There is a growing epidemic in South African society: one that is preventable, one that is well known by our society; but instead of dealing with it, we choose to bury our head in the sand and ignore it.
The HIV/Aids crisis in prisons has reached a critical level, with South African prisons having a 60% HIV/Aids rate, which is three times that of the general population.
This raises the questions: Where has the Department of Correctional Services gone wrong, and what can be done to decrease the HIV/Aids rate in correctional institutions in South Africa?
The topic of HIV/Aids in prison seems a far removed one to the general public because of South African’s general attitude toward prison inmates. In reality, however, this situation is much more relevant than most realise.
Upon release, when an unknowing HIV-positive inmate returns to his/her family, there is a risk that this person may infect a significant other with the virus, which could lead to a series of future burdens on that family.
For the individual who is aware of his/her status, a continued reliance on the state for financial and healthcare support comes into play.
In either case, the individual becomes a burden on general society instead of contributing to society in a positive manner.
The origins of HIV/Aids in correctional institutions lie in the structure of the corrections system and the preconceived notions that many people have about the inmates and correction institutions.
During apartheid, the idea of high-risk sexual behaviour taking place in correctional facilities was an essentially rejected notion, and Prison Services took no precautions to stop the high-risk behaviour from taking place. The HIV/Aids policies in place at that time were those of confusion and based on fear, stigmatism and lack
of education.
Prior to 1995, it was policy to segregate prisoners based on their HIV status.
The implementation of this policy was discontinued due to the fact that it promoted the stigmatisation of HIV/Aids and because the isolation of HIV-positive inmates came to be seen as discriminating and degrading.
However, the discontinuation of the policy did not actually address the causes of HIV in prisons, which lay in the partaking of high-risk behaviour.
This high-risk behaviour included the sharing of needles for intravenous drug usage and tattooing, violence between inmates and elements of gang culture – even more so, the inmates’ participation in high-risk consensual and non-consensual sexual behaviour. This not only spread the HI virus, but also destroyed the fibre of correctional institutions and their aim of rehabilitation.
The use of intravenous drugs through the sharing of infected needles is not as massive a problem in South African prisons as is the use of infected needles for tattooing. This is mainly because the majority of inmates, while incarcerated, mark their bodies with gang symbols. The reuse of infected needles results in HIV/Aids being transferred from one inmate to another.
The major issue in South African correctional institutions, regarding transmission of HIV/Aids, is the high-risk behaviour of consensual and non-consensual homosexual sex – a highly controversial topic in South Africa and around the world.
Sexual activity is the primary transmission mechanism for HIV/Aids, and the high prevalence of the disease adds a second reason for prison authorities to take steps to mitigate it. Participation in this type of activity is predominately a result of gang culture, where dominant inmates coerce other, more subservient inmates into this high-risk behaviour through the promise of drugs, protection or threat of violence.
Another factor that plays a role in the increase of HIV/Aids in correctional institutions is the violent culture inherent in a prison population. Fuelled by gang culture – either to demonstrate their strength or as a right of passage to prove worthy of initiation into a gang – inmates will at times fight each other, resulting in substantial injuries or death. This combat often sees blood shed through the use of fists or knives, encouraging the spread of the disease.
This behaviour is heightened by the overcrowding of correctional institutions. It is not uncommon to find a cell, meant for 50 inmates, housing more than a hundred and lacking adequate bedding and general facilities.
An example of this is Pollsmoor Maximum Security Prison in the Western Cape, which is overcrowded by 253% and drastically understaffed – making the prison a breeding ground for high-risk behaviour that increases the HIV/Aids rate in the prison as well as in the general public.
However, there have been some advancements in the management of HIV/Aids in prisons.
Starting with the advent of the new democracy, progress in correctional services took a drastic step forward with the introduction of the Constitution of the Republic of the South Africa of 1996, which changed the principles that applied to inmates’ rights. They now had constitutional access to human dignity, adequate healthcare, and fair and just treatment.
In 1998, these rights were further cemented in the Correctional Services Act, which aimed at formalising the rights of inmates regarding safety, healthcare
and nutrition.
With regard to changes that had a direct bearing on HIV/Aids, the Correctional Services department approved the availability of condoms in prisons and counselling for all inmates.
This advancement was later met with the legalisation of free antiretrovirals, to combat the poor conditions and health of HIV-positive inmates.
Although these legislative advancements were important, inmates faced the same issue regarding HIV/Aids as all South Africans – the failure of implementation.
According to inmates, there are issues with the implementation of their constitutional rights. Overcrowding makes it difficult to control diseases, exposing the HIV-positive population to opportunistic infections and making access to a healthcare professional nearly impossible.
In addition, there are issues around nutrition, an essential component of the regimen of an HIV-positive person. The lack of good nutrition, coupled with their medication not being administered correctly, sometimes causes the positive policies to have negative outcomes.
Regarding access to condoms in prisons: the Department of Correctional Services has sabotaged the policy meant to help combat the spread of HIV/Aids, by attaching requirements that make it difficult for inmates to receive condoms, including going to counselling to ask for the condoms. These requirements were added with good intentions, but in reality are counterproductive.
Many inmates are ashamed of their participation in homosexual acts, and would rather continue without condoms than risk being labelled a “moffie”.
So what can be done to correct the current problems in South African prisons? A possible answer lies in the approach by international communities to HIV/Aids with regard to inmates.
In the United States and France, the simple adoption of allowing inmates access to condoms via dispensers in the general prison areas and supplying lubricants without the need to visit a counsellor has had a positive result.
South African prisons could benefit from such a policy, as condom use is still the best option for reducing infection, short of abstinence.
Another policy that could be beneficial in South Africa is to allow inmates to carry their own medications. It shifts the onus of healthcare to the inmate, and allows the inmate to be in charge of his/her own health. It goes without saying that this would need to be coupled with adequate access to nutrition.
Implementing those two policies would be relatively inexpensive. However, the issue of overcrowding, which impacts on the first two problems, is a different matter.
Expanding prisons and hiring more correctional officers to maintain them is a necessity. By doing this, the department will be able to better implement its policies in a stronger and much more effective way.
The political will to carry this out, however, seems to be lacking. Not to mention finding the funding.
There is an overall notion that prisons in South Africa have the responsibility to rehabilitate inmates so that they may one day reintegrate into society. The onus to fulfil these responsibilities is on the government and the Department of Correctional Services. However, the general public also has responsibility to demand better from the department because without the public demand for changes in correctional institutions, the prisons will remain overcrowded and a breeding ground for gang culture – a prime factor perpetuating the spread of HIV/Aids.
The increase in the prevalence of the disease in prisons will only prove to be a greater burden on the country’s resources, and it is in everyone’s best interest that the government takes appropriate measures.
By continuing to turn a blind eye to this epidemic, we are ignoring aspects of the Constitution and convicting these inmates and their families twice – once for their crime and another to a life of pain, suffering and isolation.
It is time the government and the Department of Correctional Services take their heads out of the sand and bring about the necessary changes.
Venekai Chitanda