisor for the Asia Pacific region, based in Bangkok, Thailand.
Overcrowding, inadequate ventilation, and inadequate health services increase the vulnerability of people in jails to HIV. “While they [prisoners] may have access to health services at the community level, when… [they are incarcerated], this access is interrupted,” said Bergenstrom. The UNODC, in partnership with other UN agencies, proposed a series of public health interventions in 2012 to ensure healthcare would be accessible at all stages of detention.
“Prisons are a breeding ground for HIV and [other infectious diseases like] tuberculosis, for prisoners, prison staff and their communities,” Bergenstrom pointed out. About one-third of the people behind bars worldwide are awaiting trial, a period of incarceration that can last up to a year or even longer. Some of these prisoners will be found innocent and go back to their families and communities, spreading the risk of infection outside the prison.
In early 2012 the International Centre for Prison Studies, a London-based research organization, estimated that over 625,000 women and girls worldwide were being held as pre-trial prisoners or were serving sentences, and more than 200,000 of them were in the US.
Drug use and HIV infection are more prevalent among imprisoned women than men, according to experts. Women are more vulnerable to sexual abuse and rape by prison staff and male prisoners, and are more likely to exchange sex for food or toiletries.
“Women have specific needs which are different from the needs of men. Some women are pregnant or become pregnant while in prison,” said Yossawan Boriboontawa from the Thailand Institute of Justice, a think-tank. Thailand had more than 260,000 prisoners in 2013; of which almost 40,000, or 14 percent, were women. “In some [Thai] prisons, women are together with the male prisoners because there is no space.
There… [are] not enough female prison staff and often no separate room for body search[es],” Boriboontawa noted. In 2010, the UN adopted a global set of rules for the treatment of incarcerated female offenders, called the Bangkok Rules in recognition of the Thai government’s role in having the standards accepted. The rules are an addition to the 1977 UN Standard Minimum Rules for the Treatment of Prisoners and include the development of services for specific inmate populations such as pregnant women, mothers with children, and foreign and juvenile offenders.
They also call for alternatives to imprisonment for female offenders, and sanctions that are proportional to the offence committed and the offender’s criminal history.
“We believe that prisons should be the last resort for women prisoners, given their caregiving roles and responsibilities,” said Boriboontawa. Bergenstrom pointed out that “We cannot talk about [achieving] zero new HIV infections and AIDS deaths, unless we consider that in a prison setting, prisoners often do not have access to proper healthcare.”
The UNODC has estimated that 28 percent of the 88,000 prisoners in Viet Nam and 20 percent of the 100,000 prisoners in Indonesia are HIV positive, but researchers in many countries have long acknowledged the difficulties of gathering data on HIV prevalence and drug use in prisons. A study published in the UK medical journal, The Lancet, in 2007 noted that “HIV transmission in prisons is not easily detected until widespread outbreaks have occurred.”
In Tanzania the prevalence of HIV/ AIDS in prisons, almost all of which are heavily congested, is a possibility. A survey carried out last year showed that some prisons housed numbers of prisoners that exceeded the authorized capacity by far. For instance, the Dodoma Central Prison at Isanga, whose official capacity is 784 inmates had 1,338 which is 70.7 per cent above the authorized capacity.
Maweni Prison in Tanga had 1,028 prisoners instead of 920. Segerea Prison in Dar es Salaam had 1,878 prisoners while its capacity stands at 920. Keko Prison had 1,140 prisoners while the official capacity is 420. Statistics on the prevalence of HIV/AIDS are hard to come but certainly, the deadly disease keeps escalating. Prisoners in this country are, invariably, tortured through hard labour and fed badly cooked food.
They mostly sleep on hard cold floors. When marking Law Day last year it was suggested that “Alternative Punishment” should be adopted and implemented in a quest to curtail unnecessary prison congestions. ” It was impressed upon the legal system that if implemented properly, alternative punishment would help ease prison congestions which are now a critical problem.
Ideally, prisons are meant to be correctional facilities where offenders are taken away to reform and be able to fit into society upon their release and become productive citizens. But ill-treatment of prisoners is certain to have the reverse effect. Prisoners who feel that they have been abused and violated while in confinement are likely to take their anger on society and become repeated offenders instead of reforming.
In turn they become incorrigible regardless of the number of times they are sent to jail. If this were to be the effect of correctional facilities, it would most definitely not augur well for our society.
That is why it is of paramount importance that the conditions in prisons be improved and prisoners be treated with a bit more dignity. Otherwise there are always alternative sentences that do not require individuals to be imprisoned.
As the state looks into granting more rights to those in prison, alternative forms of punishment such as community service should also be made common. Such punishment will reduce government spending on prisoners, benefit societies and guarantee the offenders their freedom and other rights but most importantly ensure that they reform.