PRESENTATION TO. THE PORTFOLIO COMMITTEE ON
CORRECTIONAL SERVICES
HIV/AIDS DEBATE

28MAY2002
1. INTRODUCTION

· This presentation serves to respond to the information tabled by the Inspecting Judge of Prisons, Judge Fagan to this Committee on 21 May 2002 on HIV/AIDS in prisons

· The Department of Correctional Services wish to indicate that the statistics of HIM infection as communicated by the Inspecting Judge is something irresistible to the media and is unnecessarily sensationalized.

· Such a message has serious repercussions for the Department especially since it is not based on scientifically conducted study as the Judge has stressed. In quoting the Judge out of context by reporting that sixty percent of prisoners released from our prisons are infected with the HIM virus, the media has contributed to the social difficulties faced by released prisoners and their families as they will be potentially faced with stigma and rejection by communities they come from.
· The Department wishes to distance itself from the information presented to the Portfolio Committee
· The Judge has since communicated with the Department to indicate which remarks the media misconstrued. Notwithstanding that, the Department finds it important and necessary to provide a perspective and context within which this kind of information can meaningfully be processed and understood.

2. THE DEBATE ON HIM STATISTICS IN PRISONS

· No HIM prevalence survey has been conducted in South African Prisons and until such a survey has been conducted we cannot confidently conclude that any statistical figure of HIM infection is real.

· The information currently available in the Department is based on the statistical reporting from prisons and these extracted from prisoners who were
tested voluntarily as recommended by the medical staff or from their own desire to know their status.

· This therefor make the current statistics a distortion of the reality. However, it must he borne in mind that HIM prevalence in South Africa according to the Ante-Natal survey of the Department of Health, 2000 is currently 24,5%. Therefore to speculate about a 60% prison rate (which is approximately three times the national average) is highly questionable.

· The Department is acutely aware that the poor and overcrowded conditions in some of the prisons places the prisoners at a much higher risk. Nevertheless, it is the Department's position that such statistics must be viewed critically and contextually.

· A study tabled during the 2000 International AIDS Conference in Durban brought forth some valuable information that the Zambian prisons has a 27% infection rate in prisons. Understanding that the UNAIDS report on Global HIM places Zambia as the fifth highest infection rate in Africa while South
Africa was rated the sixth highest, the HIM prevalence in South African prisons may not differ much from that of Zambia.

· This assumption can only be supported by a scientific HIM sero-prevalence survey.

· An anonymous HIM epidemiological survey will have to be conducted to reveal the extent of HIM infection in prisons.

· The belief that HIM infection in prisons is at sixty percent is not based on any scientific study and is confusing to the country.

· Such a generalization without scientific evidence is a concern to the Department

· As to the mini study conducted in Durban Westville Prison with 274 prisoners (2 % of the total 11711 inmates in Durban Westville) the sample is not representative of South African prisons. Care should be taken in extrapolating from this sample to all South African prisons.
· The Department Is planning to conduct a prevalence survey with the assistance of the DOH and research institutions.

· This will help us keep track of the HIV trend and the results will help us to mobilize resources and review our strategies

· Compulsory HIM testing is unethical and unconstitutional and international institutions such as the World Health Organisation do not recommend it.

· Compulsory HIM testing is meaningless without a purpose. The consequences of such testing must be considered. Will positive prisoners have to be segregated? This will add to the already serious position regarding prison accommodation. Will anti retroviral drugs have to be provided if prisoners are tested against their will. This would have to be contextualised within government policy.

· It violates human rights

· It will require legislation
· The decision to effect compulsory HIM testing does not lie with Correctional Services

· Compulsory HIV testing may be justifiable in the event of sexual and physical abuse where the perpetrator's rights become limited

· The decision to implement such an approach does not fall within the Department's competence

· The decision to segregate the HIM positive prisoners is unethical and it will promote stigmatisation of such prisoners and their families
CONCLUSION

It can be concluded that:

· Prisoners come from an at -risk population and imprisonment could accelerate deterioration of their health.

· The statistics available which is not scientifically based is a distortion of the true picture

· Placing HIM infection in prisons at 60% is unrealistic and an exaggeration

· The Department is planning to conduct HIM prevalence survey in prisons

· Compulsory HIM testing requires legislative backing

· Anti-retrovirals are given according to government policy
· Segregation of HIM positive prisoners is not recommended. Instead information on universal precautions and other information on HIM related issues can be provided to all prisoners.


DRAFT RESPONSE
DEPARTNIENT OF CORRECTIONAL SERVICES: RESPONSE REGARDING
HIV ISSUES: STATISTICS AND PROVISION OF ANTI-RETROVIRAL DRUGS
TO PRISONERS

INTRODUCTION

The problem of HIV/AIDS in prison is a reality which the Department is committed to addressing in consultation with other role players within and outside the government spheres. The HIV/AlDS pandemic is a problem for all corrections worldwide. It is believed HIV infection is high in prison settings than in the general public and that effective strategies need to be implemented if the Correctional Services is to manage this
pandemic effectively.

VULNERABILITY OF PRISONERS TO HIV INFECTION

The prisoners come from a sector of our population which is already disadvantaged socio-economically due to unemployment and poverty. Imprisonment further increases their chances of acquiring HIV infections as a result of overcrowding and poor living conditions. stressful situation, violation of their rights by fellow-prisoners resulting in sexual abuse and coerced sex.

