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
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".