Tuberculosis and AIDS soaring in prisons

Victor N. no longer has the strength to get up from his straw mattress; he is battling tuberculosis, which has struck for a second time in some months. One of his cellmates in Edea prison near Douala is in the same state - too weary even to fight the bedbugs lacing the thin cushion on which he rests. Twelve people live in the tiny cell which adjoins a row of latrines, their meagre possessions hanging on nails on the grime-blackened wall. No matter that some are sick with a highly contagious disease, the prison is packed and there is not a single spare space to quarantine TB sufferers. There are no firm health statistics for Edea prison, which lies 60 km northeast of Cameroon's economic capital, Douala. But the situation likely resembles that of New Bell prison in Douala - one of the largest in the country with 3,000 inmates. On average two people in each cell at New Bell were found to have the infectious disease, in a 2003-04 joint study by the German development organisation GTZ, the University of Yaounde, the prison administration and local partners. At Edea prison – with 335 detainees - Victor is one of many with TB. “It’s his own fault!” says a prison guard. “[He] started smoking again; he stopped his treatment and sold his medicines. Too bad for him.” Too bad for his cellmates as well. A person with tuberculosis is contagious even during the first two months of treatment, which can take up to eight months - if it is not interrupted. But prisons have had a difficult time blocking the spread of TB, says Ello Germain Emougou, the top prison administrator in the coastal province where Edea is located. “The prisons do not have special wards to isolate these patients and hospitals are reluctant to take in prisoners because of security concerns.” One prison guard said that in fact, one night, hospital staff smashed the chains of some sick prisoners and brought them back to the prison, “because they didn’t want problems”. Problems are what the director and the sole nurse at Edea tackle every day. “We are abandoned here in these bush prisons - all assistance stops at Douala and Yaounde [the capital],” Wantoh Francis Teih, prison director said, adding that there is no budget whatsoever for health care and medicines for the more than 300 detainees. In 2004 the budget for medicines in the central New Bell prison was officially estimated at US $550 for the 3,000 inmates. “The detainee has to buy his own medicines and take care of himself,” Teih said. “If he doesn’t have the means, which is often the case, the family must intervene. But in general the family is unable, or has already abandoned the imprisoned relative.” He tells of how he even helped raised money after an appeal by the cellmates of Angelique, the only minor in the prison, who had urgent health problems but no one available to help. Prisons helpless in the face of epidemics “Tuberculosis - that’s what’s causing a problem right now,” Teih says. “Those who come to see the nurse and have means, they are taken care of; but for those who don’t have anything and who spit and cough, we can’t do a thing about it.” And some who find ways to get medicines, which come from the outside mostly through the national anti-TB programme, put others at risk by not following through with the treatment. Once symptoms begin to ease, many stop and sell off their pills. The spread of HIV/AIDS is also a daunting problem in prisons, and it’s even tougher to know the gravity of the problem. At New Bell prison, the HIV rate is climbing. In 2005 12.1 percent of inmates were found to be infected, up from 11.5 percent in 2004. But very few prisoners, even those with pulmonary TB or TB symptoms, agree to be tested. So the HIV infection rate is likely far higher, the GTZ study says. And the stigma surrounding activities that spread the virus complicates matters. “Homosexual activities and abuse - while illegal and considered abnormal in Cameroon - are common in the prisons,” the GTZ study says. “As prisoners are generally young and sexually active, this could constitute the main mode of transmission at New Bell.” While at New Bell the average age of prisoners - most of whom are male - is 28 years, at Edea most fall between the ages of 15 and 20. Despite clear evidence that sexual activity in prisons creates a breeding ground for HIV, social mores mean the situation doesn’t lend itself to an easy solution. Given the country’s stand on homosexuality, handing out condoms in prisons would mean encouraging an illegal activity. “I am totally against it!” said Edea prison director Teih. “If you hand out condoms, what do you think they’re going to do with them? A budding friendship will move into the next phase with a condom.” Authorities say other factors make prisons hotbeds for infections, primarily overcrowding. New Bell’s 3,000 prisoners live in a space designed for 700; Edea 335 detainees in buildings with a capacity for less than half that number. Other factors are a failure to isolate those with contagious illnesses, and the weakening effects of stress caused by prison conditions. Programme aims at prevention, care Officials and health experts hope things will improve under a programme launched by GTZ, prison administrators, the justice ministry and local NGOs, and designed to identify and treat ill prisoners as well as to educate prisoners and prison staff on how HIV and TB are transmitted. The GTZ study, which is the basis for the programme, recommended an emphasis on: creating TB diagnostic and treatment centres in prisons, testing all new prisoners and all prisoners and staff at least annually, and quarantining infected prisoners. The researchers also called for an HIV prevention programme in prisons, with voluntary testing, to be supervised by the national anti-AIDS council. The NGO SunAIDS has taken this on at New Bell prison, sending counselors several times a week to educate prisoners, perform testing and counsel detainees on their results. Lab workers from a Douala hospital come weekly and take blood samples from prisoners wishing to be tested. But for those who find out they are HIV-positive, to date the resources are not yet in place to provide them with antiretroviral drugs, which cost about 3,000 CFA francs (US $5.45) a month, plus some fees for follow-up. “We have to try out the system, this is something new,” says Juergen Noeske, technical advisor to GTZ’s Health/AIDS project and co-founder of the national TB programme. In the meantime even the help moral support would bring is largely out of reach for now. SunAIDS counselor Suzanne Mboni says while HIV-positive prisoners would benefit considerably from moral support from fellow prisoners, forming an association is near impossible. “The stigmatisation is so strong that they cannot get together. And yet, they need to talk to one another, support one another, help one another. That would help them a lot.”