Within the South African prison settings. the spread of HIV infection through needle sharing is not common as it is the case in developed countries. Thus in South Africa like in other :African countries the spread is mostly through sexual activities. The abuse of prisoners by fellow-inmates is seldom reported as victims are afraid of serious consequence. This is a challenge to Correctional Services to ensure that prisoner's rights are protected and that they are also empowered to protect one another while in prisons.

THE PREVALENCE OF HIV' INFECTION IN PRISONS

No HIV prevalence survey has been conducted in South African prisons and we therefore cannot confidently conclude that HIV' infection is at 60 percent in prisons. We however, are aware that the infection rate may be higher than in the general public and that the reported cases are a distortion of the real situation.

According to the National HIM Sero-Prevalence Survey of Women attending Ante-Natal Clinics in South Africa conducted annually. the HIM infection was at 24.5 % in 2000 (Department of Health. 2000). The infection rate in prisons is estimated to be higher than 24.5%?. The Department will have to conduct a prevalence survey in the same way as the Department of Health estimated the prevalence of the pandemic in South Africa using pregnant women. Within prisons the survey' will focus on prisoners and already a meeting with the Department of Health was held in 2001 to deliberate on the idea of conducting HIV prevalence survey in prisons. The Department will rely on the experiences and expertise of the Department of Health, medical universities and available laboratory facilities. The Department is planning to conduct such a survey within 2003 and 2005 and to conduct it on a continuous basis to keep track with the trend of HIM infection.

A study tabled during 2000 International AIDS Conference in Durban brought forth some valuable information indicating that the HIV sero-prevalence survey conducted in Zambian prisons reported that 270/o of prisoners were infected. According to the UNAIDS report on Global HIM, 1999, Zambia was the fifth African country with high HIM infection while South Africa was rated the sixth country. Therefore the HIV prevalence in South African prisons may not differ much from that of Zambia. This assumption can only be supported by' a scientific HIM sero-prevalence survey.

COMPULSORY HIV TESTING OF PRISONERS

Compulsory HIV testing of prisoners is not recommended internationally by WHO (World Health Organisation) and UN(United Nations). It is emphasised that HIV testing should be voluntary. In South Africa. we believe compulsory testing of prisoners is a violation of human rights and to effect such a practice will require legislative framework. The decision to conduct compulsory HIM testing of prisoners is not the Department of Correctional Services responsibility, but it is the National Government's decision. The Portfolio Committee on Correctional Services indicated in 2001 during the presentation of the Draft HIM/AIDS policy. that compulsory HIM testing of prisoners will require legislation.

Until the Department of Health makes it a notifiable infection, there is no basis for compulsory testing.

CompuIsory HIV testing maybe considered in the event of rape and other forms of sexual and physical assault .In such situations the action performed by' the perpetrator may' compel us to conduct compulsory HIV testing. It may therefore be justifiable to compel an offeder to undergo HIV testing and thus limiting his or her rights. Compulsory HIV testing is a human rights issue and the decision to effect such a practice will not fall within the competence of the Department of Correctional Services.
Implementation of "Universal Precaution " protocol is encouraged to protect both j) personnel and prisoners

SEGREGATION OF HIV POSITIVE OFFENDERS


The decision to segregate HIV infected prisoners is an ethical issue and within the South African prisons were overcrowding is a problem, the available accommodation will not be utilised optimally . Segregation of HIV positive prisoners will also promote stigma to such prisoners and their families. We believe we can do better with preventive and promoting health care while promoting observance of human rights The rehabilitation efforts the Deparii1~ent is committed to will require programmes to be put in place to train both personnel and prisoners and to encourage humane treatment of inmates.

PROVISION OF ANTI-RETROVIRAL DRUGS TO HIM POSITIVE OFFENDERS

The Department of Correctional Services derives its mandates from the government and therefore it will provide anti-retroviral treatment to prisoners guided by the policy of the government. Pregnant female prisoners who are HIV positive will access Neverapine the same way as the geucral public does access these drugs. Anti-retroviral drugs within prisons are also made accessible to the health workers in the event of needle pricks. Offenders with HIV?AIDS are provided with treatment for complications within the treatment guidelines for opportunistic diseases. Prisons participate in the project by the Department of Health where Diflucan drugs donated by' Pfizer is used for the treatment of .AIDS related conditions

INTERVENTION STRATEGIES

The following strategies are employed to address HIV/AIDS in prisons:
· Health awareness and health education tapping on all resources available
· Partnership with the community', NGOs. business sector, and other government department.
· Voluntary testing and counselling
· Management of opportunistic diseases and sexually transmitted infections
· Discharge of terminally ill prisoners
· Training of personnel and prisoners
· Management of information and reporting system
· Condom provision
· Research
· Screening for early treatment
· Policv review

· The Deputy Director HIM/AIDS has been appointed and she has commenced with the planning for the operationalisation of the Department's HIM/AIDS policy including the appointment of Provincial HIM/AIDS Co-ordinators. She will also facilitate the prevalence survey including provision of budget.


CONCLUSION

Given the seriousness of the HIV/AIDS pandemic in the general public and correctional environment in South Africa intervention strategies should be based on research-based evidence and observation of human rights principles.


Known HIV/Aids cases as at March 1996-2000