HIV-positive prisoners often locked out of services

Skeletally thin George Okoth (not his real name), 37, has been in prison on remand for murder for almost a year. He was diagnosed with HIV late in 2005, when he fell seriously ill, and has since been put on a course of antiretroviral (ARV) drugs, which increases his appetite. When he has the rare opportunity of talking to the warden, the first thing Okoth asks is whether there is any chance of improving the daily diet of maize and beans in western Kenya's Kitale Main Prison. "If it is possible to get us some fruits from time to time, and a bit more food, we would be grateful." Kenya's prison populations have little access to voluntary counselling and testing (VCT) or treatment in a system designed to hold some 16,000 inmates, but which houses more than 50,000, often in cramped, unhealthy conditions - ideal for the spread of HIV/AIDS. Kitale, with a population of approximately 1,200 men and women, depends on handouts from nongovernmental organisations for testing kits and treatment. "We are aware that the government has HIV programmes in place, with the help of the [US government's] Centers for Disease Control," said Bernard Kipsangut, the prison's welfare officer. "But these have not trickled down to the local prisons like ours." Ten inmates are receiving ARV therapy, but prison officials said they had no way of knowing how many more needed them. "We get the testing kits from Handicap International's Chanuka VCT in town, and the drugs from AMPATH, a programme run by [nearby] Moi University," said John Onega, the prison's HIV/AIDS counsellor. Inmates have been informed about HIV and were very willing to be tested, but Onega often did not have enough kits - more than 600 inmates have volunteered since the prison started testing in 2003. "Sometimes I come here with about 40 kits, but when they are finished I still have a crowd and don't know how to explain to them that I have run out," he said. "It is almost pointless to advise someone to know their status when you cannot help them do it [know their status]." HIV-positive prisoners cannot pay for treatment at nearby hospitals, and when they are sent back to the institution after operations or short stints in the wards the expectation is that they will die in prison. "When Okoth came back from the hospital in March, he was really sent here to spend his last days," Kipsangut said. "We have tried to make sure he adheres to the drugs he is given, and we occasionally can get him fruits to improve his diet. He has really picked up since he returned - he could not even walk then." Okoth said he had never discussed his status with his wife and children. Onega said, "If we had a room dedicated to counselling, where the prisoners could talk freely, the VCT would operate much better. Now, even if Okoth wanted to tell his wife, he would have to do it in public." Kipsangut agreed, pointing out that not only the prisoners suffered from a lack of HIV services, but also the staff and the surrounding community. "We have about 500 staff members, many of whom have families. We also support the neighbourhood, and they come to see our clinical officers when they need medical assistance," he said. "If we had a VCT centre and treatment facility then the whole community would benefit." The prison refuses to advise inmates, many of whom practice homosexuality behind bars, to use condoms, although counselling, testing and disclosure are actively encouraged. "While we acknowledge that there is rampant homosexuality among the prisoners we cannot provide them with condoms, as that would be tantamount to giving them a license to carry on with what is an illegal act in Kenya," Kipsangut said. Onega and his team teach the men and women the value of using condoms outside of prison, encourage HIV-positive prisoners to live positively and advise the others on how to avoid contracting the virus. Kipsangut commented, "At the end of the day, even though these men and women have committed crimes, even capital offences, they are still human and need to be cared for."