HIV in Prison
Prisons have often been described as "incubators of disease." Several factors contribute to this description, especially in Africa and Central America, including overcrowding, lack of medical supplies and lack of protection from sexually transmitted diseases provided to the inmates. Thus, HIV thrives in the environment of a neglected prison and legal system. In many cases, incoming prisoners are already infected with HIV due to poverty and devastation, conditions that often lead to criminal behavior and unprotected sexual activity. Holding pretrial detainees for prolonged periods of time in the same area as those already convicted is often caused by perpetual overcrowding that can exacerbate the spread of HIV. Overcrowding is a real problem, as sixty percent of all countries have admitted that their prisons are over capacity. Moreover, international data indicates that the prevalence of HIV is six to fifty times higher in prisons than that of the general population. Additionally, those who are already infected before imprisonment have a higher risk of dying from HIV or HIV-related diseases in prison due to the lack of medical care.
Another major cause for concern is the spread of HIV within the non-prison community. There are approximately thirty million prisoners who are imprisoned and freed every year. Inevitably, a large amount of those released are HIV positive. When reviewing all of the deficiencies that result in HIV, such as education, protection and medical care, it becomes evident that the spread of HIV is not only a health issue but has become a human rights issue as well.
Causes of HIV in Prison
The spread of HIV is rampant in the prison setting because of several issues that build upon each other. The most devastating problem, as mentioned before, is overcrowding. A report on the prison conditions in Tanzania stated that the country's maximum capacity of 27,600 prisoners is exceeded by an additional 12,300 detainees.  In South Africa, the provincial deputy director of health services in the Department of Correctional Services, King Kumalo, reported, "In a cell [that is] supposed to hold twenty inmates, you might find up to eighty inmates." This occurs despite the urgings from departments within the United Nations to ensure that one cell is given per individual for sleeping accommodations.
Additionally, the amount of HIV positive prisoners is unknown in such congested environments. For example, Russia may have a total of HIV cases between 700,000 or 1.5 million yet only 235,000 cases have been officially reported. These numbers are quickly amplified when many penitentiaries are over 200% filled.
The negligence that is inevitable when prisons are over capacity causes vast food deprivation and extreme hunger. Many times, if the HIV positive prisoners are fortunate enough to have access to medications, they have major difficulties taking their medicine because of their malnourishment. The immense lack of sustenance also leads prisoners to resort to desperate acts such as exchanging sexual acts for food.
The lack of medical care and supplies is a major detriment caused by overcrowding. In many prisons, medical aid is not readily available. In fact, according to a 2008 Human Rights Report, Tanzania has no active programs focused to aid the 9.2% of prisoners that are HIV positive. Moreover, the access to and spread of information about the prevention and cause HIV is poor. This results in the seldom, and even refused, distribution of condoms in prisons because of the belief that it will encourage homosexuality.
Overcrowding also lessens the amount of protection and supervision that is given to each prisoner. This leads to unnoticed violence, the taking of intravenous drugs, as well as a lack of protection for the most vulnerable victims--often resulting in rape. The deficiency of protection in prisons is so extreme that "prostitution rings" have been reported, "in which guards are involved in smuggling juveniles into the adult blocks, sometimes for as little as 30 US cents." The fact that juveniles are rarely separated from the adults in overcrowded prisons augments this practice immensely.
Every human being is entitled to live in a safe environment free of intimidation or abuse. Inadequate prison conditions are a blatant violation of these basic human rights. The World Health Organization (WHO) stated "all prisoners have the right to receive health care, including preventative measures, equivalent to that available in the community without discrimination. Programs should apply equally to prisoners and to the community." Moreover, if HIV is not treated and prevented in prisons, there is a possibility that it will spread throughout the community by the freed inmates. In Mozambique, an impressive 30% of prisoners are HIV positive, while 16% of the country's civilians between the ages 15 and 49 are HIV positive.
Solutions to HIV in Prison
The HIV situation in prisons around the world may appear grim but there are several ways in which it can be improved. First, the reduction of pretrial detainees will help prevent overcrowding and its ensuing problems. Reformation of the criminal justice system will help reduce the number of pretrial detainees. Reduction can also be achieved by "promoting punishment alternatives for those who commit minor crimes", as stated by the United Nations. Second, augmenting financial investment in order to build new facilities would also reduce overcrowding. Third, the United Nations Office on Drugs and Crime (UNODC) proposes the separation of juveniles from adult prisoners to reduce the chances of sexual abuse and further spread of HIV. Finally, education is another factor that would help immensely in the reversal of the HIV crisis in prisons. The proper training courses for prison officials could aid in minimizing this disease. Officials must be educated not only on prison security but on HIV facts and how it can be prevented. Through these initiatives the spreading of HIV in countries through inadequate prison conditions, especially in Africa and Central America, can be eliminated.
- HIV and Prisons in sub Saharan Africa.: Opportunities for Action. http://www.unodc.org/documents/hiv-aids/Africa%20HIV_Prison_Paper_Oct-23-07-en.pdf