A summary of this committee meeting is not yet available.
CORRECTIONAL SERVICES PORTFOLIO COMMITTEE Chairperson: Mr N Fihla
8 MAY 2001
HIV/AIDS PROGRAMME IN PRISONS: BRIEFING BY THE DEPARTMENT
Draft policy document: Management strategy: HIV/AIDS in prisons (see Appendix)
CORRECTIONAL SERVICES PORTFOLIO COMMITTEE
Chairperson: Mr N Fihla
Correctional Services Presentation 1. INTRODUCTION HIV/AIDS in Prisons is not only a health problem for Correctional Services, it is also a National health problem. On account of its primary responsibility, namely, the detention of all offenders in safe custody, ensuring provisions for the maintenance of their human dignity, and promoting a sense of social responsibility in the prison the Department of Correctional Services has a specific responsibility in supporting national endeavours of HIV/AIDS prevention. The Department has deemed it necessary to review the Management Strategy of 1996 for HIV/AIDS in order to keep in line with the International, National and World Health Organisation HIV/AIDS prevention programme(s) and strategies. This new management strategy will provide for the needs of all offenders (adults and juveniles, male and female), the children of female offenders, and including the pregnant female offender. It also include department employees as a target group in any education endeavours. 2. PURPOSE
Relevant website: Judicial Inspectorate of Prisons (includes Judge Fagan's annual report)
The Department of Correctional Services presented a draft policy framework on HIV/AIDS programme in South African prisons. The Department insisted that as with the general public awareness programs are best in preventing the spread of the disease in prisons as compulsory testing does not protect someone from acquiring HIV/AIDS.
The committee is divided on the issue of compulsory testing. The major point of discussion was how an new offender who enters prison can be protected from being infected with HIV/AIDS. The department had to clarify certain areas in the draft policy as the committee identified some contradictions with regard to full medical examinations. The issue of compulsory testing of prisoners is still to be discussed with other role players.
Ms Magoro, Director of Health and Physical Care in the department, said the Department had deemed it necessary to review the Management Strategy of 1996 for HIV/AIDS in order to keep in line with international (World Health Organisation) and national HIV/AIDS prevention programs and strategies.
She emphasized health awareness to all prisoners as the best thing the department could do to prevent the spread of the disease in prisons. She said the question of compulsory testing will not prevent the spread of the disease and compulsory testing is unconstitutional.
Ms Magoro said the awareness programs would involve offenders themselves, their families as well as the community. What is important is an adequate management of sexually transmitted diseases because they believe that STDs go hand in hand with HIV/AIDS.
She said each prison should have one or more HIV/AIDS focal person/s who will be actively involved in coordinating programs. These persons need not necessarily be nurses, however, they must be trained and have sufficient knowledge about HIV/AIDS. Every staff member in the department will be trained in HIV/AIDS awareness. On the controversial issue of the availability of condoms, Ms Mogoro said that condom availability should be an integral part of prevention as it is with the general public.
A controversial section in the document was the statement that HIV positive offenders will not be segregated from non-HIV offenders, treatment will be the same as in the general public.
For more details on the presentation please refer to the attached document
Mr D Bloem (ANC) asked how many doctors there are in South African prisons.
Ms Magoro said the Correctional Services does not have their own doctors rather they have doctors that do sessional work in prisons. She said they are still looking forward to employing full time doctors, otherwise currently they rely on the assistance of the Department of Health. She said all prisons have access to doctors within the prison setting. They are hoping to get full time doctors in the big centres of Johannesburg, Pretoria, Pollsmoor, Saint Albans in Port Elizabeth, Durban-Westville.
Ms Sosibo (ANC) asked how does the department know that prisoners have been sodomised, do they report to the authorities or what?
Ms Mogoro replied that the occurrence of sodomy is very difficult to be identified. Prisoners do not want to reveal their sexual orientation. She said the issue of reporting lies with the custodial staff who are most of the time with prisoners.
