JOHANNESBURG, 26 July 2011 (PlusNews) - Obtaining HIV treatment in jail is becoming easier as about 9 percent of South African prisons now offer antiretroviral (ARV) drugs in-house.

Leeuwkop Prison, north of Johannesburg, where minimum-security prisoners tend horses and cattle and raise crops, is the latest jail to launch its own antiretroviral clinic - one of 22 such in-house HIV treatment centres, according to the Department of Correctional Services' 2010 annual report.

The prison has also begun providing inmates with condoms, as have others, including Johannesburg Prison in the city's largest township, Soweto, said Gauteng correctional services spokesperson Simphiwe Kondleka.

According to South Africa's Institute for Security Studies, the country's 240 correctional facilities house 160,000 prisoners - a third more than they were originally designed for.

At Leeuwkop, 13 percent of the 4,500 prison population are HIV-positive. Although the HIV prevalence among Leeuwkop's prisoners is not far off South Africa's national HIV prevalence rate of about 18 percent, limited studies among some of the country's prisons have found HIV prevalence rates of as high as 45 percent.

"Correctional services are a microcosm of the country; what we see in our country will be found in our facilities - even disease patterns," noted Nontsikelelo Jolingana, chief deputy commissioner (CDC) of development and care for the Department of Corrections.

According to Jolingana, the department is also working to accredit at least three more facilities in Gauteng province.

Changing of the guard

Just five years ago, South African courts ordered the government to take steps to provide all prisoners with access to treatment. The judgment followed a court case involving 13 HIV-positive inmates and the AIDS lobby group, the Treatment Action Campaign.

Before the Leeuwkop ARV clinic was launched, the prison's more than 300 HIV-positive inmates on treatment had to be shuttled to an inner-city Johannesburg health facility, posing major logistic and security problems for correctional services.

"The prison's clinic benefits the whole process - it increases access to treatment and care, and compliance with treatment for prisoners," said Gloria Lekubu, regional HIV and AIDS coordinator for Correctional Services in Gauteng.

Lekubu added that not only would the clinic mean fewer security risks but also that the Department of Correctional Services would save money it previously had to pay the Department of Health for treating prisoners in public clinics.

The Department of Correctional Services dedicates about 10 percent of its annual budget to prisoner care, which includes access to medical services.

For HIV-positive inmates such as Prince, it also takes a lot of stress out of treatment. "In South Africa, there's an overcrowding of prisoners, which makes it difficult for us to get treatment," he told IRIN/PlusNews. "In a day, there may be 30 to 40 of us who need to go to the clinic, and there's a shortage of [correctional staff].

"The new clinic means I will be counselled in time, I will see a doctor in time and there won't be a shortage of ARVs."

Balancing act

South African health NGO, the Aurum Institute, helped finance and design the clinic, said Gillian Gresak, deputy director of HIV and Tuberculosis treatment, balancing security concerns and infection-control measures.

According to the World Health Organization's Stop TB department, overcrowding, poor nutrition, and high alcohol and drug use in prisons, make prisoners very susceptible to developing active TB, with the rate of new TB infections on average 23 times higher than in the general population.

Inadequate TB control measures are another risk factor. Typically, many health facilities keep windows open to prevent TB infection, which can be spread by coughing, but in many prisons, windows were not designed to open, Gresak told IRIN/PlusNews.

Another infection control measure, the use of ultraviolet lights indoors, was also ruled out as the lights could be dissembled and used as weapons, added Aurum operations manager Joyce Lethoba.

Ultraviolet lighting has been shown to reduce TB transmission by up to 70 percent in hospital wards by killing the bacteria that causes TB.

Instead, Aurum designed outdoor waiting rooms much like those pioneered by Medecins Sans Frontieres in its HIV/TB clinics in South Africa's Western Cape. With a separate area to collect potentially infectious sputum samples, the waiting rooms allow for maximum ventilation with minimum security risks, Lethoba added.

Aurum has been in talks with the Department of Correctional Service to support the establishment of future prison clinics in the province.