Poor criminal justice systems are resulting into high rates of HIV and tuberculosis in both prisons and the wider community, new findings by The Lancet released at an International AIDS conference in South Africa have shown.

The conclusions were made basing on available data, which indicated that levels of both HIV and tuberculosis are substantially higher among prisoners than in the surrounding community.

For instance, HIV prevalence was found to be around three times higher among prisoners in Eastern and Southern Africa.

This stands at 15.6 per cent compared to 4.7 per cent.

At 13 per cent, levels of HIV infection tend to be higher among female prisoners than male prisoners which stands at 7 per cent, particularly in west and central Africa and one study reported that one in six prisoners in parts of West Africa had tuberculosis.

Dr Pam Das, the Senior Executive Editor  and Dr Richard Horton, Editor-in-Chief of The Lancet said "Africa, by far is the region most affected by HIV globally, has among the most marginalised of all incarcerated populations. Many prisoners face years in detention without ever being formally charged or tried for alleged offenses.”

He added that pre-trial detention is a high-risk environment for exposure that interrupts treatment for persons on HIV or TB treatment, which calls for urgent reforms.

"There needs to be an urgent reform of the criminal justice system and legislative reform to eliminate this hugely damaging practice,” he added.

 The authors suggest that urgent criminal justice reforms are needed to reduce the number of individuals in pre-trial detention and to alleviate overcrowding, together with the massive scale-up of treatment strategies in Sub-Saharan Africa.

For example, some studies indicated that condom provision was illegal in some sub-Saharan African countries while in others prison health services are isolated from national public health programmes and some ministries of health exacerbated the issue. 

Adopting good practices

Release on a warning for non-violent prisoners and the use of electronic monitors could help fight HIV.

Further, according to The Lancet, practices that include involving prisoners in a range of services such as health education and symptom screening in countries like Rwanda, South Africa, Zambia, and Zimbabwe are helping to slash the burden of these diseases among prisoners.

However, this may not be the case in all countries, according to author Salome Charalambous from the Aurum Institute in South Africa.

"Dedicated resources for health as well as reforming laws and policies that result in lengthy pre-trial detention will be crucial to reducing prison populations that put large numbers at risk of potentially life-threatening infections,” she said.

 Currently, HIV prevalence in Rwanda stands at 3 per cent, according to the latest Rwanda AIDS indicator and HIV incidence survey.

Dr Placide Mugwaneza, the head of the HIV Prevention Unit at Rwanda Biomedical Centre, told The New Times that specific strategies were put in place to ensure that high risk members of society  have access to education on HIV.

"In this line, health facility based interventions are offered through education sessions and other communication materials. In addition, community based interventions,  including outreach education and peer education are provided,” said Dr Mugwaneza.

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