Mr Bloem said the reason for asking about the presence of doctors in prisons was that they are dealing with the dangerous disease of HIV/AIDS in prisons. If the department does not have doctors, how will it be possible for them to identify inmates who are infected with HIV/AIDS. He had visited a prison in Upington and was told that the last time a doctor had visited the prison was two years before. He said the health situation in the prison was bad and there were prisoners who were suffering from various diseases. He added that he had submitted a report on that situation to the Minister and the Commissioner.
Ms Magoro responded that the shortage of doctors is a reality in the country, even in the Department of Health. The training of health professionals in primary health care would help nurses to diagnose and prescribe medication. Correctional Services is committed to train nurses in primary health care. Ms Mogoro added that at the same time the scope of practice of primary health care nurses would allow them to refer sick prisoners to doctors outside prison. She said the reality of the situation is that a doctor cannot visit all prisons.
Adv H Schmidt (DP) noted that in the last thirty months a total of 457 inmates had died in South African prisons because of HIV/AIDS. He said according to Judge Fagan, the inspecting judge for prisons, a total of 7000 inmates will die in South African prisons within the next five years. According to the same Judge a total of 45 000 inmates will die in South African prisons within the next ten years. Adv. Schmidt asked the department whether they agree with these figures. Further, what can be done to protect the rights of people who enter prisons from being infected?
Ms Mogoro said these statistics are projections. From a medical point of view, the natural history of a disease is that it first goes up and then it reaches a plateau. As the rate goes up, awareness and also interventionist strategies increase. She made an example of HIV/AIDS in KwaZulu-Natal which she said is almost at its peak. That is what happens when programs are effective. The projection figures can be affected by the intervention programs that are there.
On protecting people who enter prisons from being infected, Ms Mogoro said the awareness programs that are there are the most important interventions in terms of intensifying prevention methods.
Ms P Cupido (DP) was very concerned about the projected figures mentioned by Adv. Schmidt. She added that there many cases are unidentified so the projections could be even worse.
Ms Mogoro replied that the Department is planning within the next Medium Term Expenditure Framework to do a survey to determine how many prisoners could be HIV positive. She said they will take a representative sample in each province and the prisoners would be told that the tests are voluntary and anonymous. She said they would use this data as a projection, as it is a more reliable and scientific information than their current statistical report.
Ms Cupido identified some contradictions within the draft policy. On page two of the draft policy it is said that medical checks will be performed on all offenders entering the prison system at regular intervals. On page seven of the draft policy it said that all offenders must be medically screened on admission to identify early signs of HIV/AIDS, STDs, other infections and diseases. Yet in contradiction, on page 4, it is said that compulsory testing of offenders to determine their HIV/AIDS status is forbidden. Her question went back to the issue of protection of new offenders given these contradictions.
Ms Mogoro replied that these are not contradictions as a full medical check means the history of the person, a physical observation of the person and it can also mean tests. However, it is stated that there will be no HIV tests amongst these medical tests.
Mr A Tsetsane (Department) clarified the issue of compulsory testing with regard to full medical examinations. If a medical practitioner does a medical examination and sees symptoms that show that this person might suffer from HIV/AIDS, the doctor can suggest that the person should go for an HIV test but the person will not be forced to undergo such a test.
Ms Cupido said she was referring to a sentence on page seven where it states that all offenders must be medically screened on admission to identify early signs of HIV/AIDS, STDs, other infections and diseases. She cross referenced this with page four where it states that the compulsory testing of offenders to determine the presence of HIV/AIDS is considered unnecessary and forbidden. The question is what if a prisoner contracts AIDS in prison, does not that prisoner have a case against the government for not been protected against HIV/AIDS?
Ms Mogoro said protection against infection has more to do with behavioral changes and the awareness that you give to prisoners and their supervision. But compulsory testing does not protect someone from acquiring HIV/AIDS.
Mr Bloem quoted a sentence on page four of the draft policy that says information on the HIV status of an offender must not be divulged to others including officials, other offenders and relatives. He said it is a known fact that in prisons the department is dealing with people who fight every day and contact with blood cannot be avoided. If a prisoner fights with another one who is HIV positive, it means that the other inmate is in danger of contracting AIDS. Mr Bloem said he concurred with Ms Cupido that there is a contradiction in the document.
