Prison officials attend HIV/AIDS workshop

Guyana Chronicle
June 1, 2000

PRISON officials throughout Guyana participated in a two-day training workshop on how to deal with HIV/AIDS in jails in the face of sexual contact between male inmates, said to be a common practice in prisons around the world.

Guyana's prisons are in the same predicament as all other prisons around the world, with fewer resources for management and programmes, Dr Maxine Swain, Programme Manager of the National AIDS Programme Secretariat, told participants on Tuesday. The workshop was conducted at the prison service sports club on Camp Street, Georgetown.

According to Dr Swain, some of the sexual activity is consensual and some coerced to a lesser or greater degree.

"Rape also exists. Sex between men in prison includes anal sex," she lamented, adding that unprotected, this is a high-risk factor for HIV transmission.

The risk is even greater if lubrication is not used, and if the sex is forced, as in the case of rape. Condoms are not available in prison as a rule, Dr Swain observed.

Because HIV/AIDS in prison remains a difficult and controversial subject, Dr Swain emphasised that the activities in prisons are usually criminal within the prison environment and meet with disciplinary measures, not health measures.

The workshop is sponsored jointly by the National AIDS Committee, the National AIDS Programme Secretariat and the Guyana Prison Service. Ms Merle Mendonca of the National AIDS Committee chaired the opening session.

The topics covered included pathogenesis prevention, testing management, medical and ethical considerations, and methods to devise a management strategy.

With regards to effective HIV/AIDS prevention and care programmes, Dr Swain maintained that prisoners have a right to be provided with the basic standard of medical care available in the community.

Sometimes prisoners are isolated or placed in particular wings of the prisons, but Dr Swain warned that if such measures are carried out, they should be done without any reference to whether the inmates are or are not infected with HIV.

Isolation of prisoners on the grounds of their HIV status does not generally help reduce transmission of the virus, she said.

Guyana, she added, has probably one of the most advanced AIDS epidemics in the Western Hemisphere as suggested by the "patchy" data available, she said.

Dr Swain disclosed that according to the UN-AIDS classification, Guyana is one of the few countries in the Americas with a generalised epidemic - HIV has spread beyond the vulnerable groups into the general population.

From 1987 up to 1999, a cumulative total of 1,602 AIDS cases has been reported to the Ministry of Health.

The actual figure is likely to be two to three times higher according to estimates made during a 1997 review of the surveillance system carried out by the Ministry of Health and CAREC-CTZ.

HIV-1 sero-prevalence rates have been measured in several surveys, which, however, were not often well documented, Dr Swain told the forum, adding that rates ranged from three per cent to seven per cent in antenatal care (ANC) attendees and from 21 per cent to 45 per cent in vulnerable groups.

"HIV prevalence in many prisoners is already high - higher than the population at large - and still increasing," she said, pointing out that those who are HIV-positive in prison were already infected on the outside.

Dr Swain emphasised that prison conditions are ideal breeding grounds for onward transmission of HIV infection and these can be divided into general and specific factors.

She pointed to general factors such as overcrowding, a climate of violence, tension and fear, lack of information about HIV and a lack of adequate facilities.

The specific factors are injecting of drugs with shared, unsterilised needles and syringes (which is not a problem in Guyana), unprotected penetrative sex between men, and tattooing with shared unsterilised equipment.

And Director of Prisons Dale Erskine observed that management of prison systems throughout the world is becoming more complex and demanding in the efforts to maintain safe and humane environments for prison populations, particularly their health care.

He maintained that the prison populations reflect and magnify society's problems.

Poverty, dysfunctional families, unemployment, lack of education, substance abuse, physical and sexual abuse and neglect are recognised as contributing factors to the development of criminal behaviours.

Erskine noted that many inmates come from medically under-served communities, or have indulged in behaviours that have lead to disease or a compromised health status.

More often than not, the prison setting is the only place that provides an opportunity for these medical problems to be identified and addressed, he said urging the prison officers to first understand the legal rights of inmates to receive health care services.

"I am positive that this forum will provide the knowledge base that will allow us to reduce risk behaviours modification, in that, inmates as well as ourselves can become more informed and active participants in health care with reference to HIV/AIDS," he said.

Erskine called on his staff to try to understand the scope and dangers of the disease and the humane treatment and right of infected inmates.

Chairman of the National AIDS Committee, Mr Andre Sobryan said that the four objectives of the body are to promote and advocate the work of the National AIDS Programme; to further develop and ensure the implementation of the National AIDS Policy; to provide a networking mechanism which would allow Non-Government Organisations, governments, donor agencies and others to secure these objectives; and to act as an advisory body to the Minister of Health on the HIV/AIDS situation.

He explained that the National AIDS Programme benefits from the full support and expertise of the National AIDS Committee.

The National AIDS Policy has already been circulated among the medical personnel in Regions Three, Four, Five, Six, Seven and Ten, Sobryan said.

He stressed that the prison workshop was a ground-breaking exercise and the beginning of networking between the National AIDS Committee and the Guyana Prison Service.(ROBERT BAZIL)

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