Thursday, 3 March 2011

On that bothersome matter of whether to distribute condoms in prisons..

This is a major debate that has transfixed many in Botswana recently, but one which has been an ethical dilemma for much of the world for a while.

Bright's story

Bright, a Zambian, was sent to prison in Zambia for two years for selling cannabis.

"I did it because of hunger," says Bright softly.

"There's not much food in prison. Sex has become the way of payment."
One day, the cell "captain" gave Bright extra food, then asked him for sex.

"I had never had sex with a man, but I did it. The first time it was painful, but I joined a group of maybe 20 men who did that.

"Mainly they were people who were condemned, or who had been jailed for 25 years. They hadn't seen women for a long time."

He fidgets as he talks, swallowing his words. His nervousness is understandable - it is illegal in Zambia for men to have sex with each other, and socially unacceptable.

The Legal problem

The difficulty with any policy that allows the distribution of condoms in prisons in those countries where sex between persons of the same gender is illegal, is that such a policy will itself be illegal, since it would be seen as purporting to promote illegality.

Many men will already be carrying the virus when they are incarcerated, but once inside it can be spread by tattooing or sharing razors. The biggest risk factor, though, is sex.

"When we gathered the prisoners in focus group discussions and asked how many had taken part in male-to-male sex, the answer was 'all of us', says Dr Simooya who heads In But Free, an HIV/AIDS intervention in prisons.

"Most said it was because of boredom. But some mentioned that it was a form of exchange. You could give sex in return for soap, food, salt and so on."

"You can't legislate against sex," the doctor says.

"Its better to be practical and ask how we can prevent the transmission of HIV. We must consider putting condoms in prisons."

The process of changing laws in any country is onerous at the least and can be extremely difficult in situations where oppressive laws enjoy popular support as the anti-gay laws in many sub-Saharan African countries currently do. Therefore, it will be unwise to consider waiting until such a time as these laws are changed before appropriate measures are taken to prevent the further spread of HIV within prisons.

Pretending that male-to-male sex does not occur in prisons is like burying one's head in the sand. It seems even greater folly to ignore this fact, when we remember that many of these inmates who do not die of the disease will eventually upon their release from prison, return into the community with the likelihood that they will spread the virus even further.

The way forward

If we acknowledge that to wait until laws are changed is not a viable option, since in the interim prisoners continue to be infected with HIV, and in Africa many still die from AIDS, then what can be done?

My view is that the example of Lesotho should be followed by all other African countries facing this moral quandary. In Lesotho where homosexual acts are just as illegal as they are in many other African countries, prison officials know that they cannot distribute condoms, so they just make them available. They simply leave boxes of condoms in strategic places and refill them when they are empty. After all, it is not illegal to be in possession of a condom. The success story is that the condom box is usually empty, and now the authorities are trying to work out how that translates into reduction in seroprevalence.

It is commonly accepted that HIV prevalence rates within prisons are higher than within the general population. Prisons are risk environments for consensual and non-consensual sexual relations, and if this sexual activity accounts for the high prevalence rates inside prisons, then creating interventions that promote safe sex should ostensibly be a public health priority of the first order.

Will the inmates use them?

No question is bigger than this one. Even if condoms are made available to inmates, will they use them?

"Surprisingly, most prisoners we've surveyed have said no," says Dr Simooya. "They think male-to-male sex is un-Christian, un-African, and will promote homosexuality." (I laughed out loud when I read this)

Bright has other reasons for thinking condoms might not be favoured by some of the prisoners, especially those serving long terms.

"One man told me he was HIV-positive and threatened to kill me if I didn't have sex with him. Those people don't want to use condoms. If your sentence is short, they want you to be positive like them and go and spread the disease outside."

Bright was tested for HIV when he left prison, but he never followed it up.

"I'm scared," he admits, catching his breath.

"When I came out of prison, I was sick with malaria, headaches, diarrhoea. I was very scared that maybe they would find me with HIV, that's why I didn't go back."

More reading: Here, here, here and here.


AfroGay said...

Pro-condom campaigners are so right. I said as much about two years ago here and here.

Sadly, prison officials will not listen any time soon. Sad, very sad indeed.

Mimi said...

A friend of mine from the US told me that it's the same way in their prisons, that they don't give out condoms. It should qualify as cruel and unusual punishment.