Tackling HIV in prisons

“The last thing you want to find out after serving your jail term in prison for possessing drugs is that you are HIV positive,” says Fortunatus Domalale.

That is what happened to Fortunatus Domalale, a former scrap dealer whose drug addiction led him to spend two years in prison without the knowledge of his family back in the Upper West Region, where he comes from.

He left Samatugu, his hometown, five years ago to the nation’s capital to seek greener pastures, leaving his old mother and other siblings back in the village.

Fortunatus contracted HIV, having unprotected sex long before he entered prison.

In some way, he had prison to thank because it was in prison that he was first diagnosed and treated, but unsurprisingly, the care he received as a prisoner with AIDs was somewhat lacking.

Getting the right drug and getting them on time are challenging, especially in Ghana, where the prison service is not medically well-resourced.

Their infirmaries cannot be matched to the standards of infirmaries in prisons of other developed nations like the United States of America, United Kingdom and the rest.

Ghana’s prisons have over 15,000 inmates, including officers, but they have no hospital of their own to cater for the health needs of inmates and officers as compared to other security services that have their own health facilities that cater for personnel and their families.

The Police Hospital provides medical care for officers of the service and their dependants, while the 37 Military Hospital, belonging to the Ghana Armed Forces, prioritises the health needs of soldiers and their families.

“Come to think of it, jail is a terrible place to discover that you have AIDs as an incarcerated fellow,” Fortunatus declares, adding that “you are thinking about how to get out of that place where you have been locked up and at the same time thinking about the sickness which will lead you to your grave,” he points out.

Statistics

Records from the Ghana Prisons Service indicate that in 2016 alone, about 224 inmates, including 32 females, were diagnosed with HIV in the 43 prisons across the country.

Though records available indicate that most of the inmates with HIV were affected before they entered into the prison, incarceration offers ample opportunities to spread the virus.

High-risk behaviours such as blood covenants, sharing of unsterilised skin piercing and sharp instruments like razor blades, needles and unprotected sex are some of the imputed malpractices common in a prison setting.

The affected inmates, according to Josephine Fredua-Agyemang, Director of Prisons in-charge of Welfare of inmates, staff and their dependants, come with little or stark ignorance about HIV and TB, and these inmates are those who indulge in risky lifestyles oblivion of its implications.

“Nsawam Medium Security Prison recorded the highest number of inmates with the diseased with a total of 68 inmates, including 12 females,” DDP Charity Araba Magusen, in-charge of Nsawam Prisons Health Centre, discloses.

In Akuse, 11 males and one female were diagnosed with the disease, while 12 were also diagnosed with the disease at Koforidua Prisons.

Most of the inmates diagnosed with HIV are said to be having tuberculosis as well, according to reports from the Planned Parenthood Association of Ghana (PPAG).

At an annual national advocacy session organised for heads of the various prisons in the country and other stakeholders in Accra, Madam Fredua-Agyemang reveals that these high risk behaviours and practices among inmates have been the main cause of the spread of the diseases in prisons.

Fortunatus says sharing personal hygiene kits in prison among friends is a common practice among inmates.

Those without razors can borrow one (used ones) from inmate friends to use after which they return them.

“In prison, we do things together; a good friend who is often visited by his family and friends, sometimes share their things with those of us who are not visited at all,” he narrates.

There are no barbers in prisons where inmates who would want to have their hair trimmed can go for their haircuts; hence they depend on friends to shave their hairs.

Fortunatus adds that one blade can be used to shave the hair of more than two people without thinking of its implications.

He says since none of his family members knew he was in prison, he depended on friends for his needs.

HIV Stigma In Prison

In previous years, HIV has been portrayed as a disease that is so dangerous to the extent that contracting it means the carrier has signed his or her death sentence.

Persons carrying the virus were often shunned by family and friends for fear of contracting the disease.

Fortunatus says this behaviour is not different in prison.

“Prison is also like a community for us inmates and so if one is diagnosed of the sickness, everybody redraws from you; nobody would want to draw closer to you,” he says.

Stigmatisation is a bigger issue that the Ghana AIDs Commission (GAC) and its stakeholders have over the years been fighting against but are yet to win the war against that.

Fortunatus says, “No one wants to come near you in prison if they know you have AIDs, so most people try to hide their diagnosis.”

This stigma stays with many HIV patients after their release since they fear that their families will also reject them.

