Guarding against HIV in prisons

Kigali Central Prison (KCP), in the capital of Rwanda, has the nation's highest number of HIV-positive prisoners. "This one [visitor] has been more difficult to keep out. You can't see it coming and it is impossible to see it being passed around," said Vincent Rugema, chief prison warden.

The prison holds more than five times the recommended capacity, with most inmates awaiting trial for crimes related to the 1994 genocide, in which the government estimates some 937,000 Tutsis and moderate Hutus were murdered.

A national demographic health survey in 2005 found that three percent of the Rwanda's eight million people were living with HIV.

But 16.48 percent of women and 15.11 percent of men among KCP's 60,000 inmates are HIV-positive, according to the National Commission for the Fight against HIV/AIDS (CNLS).

BEHIND BARS WITH THE VIRUS

Ramathan Iyakaremye, 33, a former electrician, has served 10 years of a life sentence for killing two neighbours and manning a deadly roadblock during the genocide, but a more immediate worry weighs on his mind: "I don't need a life sentence - this disease will take me away much earlier than the sentence or anything else," he said. He learnt of his status late in 2005 after a free HIV test by a local nongovernmental organisation.

He cannot afford to supplement the prison diet, and life-prolonging antiretroviral (ARV) medicines are not available. "Look," he said, rolling up the sleeve of his pink prison uniform. "I'm shrinking every other day; I'm disappearing."

SPREADING IN PRISON

HIV-positive inmates say they were infected before they were jailed because Rwanda's prison regulations do not allow conjugal visits. "Due to a lack of choice, some men look to other men for what they should have received from their wives or other women," said prisoner Jean-Bosco Habiyambere. "Basically, men sleep with men."

Nathan Gasatura, president of the CNLS, said he did not know of any cases of homosexuality in Rwandan prisons but "judging by common trends elsewhere, it is possible that due to lack of heterosexual partners, the inmates may be engaged in such sexual practices".

There have also been reports of inmates engaging in sexual activity while working outside of the jail, and of prisoners bribing their guards to allow visits from family and friends. "I have come across men who have three-year-old biological kids, yet they have been in jail for 10 years," said journalist Sula Nuwamanya.

Rwanda does not provide prisoners with condoms, but Gasatura acknowledged that "if you suspect there are sexual practices going on, then it would only be wise to provide them [inmates] with condoms".

TAKING ACTION

Although prisoners do not receive ARVs, the authorities started paying more attention to HIV prevention and counselling about three years ago.

The International Committee of the Red Cross (ICRC) informs prisoners about HIV and the dangers of high-risk behaviour, while NGO Population Services International (PSI), a health NGO in low-income countries, offers voluntary counselling and testing (VCT), and trains peer educators to influence behaviour change and provide post-VCT counselling.

Supported by PSI and the ICRC, the CNLS held training sessions at several Rwandan prisons in July, in which prison employees and prisoners were taught to sensitise their fellow inmates about the pandemic.

"With all the justice and reconciliation initiatives going on, thousands of genocide suspects are being released and returning to their towns and villages," Gasatura said. "What these people bring back to their communities is of much concern to us. We also look at it from the perspective that these are fellow Rwandans who need as much care as any one else."