Male prisoners in South Africa and elsewhere are at a very high risk of being infected with HIV.

• Infection rates can be up to 10 times higher than the rate in the community outside prison.
• It has been estimated that six out of ten prisoners released from jail in South Africa are HIV-positive.
• Aids is the main cause of death in prisons, and almost all natural (non-violent) deaths in prison are Aids-related.
• Unlike violent deaths, Aids-related prison deaths are increasing rapidly.

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These statistics do not only affect sentenced prisoners. Awaiting-trial prisoners – many of whom are only in prison because they cannot afford bail – are also at risk.

Why are prisoners at high risk of infection?
The prison environment seems to encourage the spread of the virus. This is due to certain features of prison life:

• Sex between male prisoners is quite common, but condoms are not always available or used. Often, sex is used to pay for protection, goods or favours.
• Rape is unfortunately a fact of prison life. It has been estimated that 70-80% of suspects are raped by other prisoners soon after being arrested. Violent rape, which involves physical trauma and often bleeding, is a particularly effective way of transmitting the virus. Young prisoners are particularly at risk of being raped.
• Prison gangs use rape (usually gang rape) to recruit new members, and as punishment for disobedience or refusal to join. A disturbing new kind of gang punishment is rape by a prisoner who is known to be HIV-positive.
• Most prisoners are young men from poor communities, who are at a higher risk of being HIV-positive than the general population. There are constantly more young men coming into the prison environment, bringing HIV with them. (Older, long-term prisoners have a lower risk of infection.)
• Violence is common in prisons: bleeding wounds are a potential source of infection.
• Many prisoners get tattoos done in prison. Unhygienic tattooing using shared needles is a relatively minor cause of HIV infection.

Why do HIV-positive prisoners develop Aids quickly?
HIV-positive prisoners are likely to get sick more quickly and more severely than if they were not in jail. This is because of unhygienic prison conditions. Problems that can put a strain on prisoners’ health include:

• Overcrowding. South African prisons hold far more prisoners than they were designed for. This puts a strain on resources, and makes it difficult to maintain cleanliness and health standards.
• As well as HIV, contagious diseases like tuberculosis spread easily in overcrowded environments, damaging prisoners’ health and ability to withstand disease.
• Lack of fresh air and exercise weakens prisoners’ physical condition.
• Many prisoners are under a great deal of psychological stress, due to their situation in life, as well as overcrowding and unpleasant, violent prison conditions. High stress levels further weaken the immune system and make prisoners more vulnerable to illness.

Improving the situation in prisons
The South African Department of Correctional Services has started to provide anti-Aids medication to HIV-positive prisoners. These drugs include the anti-retrovirals AZT, 3TC and Nevirapine, which can help to keep HIV-positive prisoners healthy for longer.

It has been suggested that separating prisoners into different groups, such as first-time offenders, violent criminals, awaiting-trial prisoners and so on, would help to reduce the power of prison gangs, and generally help to control the spread of HIV.

Changes in the legal system to cut down on the number of awaiting-trial prisoners would also ease overcrowding.
 

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