Mr G Oosthuizen (ANC) echoed the same reservations on the draft policy framework, that there is a bit of contradiction from one position to another. He requested that the department re-look at these contradictions. They should review this draft which is a very positive endeavor and then return to the committee with a refined document.
Mr M Dyani (ANC) said he does not feel there is any contradiction in the draft policy after the explanation given by the department. Everybody knows that to divulge the HIV status of a person is unconstitutional. The department has explained that a person cannot be forced to undergo HIV testing or be separated from others because of being suspected of having HIV. Mr Dyani said this is not the problem of the department, it is a national problem. However, the most important question is what will happen if a person enters the prison and as a routine he is tested and is found HIV negative, and the same night the prisoner is raped and sodomised by an HIV positive inmate in a communal cell? If the infected prisoner can sue the state, how is the department going to defend itself?
Ms Mogoro said the custodial staff and everybody working in the prisons must know that anyone could be a potential HIV/AIDS carrier, even the person you help in the street; there are universal precautions. The department had presented the issue of compulsory testing to the committee and the decision taken had been that compulsory testing of offenders will still need to be discussed with the involvement of all role players. The committee could assist the department with this. She pointed out that if compulsory testing is agreed upon the most reliable test would cost the government R150 to R200 per prisoner.
She noted that if compulsory testing on admission is effected, how many of the offenders will arrive having the HIV virus which does not show up in the laboratory because of the twelve week window period. Further, what about the implications regarding personnel resources, finances, the available space in prisons and antiretroviral drugs. She said compulsory testing has far-reaching implications - it is not just a question of testing people.
In conclusion the Chairperson said HIV/AIDS is a major challenge facing the prisons and the issue not only affects the department but the nation as a whole. He commented that the best method would be the intensification of awareness in prisons. He reiterated that compulsory testing was against the Constitution.
The meeting was adjourned.
DRAFT POLICY DOCUMENT
HIV/AIDS in Prisons is not only a health problem for Correctional Services, it is also a National health problem. On account of its primary responsibility, namely, the detention of all offenders in safe custody, ensuring provisions for the maintenance of their human dignity, and promoting a sense of social responsibility in the prison the Department of Correctional Services has a specific responsibility in supporting national endeavours of HIV/AIDS prevention. The Department has deemed it necessary to review the Management Strategy of 1996 for HIV/AIDS in order to keep in line with the International, National and World Health Organisation HIV/AIDS prevention programme(s) and strategies. This new management strategy will provide for the needs of all offenders (adults and juveniles, male and female), the children of female offenders, and including the pregnant female offender. It also include department employees as a target group in any education endeavours.
framework for the prevention of HIV/AIDS pandemic.
- To guide all officials (nurses, disciplinary staff, social workers, psychologists,
teachers, chaplains etc.) in HIV / AIDS prevention, care and support.
- To guide external support organisations providing support (financial and technical assistance, etc.) for all HIV / AIDS-related activities in prison.
- To provide mechanism for mobilisation and allocation of resources.
- To provide guidelines for monitoring and co-ordination of activities for preventing the spread of HIV / AIDS, and caring for prisoners with HIV and AIDS.
- POLICY FRAMEWORK(MANDATES)
- Standard Minimum Rules for the Treatment of Prisoners, UN, 1957.
- World Health Organization (WHO) Guidelines on HIV-Infection and AIDS in prisons
- Constitution of RSA 1088 1996
- Correctional Services Act 111 of 1998
- White Paper on Transformation of Health Services 667/1999
- Health Act 63 1977
- Statement to the National Assembly : DR M E Tshabalala-Msimang, Minister of Health, on HIV/AIDS and Related Issues, 16 November 1999
- HIV/AIDS Strategic Plan for SA 2000-2005, Department of Health
- Management of Strategy for HIV/AIDS : Correctional Services, 1996
- Performing full medical check on all offenders entering the prison system at regular intervals.
- Promotion and encouragement of voluntary HIV testing.
- Non-segregation of HIV/AIDS offenders from other offenders.
