‘Prison conditions seedbed of HIV, TB transmission’

LINEO MABEKEBEKE

MASERU – As in many countries, there are a number of key affected populations in Lesotho, one of them being prison inmates and studies show that prisons are a high-risk environment for HIV transmission. Again, prisoners who are already HIV-infected often end up with very weak immune systems because of overcrowded living conditions, making them more vulnerable to getting ill.

With numerous HIV service gaps in prisons in Lesotho, the HIV/AIDS epidemic still presents a major challenge, with prevention programmes having been shown to rarely reduce HIV transmission for inmates, while many prisoners with HIV are unable to access life-saving treatment. A prison term of three years for ex-inmate Tello Motsitsi of Koung, Qacha’s Nek presented many risks, including the possibility of contracting HIV/AIDS. From the very first day, Motsitsi could tell that inmates are many times more likely to acquire an HIV/AIDS infection than on the streets.

He identified several factors that exposed them to HIV infection as well as contracting TB within the prison system, which included coerced sexual intercourse given in exchange for toiletries, food, and other privileges such as protection from others.

During his stay, he could also tell that the facility does not regularly supply enough condoms and lubricants for inmates. “Not only did we lack those commodities, but none of the organisations that deal with HIV/AIDS provided us with information on the correct use of them or how we should protect ourselves from the disease,” he says.

Apart from that, he says the requirements that enable ART to be effective, including adherence and access to proper nutrition, were not fully catered for within the facility. He says despite the little knowledge that one may have to protect themselves from being infected, it is a matter of fact that the health and well-being of prisoners are often neglected and overlooked.

“Prisoners are among the most neglected of the key populations, bearing higher burdens of HIV,” Motsitsi adds. “In most cases, the inmates are not aware of the high risk they are confronted with; they end up being engaged in actions that may expose them to HIV, with HIV responses that are large, failing key populations, including people in prisons and other closed settings,” he says.

He also notes that prison conditions are conducive to the spread of infectious diseases such as HIV and TB, characterised by overcrowding, insufficient and intermitted access to sanitation and hygiene, as well as inadequate nutrition, among others.

“People in prisons and other closed settings still face barriers to accessing evidence-based HIV prevention, testing, treatment, and care,” Motsitsi explains. While serving his three-year term from 2018 to 2021, despite their fears, he says prisoners continued to do what prisoners do; high-risk sexual behaviour remained the norm.

“Finding out I was positive took a toll on my self-esteem. But with every easy acceptance, I am regaining confidence and starting to love myself even when others do not. All these I gained after I left the prison, because no one in there made me know myself better than I do now,” he says.

Although Lesotho has made significant advances in the fight against the disease, Motsitsi says there is still a lot of work to do, focusing on prisoners. As a way of assisting facilities to reduce the high risks of contracting HIV and other diseases, a peer educator from Phelisanang Bophelong, Tsatsi Ramoepane, says all they do is facilitate sessions that give information to inmates about HIV/AIDS testing, voluntary medical male circumcision (VMMC), TB, and STI screening.

Among others, they also supply condoms which are readily available. They are working with all facilities, including male and female prisons, as well as juvenile centres. According to the UNAIDS human rights fact sheet series of 2021, inmates have the right to the highest attainable standard of health and to accessible health services, including HIV and TB, without discrimination.

The report says the services should be equivalent to those available in the community. An Ombudsman report on the inspection of correctional services facilities in 2023 indicates that access to adequate and comprehensive health care for inmates was limited and highly compromised in some facilities.

Inmates were reported to easily and regularly contract communicable diseases such as the common cold, tuberculosis, and coronavirus due to poor hygiene practices. It was observed that there was also an insufficient supply of drugs and medical instruments to treat detainees. Most facilities had health services in place that were poorly stocked and manned, with inmates being given paracetamol for all ailments, irrespective of the seriousness of the illnesses.

“In some institutions, there were specific dates designated for the inmates to get medical attention, while at others, such as Quthing, Qacha’s Nek, and Thaba-Tseka, there were no nursing officers in-house,” the report highlights.

Inmates reported that there were delays in getting medical assistance, which led to some of them dying in the cells. “This compromises the quality of health care services deemed necessary for our well-being,” they say.

Levels of adherence to health care were found to be highly compromised due to the limited health services and manpower within the facilities. On a positive note, the Ombudsman noted that the Maseru Central Prison has a newly constructed structure for a clinic funded by the United Nations Development Programme (UNDP) that is yet to be opened for use.

It is anticipated that issues surrounding inmates’ health and their healthcare will be adequately addressed within this facility. However, the Ombudsman applauds efforts to curb the spread of communicable diseases within facilities but is concerned about the extended isolation periods which, although intended to prevent the spread of diseases internally, may mentally affect detainees with depression, anxiety and the like.

As such, strict isolation timelines set out in facility rules and standards should be adhered to so that medically fit inmates can be moved to normal cells once the isolation period is completed. “Further, the conditions under which inmates live not only threaten their health from within the facilities as officers and the population at large are also at risk because inmates are not a static population as they move around the correctional facilities system and back and forth between the facilities and the outside world.

“As such, addressing communicable diseases such as COVID-19, HIV, and TB inside facilities is crucial not only for their health and well-being but also to prevent the spread of these diseases,” the Ombudsman recommended.

The office further suggested that the budget should be increased to ensure adequate and consistent drug supply within 12 months of the issuance of the report and that the Lesotho Correctional Services (LCS) should offer periodic hygiene and health education on selected relevant topical issues, such as communicable diseases, to inmates occasionally in order to maintain their healthy behaviour.