Prisons have to confront realities of HIV transmission - Dr Swain Officers sensitised on issues Stabroek News June 1, 2000 The Prison Service is cognisant of its responsibility to not just treat the medical conditions of inmates but to also advocate healthy lifestyle changes and reduction of high risk behaviour particularly as it relates to the HIV virus. This was stated by Director of Prisons (ag) Dale Erskine on Tuesday at the opening of a two-day workshop for prison officers held at the Prison Officers' Sports Club. The workshop formed part of the National AIDS Committee's (NAC) outreach programme and was held in conjunction with the National AIDS Programme Secretariat (NAPS) and the Guyana Prison Service (GPS). The purpose of the workshop was to provide officers with the information needed for the effective management and prevention of the spread of the Human Immuno-deficiency Virus (HIV) which causes AIDS. "As prison officers we must recognise also that health education in this respect in the prison setting is an essential part of the health care programme," Erskine told his colleagues. And according to Programme Manager of NAPS, Dr Maxine Swain, prison conditions were often ideal breeding grounds for onward transmission of HIV. She said that the epidemic was already high in most prisons--higher than the population at large--and still increasing. "Many of those who are HIV positive in prison were already infected on the outside," she said. The spread of the virus in prison could be divided into two factors--the general and the specific. The general factors were listed as overcrowding, a general climate of violence, tension and fear, lack of information about HIV, and lack of adequate health facilities. The specific factors were injecting of drugs with shared unsterilised needles and syringes, unprotected penetrative sex between men and tattooing with shared unsterilised equipment. Dr Swain said that the fact that the virus which causes AIDS was found in prisons was a cause for utmost concern, not only for the prisoners and prison staff, but also for the society in general. She noted that prisons were not cut off from the world outside and pointed out that most prisoners left prison at some point and returned to their communities; some after a short period of time inside. According to her, both prisoners and prison staff ran the risk of HIV infection in prisons. Although sex between men in prison was commonplace condoms were not available in prisons as a rule. "Drug use and men having sex with other men in most societies are illegal, or condemned by sections of cultural or religious opinion. Such behaviours within the prisons are frequently outlawed," Dr Swain said. She continued that this strict illegality of various forms of behaviour in prison resulted in denial that the activities took place and a great difficulty in even starting to discuss ways to overcome the problems. According to Erskine, the management of prison systems throughout the world was becoming "more complex and demanding" in the effort to maintain safe and humane environments for their populations, particularly their health care. "One would appreciate that prison populations reflect and magnify society's problems. Poverty, dysfunctional family life, unemployment, lack of education, substance abuse, physical and sexual abuse and neglect are recognised as contributing factors to the development of criminal behaviours," the prison head said. When examined closely, "we see that these social factors also contribute to the mental and physical health problems and behaviours that impact on the well-being of offenders," he said. Erskine saw the above factors as being so tightly interwoven that it was difficult to untangle the many intricacies and isolate a single causal thread for the criminal or health risk behaviour. "It is known that many inmates come from medically underserved communities, or have indulged in behaviours that have led 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. He acknowledged that as prison officers they must first understand the legal rights of inmates to receive health care services. He further said that they must all feel the obligation to give the best care that they could to inmates. This, he said, would be done in the context of the available resources and those they could source. The situation was an urgent one and it involved the rights to health, security of person, equality before the law and freedom from inhuman and degrading treatment. "It must be urgently addressed for the sake of the health and safety of the prison staff and for the sake of the communities from which prisoners come and to which they return," Dr Swain said. She saw the commencement of the training as timely and a positive step in the right direction of addressing the complexities of HIV/AIDS in a prison setting. She expressed the hope that the training would stimulate the interest of all concerned to join in the fight against "this terrible epidemic that seeks to destroy the future development of this young nation." Erskine said the programme was necessary in the prison's efforts to provide health care for inmates living with HIV/AIDS inmates or potential ones. "I am positive that this forum will provide the knowledge base that will allow us to address risk behaviour modification, in that, inmates as well as ourselves can become more informed and active participants in health care. It is necessary that we understand the scope and dangers of this disease, the humane treatment and rights of inmates," he said. Chairman of the NAC, Andre Sobryan also spoke at the opening and gave an insight on the national policy document on HIV/AIDS in Guyana. (Samantha Alleyne) Follow the goings-on in Guyana in Guyana Today