- Availability of pre and post testing counseling services for offenders.
- Ensuring full offender, family and community involvement in HIV/AIDS activities.
- Adequate management and control of sexually transmitted infections.
- The availability of condoms to enable the offenders to protect themselves.
- Provision of appropriate post exposure prophylaxis services in all prisons for personnel who during work are exposed to body fluids- blood, blood-contaminated fluids, and other body fluids and needle pricks.
- Accessibility to adequate health care services for the proper management and effective treatment of HIV/AIDS and other complications.
- Consideration of early release of offenders who are terminally ill.
- Ensuring continuity of care and support after release
- Proper handling of dead bodies to ensure protection of personnel and offenders.
- Ensuring effective surveillance of HIV/AIDS and STDs and anonymous epidemiological surveys to determine the magnitude of the epidemic.
- Monitoring of HIV/AIDS activities to determine the effectiveness of intervention programs.
- A multidisciplinary approach and accountability in the provision of services.
- Multi skilling of personnel to help reduce the impact of HIV.
- Provision of services that meet the needs of the youth and female offenders.
- Ensure that there is an HIV/AIDS focal person in each prison who will be actively involved in coordinating HIV/AIDS programs.
- Creation of a supportive environment at all levels (Head Office, Provincial, Management Area and Prison).
- Active involvement of the management at all levels in HIV/AIDS activities or programs.
- Ensure measures to protect the rights of offenders against possible infection.
5. GENERAL POLICY STATEMENT
It is the policy of the Department of Correctional Services to render effective and efficient HIV/AIDS and STDs health care services for the offenders and to release them back to the community with minimal risk to their neighborhood. This can be achieved through the implementation of relevant intervention strategies.
- This information must be kept confidential at all times.
- The principle of "need to know basis" or "shared confidentiality" should be applied only to those who need to know in order to render appropriate health, social, psychological, religious care, and custodial (security) care of HIV positive offenders.
2. HIV TESTING AND COUNSELLING
- Testing "offenders" for HIV-antibodies must only be carried out, upon request of the prisoner, by recommendation of a registered nurse or by written order of the attending medical officer/practitioner.
- In all cases where voluntary testing is requested the offender must consent to the test in writing, and be subjected to adequate pre- and post-test counseling.
- An HIV test carried out without an informed consent shall be considered to be an unlawful infringement of the offender or the child's bodily integrity and invasion of privacy.
- If a child is to be HIV tested, the parent or legal guardian should give an informed written consent.
- For the mentally ill or handicapped offenders, the spouse, parent or the appointed curator ad litem should give the consent for testing.
- The counselor must ensure that the patient understands: the reasons for testing, nature of the test, the meaning of the positive and negative test results, implications of the results both negative and positive and follow-up plans.
- In the event of anonymous HIV epidemiological surveys, written informed consent must be obtained from all participants.
- In terms of the Medical Research Council's Guidelines on Ethics for Medical Research, offenders are regarded as a vulnerable group, and research should be subjected to scrutiny and monitoring.
- Voluntary testing of offenders should be encouraged and services should be accessible and incentives should be provided to those who come out for testing.
- All HIV positive tests must be confirmed.
- Counseling must be conducted by a professional trained in counseling.
3. SEGREGATION OF HIV/AIDS OFFENDERS FROM OTHERS
- Medical segregation(isolation) will only be practices when indicated by the
person's medical conditions e.g. active TB, incontinence, persistent bleeding, sores and other infections to prevent the spread of infection to others.
- Should medical isolation(segregation) be carried out, it will be done without any reference to whether the offender is or is not infected with HIV.
- HIV positive offenders should have equal access to workshops and work in
the kitchen, farms and other work areas. They shall also participate in all other programs without discrimination.
4. HEALTH AWARENESS AND INFORMATION TO OFFENDERS
Programs with a captive population.
- Information about HIV must be given to offenders on admission and on a
continuous basis and during release programs regarding HIV/AIDS and STDs.
- The information should include: HIV/AIDS-what it is, cause, risk behaviors, spread within prison environment, signs and symptoms, stages, complications, prevention, safer sex, STDs, etc.