“Some of us inmates are often rejected by our communities after serving our sentence and one cannot afford suffering the stigma of being an ex-convict and having HIV in addition,” Fortunatus opines.

The Ho Regional Commander of the Ghana Prisons Service, Victor Agbelengor, confirms that the issue of stigmatisation is very real, and it has to be addressed as soon as possible.

He suggests that if possible, there is the need for HIV statuses of the inmates be confidential and be treated as such at all times.

Meanwhile, Dr James Amuzu, Executive Director of PPAG, reveals that the organisation is ready to provide education and training for the prison officers upon their request.

HIV Outreach In Prisons

Health professionals posit that prevention is better than cure, and Madam Fredua-Agyemang confirms that advocacy programmes over the period have significantly contributed towards the well-being of officers and inmates.

Available statistics by Global Fund of cases involving inmates at the various prisons establishments bear eloquent testimony.

“It is on record that over 10,550 inmates representing 73 percent of inmates have been reached with HIV prevention programmes, Anne Marie Affainie – Godwyll, Programme Manager of Global Fund,” mentions.

A total of 181 prison officers have also been reached with the advocacy session to enable them to best handle inmates carrying the disease from spreading.

About 645 peer educators being inmates have also been selected and trained on tuberculosis and HIV-related topics to educate their fellow inmates on HIV.

Eight-six prison officers who serve as escorts during the peer educators training for the selected 645 inmates also benefitted from the training.

Fortunatus says the peer educators often held one-on-one and small group discussions for the inmates.

Other activities such as film shows, drama performances on HIV & AIDs and TB are often organised for inmates as a preventive measure to curtail the spread of the disease.

Screening Of The Virus In Prisons

Some of the commanders in the 43 prisons across the country who attended this year’s annual national advocacy session organised for heads of the various prisons confirmed that some of the inmates receive their HIV test during the reporting periods and know their status, but it is done voluntarily.

“In 2015, a total of 8, 601 received HIV test during the reporting period and out of that, 20 of them were discovered with the virus and were referred for evaluation and treatment,” Ms Affainie-Godwyll says.

In 2016, however, the number reduced to 7,835 prisoners receiving HIV test on reporting and 106 were diagnosed of the virus and were also referred for evaluation and treatment.

Those who do not undergo the testing are later counselled by the peer educators to see the need to know their status.

State Of Prison Infirmary

Superintendent Vitalis Aiyeh, Chief Public Relations Officer of the Ghana Prisons Service, confirms that all the 43 prisons have infirmaries but had no assigned medical doctor to attend to patients.

He says incarcerated health professionals sometimes assist the prison officials to cater for the health needs of the sick inmates at their various infirmaries.

“We do not have the logistics but we are doing our best,” he admonishes.

Inmates who have special medical cases like those with HIV, TB and other diseases are often secluded from the others and given special care by officers.

Those on drugs are often given drugs that are available at the infirmaries and those who are to be transferred to see specialists are often taken to the various government hospitals for treatment.

He states that for HIV patients, the meals served them sometimes are highly nutritious than the normal meal given to the rest because they need extra nutritional support to take their drugs.

However, James Adu-Mensah Danfoku, HIV focal person at the Ghana Prison Service, confirms that not all prisons have food supplements for HIV positive inmates.

Some prison commanders also confirmed that their prisons did not have enough funds to cater for confirmatory test.

As a result, some health facilities have refused to treat inmates due to debts accrued by the prisons.

Some of the inmates who have not been enrolled on the National Health Insurance Scheme (NHIS) are often not able to access treatment at the government facilities as well.

Madam Charity Araba Magnusen of the Nsawam Medium Prisons confirms that inadequate supply of drugs of the anti-retroviral drugs at referral points is also a challenge to officers, since most prisoners living with HIV are rather being treated with Septrin at the prison infirmaries.

The Way Forward

Prison health issues, they say, are also public health issues, and Fortunatus suggests that government and other non-governmental organisations (NGOs) come in to assist inmates with personal hygiene kits to discourage inmates from using others used razor blades.

Superintendent Vitalis Aiyeh suggests that since health service is a major issue in the prison sector due to overcrowding and congestion, efforts should be put in place to make screening for diseases, especially HIV, mandatory before individuals are admitted.

Fortunatus is, therefore, appealing to the Ministry of Interior, with oversight responsibility of the Ghana Prison Service to, as a matter of urgency, ensure that they also get a health facility to serve the needs of inmates.

By: Linda Tenyah-Ayettey

Email: lindatenyah@gmail.com