HIV infected prisoners’ suffering

by Khopotso Bodibe

It was September 2005. South African Aids activists were busy focusing on countering rampant Aids denialism and trying to get government to speed up access to antiretroviral medication for millions of HIV-positive citizens.

At Durban’s Westville Prison, another sad chapter in South Africa’s Aids history was starting to play itself out.

Fifteen HIV-positive male inmates were fighting for their lives.

While the country was trying to put structures in place to make access to antiretrovirals easier for the general population, prison authorities were denying these men access to lifesaving treatment.

Court papers would only identify them by their initials: EN, BM, DM, EJM, LM1, MAZ, MSM, ND, SEM, TJX, TS, VPM, ZPM and LM2.

Some of these anonymous prisoners died by the time lawyers and activists became aware of their desperate plight. The Aids Law Project (ALP), a non-profit human rights-based law firm, pulled out all the stops after being alerted to the men’s plight in September 2005.

None of the men was on ARVs despite the fact that the Department of Correctional Services (DCS) had known they were in urgent need of the medication.

In the case of MSM, the department had known since November 2004 that he needed ARV treatment, yet he would not receive any until July 2006. He died a few weeks later. The lives of four other men – EN, DM, EJM and BM – were also hanging by a thread.

Medical records revealed that these prisoners had full-blown Aids by 2005 – with 13 having CD4 counts of less than 100. ARV treatment is supposed to start once a CD4 count is 200.

An estimated 110 Aids-related deaths had occurred at Westville since the beginning of 2005 and about 50 offenders with a CD4 count of less than 200 were housed at Westville.

Yet many of those who urgently needed antiretroviral treatment were not getting it.

This was despite the Cabinet’s approval in late 2003 of a comprehensive plan for the treatment of HIV/Aids that included inmates.

When quizzed on why ARVs weren’t being given to inmates at Westville, the DCS’s official response was that the Health Department required individuals to have a valid South African ID before they could enrol for treatment.

More than 200 enraged HIV-positive inmates at the prison embarked on a three-day hunger strike in March 2007 to demand treatment. The Treatment Action Campaign (TAC) revealed that in the three months preceding this strike, more than 20 inmates had died of Aids-related infections. A further 78 had died in the preceding year.

The hunger strike came about after months of negotiations with prison authorities to resolve the obstacles to prisoners’ ARV treatment.

Westville Prison officials also argued that they had difficulty accessing public hospitals. The prison had an arrangement with the nearby King Edward VIII Hospital but the hospital would only book four prisoners a week.

The ALP was first alerted to the 15 Westville inmates in September 2005 by TAC volunteers who were running education programmes in the prison. ALP lawyers, led by Jonathan Berger, visited the prisoners in October to establish the facts. The ALP immediately wrote a letter to the DCS and the authorities of Westville Prison to notify them of the prisoners’ complaints and asked that those inmates who qualified for treatment receive it.

At a subsequent meeting held between the DCS and the ALP in December 2005, the department undertook to fast-track the provision of ARV treatment to those prisoners.

This did not happen and only a few inmates got treatment, some when it was too late.

The ALP eventually filed an urgent application with the Durban High Court on April 12, 2006, on behalf of the inmates at Westville.

By that time, one of the 15 inmates had been released on medical parole, while another had received ARV treatment. The court application aimed to ensure that the remaining 13 prisoners be put on ARV treatment immediately.

As a result of the application, the Departments of Correctional Services and Health requested a meeting with the TAC (also an applicant in the case), and the ALP on April 25, 2006. At the end of the meeting, it was agreed that the 13 applicants would begin treatment within three weeks. The ALP agreed not to proceed with the case if the government parties noted the agreement in writing by Friday, April 28, 2008. But they failed to deliver and the ALP proceeded with litigation. An urgent application was brought before the Durban High Court on behalf of the prisoners on May 3, 2006.

In the court papers, the ALP indicated that it wanted the government to be compelled to provide ARVs to the 13 inmates and all others who needed immediate treatment.

On June 22, 2006, Durban High Court Judge Thumba Pillay granted the relief. Not surprisingly, the government appealed. But Judge Pillay made an interim execution order that compelled government to provide ARV treatment to prisoners in line with the earlier order, pending the outcome of the appeal.

On August 28, 2006, Judge Chris Nicholson upheld the earlier interim execution order. He criticised the government, which had still not made any attempt to improve its ARV rollout programme at Westville, saying it was in contempt of Judge Pillay’s order. Following the court ruling, the DCS slowly started to accredit correctional centres to provide antiretroviral therapy at the beginning of 2006.

By the end of September 2006, health facilities at four correctional centres had been accredited to provide ARV treatment.

Accreditation of more prisons has been ongoing since then.

Correctional centres that don’t have the capacity to provide the service now routinely send inmates to accredited health facilities for ARV treatment.

The DCS noted in December 2007 that 20 percent of prisoners were HIV-positive. However, the real figure is likely to be higher as it excludes awaiting-trial prisoners.

A study released by the Institute for Security Studies (ISS) in 2003 showed that about 41 percent of inmates were HIV positive and that since 1995, reported cases of HIV/Aids in prisons had risen by an astounding 750 percent and natural deaths by about 600 percent.

Overcrowding also creates a fertile environment for sexual assault. South African prisons have the capacity for 114 559 prisoners but are currently accommodating over 165 000. High-risk sex is commonplace in prisons, usually in the form of unprotected anal sex and rape. Two of the most powerful prison gangs are the 26s and 28s, with the latter’s power structure reputed to be based on homosexual partnerships and the prostitution of certain male inmates.

Rather than accepting the reality of sexual activity and the attendant risks, most prison authorities in South Africa do not make condoms easily available. In many prisons, inmates have to approach a medical officer to ask for condoms. The reason for this not clear.

The only logical conclusion is that policy-makers are uncomfortable with anything linked to homosexuality. As long as rape and sodomy in prisons are ignored, they will remain among the main driving factors behind South Africa’s HIV epidemic.

• Khopotso Bodibe is Health-e News Service’s radio Editor. This is an edited extract from The Virus, Vitamins and Vegetables, published by Jacana Media.