The Southern African HIV Clinicians' Society recently published guidelines aimed at the prevention and treatment of HIV and TB in prisons, affirming the rights of prisoners to quality health care.

Dr Juno Thomas is a specialist physician and works at the AIDS clinic at Chris Hani Baragwanath Hospital in Soweto and has prisoners coming to her clinic every week. They primarily come from Mondeor Prison in Johannesburg and occasionally from outlying prisons such as Leeuwkop.

"All the prisoners that get referred here have, by definition, a CD4 count of less than 200... Many of them also have concurrent TB - whether it's been diagnosed before being referred to us or not. Many of them also have numerous other co-infections and other conditions which also need to be appraised and treated appropriately", she says.

She added that "due to administrative shortfalls, over-crowding and a chronic understaffing of prison medical services, it is often when they are ill and their immune systems are severely weakened that inmates show up for treatment".

With the guidelines, it is hoped that disease will be detected early so that prisoners can receive the appropriate care and treatment if and when it's needed. Jonathan Berger of the AIDS Law Project, says this is crucial because of the amount of disease found in prisons.

"If you look at the statistics put out by the Judicial Inspectorate of Prisons looking at prison deaths from natural causes, the vast, vast majority of prison deaths are actually taking place in the first year post admission to a facility. And what that means is that the vast majority of HIV infections are acquired outside of the prison context and people are coming in with it... So, you really do have... a lot of HIV and TB coming in to the prison. You compound that with situations of terrible over-crowding, poor infection control, poor diets... With all that put together... it really is a breeding ground for TB".