Sentenced and locked away, prisoners in many African countries have been forgotten by HIV/AIDS prevention programmes.
"Our ministers still have their heads buried in the sand like ostriches, they don't want to face the problem," a Tanzanian prison activist who asked not to be named told PlusNews.
The World Health Organisation's guidelines for HIV/AIDS in prisons state that all inmates have a right to equitable health care, and national AIDS programmes should be applied in jails.
But that is rarely the case, delegates to the International AIDS conference in Barcelona heard this week.
Oscar Simmoya is part of a Zambian community-based organisation (CBO), In But Free, which has been lobbying for the release of chronically ill prisoners.
"There are many individuals who are crowded in these prisons with very inferior health services. There is a lot of high risk behaviour, and not enough appropriate information on how they can protect themselves," he said.
A 1999 study conducted by Zambia's Copperbelt University of over 10,000 prisoners found that 27 percent were HIV positive, higher than the general adult infection rate.
Poor living conditions - including inadequate sanitation, overcrowding and bad food - are major problems. Most of the jails are more than 60 years old and need rehabilitating, Simmoya said.
Diseases such as cholera and dysentery are common. "This is not just about HIV/AIDS, it's a whole complex problem," Simmoya noted.
Because prisoners lack even basic nutrition, food is a valuable commodity that is bartered for sex.
"In one prison we went to, the cook had the most sexual partners, because he controls all the food. Even gang leaders now use food as a bargaining tool," he said.
According to Simmoya, moral and legal barriers prevent prisoners from receiving adequate care and protection, even though the prison authorities are well aware that unsafe sexual activity takes place.
High-risk behaviour such as sodomy is a criminal offence in Zambia. Consequently condoms are not made available to inmates.
Prison officials are reluctant to allow CBOs such as In But Free into prisons, alleging they are trying to encourage homosexuality.
Simmoya said that both prison officials and inmates in Zambia were "uncomfortable" about the issue of condom distribution, and the implied acceptance of homosexual sex. However, he said, they would be gradually made available by his organisation.
In But Free has initiated HIV/AIDS intervention programmes, which have trained prison inmates as peer educators and counsellors. Voluntary counselling and testing services are also part of the project.
"These are moderate achievements. There is more to be done, we need to make everyone aware that prisoners have been sentenced to prison and not to HIV/AIDS," said Simmoya.
- Human Rights Watch - Prisons in Africa
- In But Free - an HIV/AIDS prison project in Zambia that involves peer educators. []
- HIV/AIDS in Prison: Problems, Policies and Potential - a report by the Institute for Security Studies
- South African Department of Correctional Services
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