HIV/AIDS in prison : the public policy challenge for South Africa.

Abstract

In South Africa, both the number of people entering prison, and the number of people infected with HIV, are steadily increasing. While reliable statistics are not available on the number of HIV+ prisoners, the characteristics of the typical prisoner are those of a demographic group at high risk for HIV infection. As a result, many prisoners will already be HIV positive upon entering the prison. Additionally, the prison environment creates many situations of high risk behaviour for HIV transmission, which means there is also an as yet undetermined portion of inmates who will contract HIV while incarcerated. The current government policy is to provide HIV testing and condoms in conjunction with counselling, although poor design and implementation of this policy has limited its impact. In addition to issues of HIV infection and transmission, the government must address the needs of prisoners who have developed full-blown AlDS and will likely die as a result while imprisoned. AIDS is already the leading cause of death for prisoners in many countries, as well as in South Africa Adequate medical care, proper nutrition, and early release for those in the late stages of AIDS, are the international standards for minimum humane treatment of these prisoners. Today, crippling bureaucracy prevents the humanitarian release of dying· prisoners from South African prisons. Reliable data on the nature and extent of HIV/AIDS infection in South African prisons has yet to be obtained, owing to the closed nature of the prison administration. In order to design and implement effective policies, the secrecy surrounding the prison system must be eliminated so that further research and study may take place. Unlinked, anonymous HIV testing should be undertaken on a sample of the prison population so that accurate information and projections about HIV/AIDS in prison may become available. Until the government allows the issue to be quantified, the design and implementation of better policies will not be possible. The best HIV/AIDS policies are those which recognise the impact of prisoners' health on public health in general. Because the prisoner population consists of a core transmitter group, the pnson provides a critical intervention opponunity for the prevention of HIV infection in the greater community Further research on this issue should therefore focus on the evaluation, design, and implementation of intervention programs Intervention in the prison environment should include targeted education and use of existing gang structures to engender behavioural change The issues of HIV/AIDS in prison are compounded by issues of prison reform in general. The conditions in South Africa prisons are unconsitutional, and exacerbate the problems presented by HIV/AlDS. The most pressing problem in South African prisons is overcrowding; a problem which the Department of Correctional Services is all but powerless to address. Just as HIV/AIDS in the general community requires a multi-sectoral solution, so too does HIV/AIDS in the correctional setting. The Department of Correctional Services must re-evaluate both its policies and its entire policy making process in order to address HIV/AIDS in South African prisons.