UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS
AIDS awareness in Colombo prison
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October 2007
Colombo, Sri Lanka
Nitin Jugran Bahuguna
Situated in the very heart of Colombo is Welikada prison, a historical building housing both male and female prisoners. According to popular myth, the two units within the prison complex - the Magazine Male prison and the Magazine Female prison - are so named because the building was a safe haven used by the colonial masters to store ammunitions.
Today, what distinguishes the building is that the female section of the prison is over seen by an all-women staff. Unlike the male section where the under trials are segregated from the convicts and hardened criminals, the female unit is home to all categories of prisoners.
But as they sit grouped together in a large common room, engaged in animated discussion, it is hard to imagine that they are not one homogenous entity. The topic of discussion is another surprise, for they are talking about the deadly virus - HIV - and how to protect themselves from it.
Revathi, who is serving time for a drug related offence, points to two inmates who are now demonstrating how to use a condom. "Before coming here, I could never imagine being a part of such a group activity as women in our culture don't talk about sexuality," she says frankly.
The scene is indeed unique and one of the fine examples of HIV/AIDS care and prevention initiatives which have been introduced in prisons. The programme is being implemented by the United Nations Office on Drugs and Crime (UNODC). But for a majority of prison populations in South Asia, the success of HIV-related prevention and treatment programmes remains limited.
Prison populations tend to be high-risk groups for the spread of HIV, both because of the activities in which they engage before and while in prison, and because of the unique characteristics of the prison environment. HIV prevalence among prison inmates is also typically found to be higher when compared with the general population.
Effective policies to prevent spread of HIV inside prisons and other correctional institutions are often hampered by a number of things - the denial of the existence of the factors that contribute to its spread; overcrowding, unsafe sexual activities and drug abuse; violence, gangs and lack of protection for young, female and weaker inmates. Corruption and poor prison management also play a role.
These factors create an environment that increases the vulnerability of the prisoners to HIV infection and diseases such as tuberculosis, hepatitis and sexually transmitted infections.
Nevertheless, through ongoing interventions such as the one in the 600-strong women's jail in Welikada prison, UNODC has been able to demonstrate the effectiveness of the peer approach inside prison settings. Through group discussions, role plays and games like snakes and ladders, the inmates spread the message of HIV prevention and care among themselves.
Apart from the prisoners, the wardens and other staff are also provided information on how to promote confidential and voluntary counseling, testing and psychological support, states Dr Jayadev Sarangi, Prison Expert at UNODC's South Asia office, who is overseeing the Welikada prison intervention.
"If the prison is not safe, it'll become a danger to the society. These prisoners are going back to their husbands, wives or sexual partners. When you have such a high-risk situation, it's difficult to control HIV/AIDS," Dr Sarangi observes.
For inmate Vani, an ex-drug abuser, the intervention has brought about two magical changes in her life - knowledge and empowerment. "If you don't have knowledge, you are very likely to get into trouble. With proper knowledge dissemination, I now know what is right and wrong," she confesses candidly. "We believed that a syringe was properly cleaned by wiping it with a cloth or tissue. Now I know that is a myth and that reusing such syringes is dangerous as it could be infected from a previous user having HIV."
Another prisoner, Shreelatha, a sex worker, praises the programme for providing life skills to the women. "Just having knowledge about HIV and condom use is not enough. We need to have skills to negotiate safe sex with clients. If you don't have such skills, you are more vulnerable to infection," is her frank diagnosis.
"The group activities among the women prisoners have raised confidence levels and motivated us to go for STI/HIV testing," adds Revathi.
The fact that prison inmates are an important vulnerable group to HIV/AIDS was highlighted at the recent 8th International Congress on AIDS in Asia and the Pacific (ICAAP) recently held here. "HIV/AIDS prevention and care for prisoners should be equivalent to that available in the general community and drug treatment should be offered as an alternative to jail for those who are dependent on substances," underlined Mr Gary Lewis, UNODC's Representative for South Asia.
"We advocate that general prison conditions should be scrutinised, both internally and externally, and that prisons should be secure, safe and orderly so that the risk of HIV is reduced," he said in a special session on 'HIV/AIDS Prevention, Care and Treatment in Prison Settings'.
Worldwide at any given time, there are approximately 10 million prison inmates, with an annual turnover of 30 million. Thus, after release, millions of prisoners return to social networks in the general community, thereby facilitating the spread of HIV to the community. "In South Asia, you have the problem of overcrowding. For instance, in the prison that I used to head, we have 14,000 prisoners at one time and the turnover in a year would be 100,000," informs Dr Sarangi.
Given the high numbers, one has to keep track of those released and continue to give them care and treatment failing which the intervention in the prison will not be effective, he points out. According to a recent International College for Prison Studies, Kings College, London, the occupancy level in prisons are: Bangladesh - 277.1 percent; India - 139 percent; Maldives - 147.4 percent; Nepal -142.6 percent; and Sri Lanka - 193.2 percent.
Other challenges in the prison include the continued denial by authorities of the existence of unprotected sex and drug abuse, high prisoner turnover, low civil society participation, low awareness of HIV and AIDS, coercion of men to have sex with other men and inadequate protection mechanisms for the weak and vulnerable. "If you don't defeat denial, you can't address the issue. And, in a prison, on your first night, you're raped. There is no systemic protection and you carry the virus home," adds Sarangi.
Currently, UNODC is supporting 22 prison intervention sites in South Asia (Two in Bangladesh, four in India, one in Maldives, one in Nepal and 14 in Sri Lanka), reaching out to over 20,000 prisoners and building capacities of 4,250 stakeholders such as prison officials, welfare officers, doctors and NGOs.
(Names of women prisoners have been changed to protect their identities)