- Female offenders should be informed about mother-to-child spread during pregnancy, birth and breast-feeding.
- Female offenders should also be informed about the available reproductive health care services such as TOP (termination of pregnancy).
- Health education should be given to all categories of personnel.
- All new recruits shall be taught about HIV/AIDS including risk factors in prisons.
- A variety of strategies such as pamphlets, lecturing, discussions, audiovisuals, debates, workshops, dramas, role-plays, etc should be employed in preventive programs.
- Young offenders should be trained in life skills to enable them take responsible decisions regarding their health and lives.
- HIV/AIDS programs should be culturally, language, literacy, gender and age specific.
- Warders in all prisons should participate in HIV/AIDS programs, as they are daily in contact with offenders.
- The World AIDS Day and all other national and international
Commemorations such as Women's Day, Youth Day, Human Rights Day, etc shall be commemorated in such a way that the target groups or people are sensitized about HIV/AIDS. These celebrations should be used as opportunities to promote awareness about the epidemic.
5. SCREENING ON ADMISSION
of HIV/AIDS, STDs , other infections and diseases.
- Unexplained loss of weight-7kg or 10% of body mass accompanied by the following symptoms require further medical attention :
- Continuous or recurring fever of 38 degrees or higher with night sweet
- Diarrhea for two weeks without interruption
- Oral thrush or herpes
- Tender or enlarged glands-neck, groin, armpit
- Upper respiratory infections for longer period
- Loss of appetite, fatigue lasting two weeks, the presence of STDs
6. UNIVERSAL PRECAUTIONS
7. AVAILABILITY OF CONDOMS
information regarding their use.
- Condoms dispensers shall be secured at accessible areas in all prisons.
- Nurse managers shall keep a record of the number of condoms dispensed
for monitoring purpose.
- The availability of condoms should be seen as an integral part of the HIV/AIDS intervention strategy.
8. MANAGEMENT OF STDs
- Provision of proper treatment and health education including monitoring is essential for the effective management of STDs.
- Nurses should be trained in Syndromic Management of STDs.
- A system of tracing contacts should be put in place in each prison.
9. NON-CONSENSUAL (COERCIVE) SEX AMONG OFFENDERS
- All offenders must be sensitized on admission and on a continuous basis about the fact of sex in prison.
- Both offenders and personnel must be sensitized about the dangers of unprotected sex, violation of others' human rights and the criminilazation of any non-consensual (coercive) sex or rape.
- All rapes must be reported and the victim receives medical intervention. Offenders must be empowered to protect themselves from rapes and abuse by fellow-offenders.
10. MANAGEMENT OF HIV/AIDS AND OPPORTUNISTIC DISEASES
strategic prisons for the referral of offenders who need 24 hours health care service.
- The use of anti-retroviral drugs such as AZT for the treatment of HIV/AIDS, rapes, occupational exposure (except for needle pricks among health workers) and prevention of mother -to-child transmission on public expense is not allowed.
- The management of opportunistic diseases and infections shall be in accordance with the guidelines of the Department of Health.
- High protein and high kilojoule diet shall be provided to offenders who are HIV positive.
- Management of the physical, emotional, social and spiritual needs and problems of offenders to reduce the stress level and retarding progression into full-blown AIDS.
12. CAPACITY BUILDING
take care of their sick offenders.
- Multidisciplinary HIV/AIDS committees shall be established at head office,
provincial, management area and prison level. Offenders must be involved in
- Each prison must set targets for training in counseling, peer education, HIV/AIDS, human rights, trainers etc; prevention programs and health education, meetings, support groups for offenders and personnel.
- Each prison must have an HIV/AIDS plan which is being strictly implemented and monitored and evaluated for impact.
- Each prison must identify and ensure that resources are available- human, fiscal and logistical to support HIV/AIDS programs.
- Each prison must have offender and staff peer educators and the selection
Criteria for such a task could include:
- Respect by colleagues and offenders
- Respect by fellow offenders
- Ability to communicate
- Interest in Health or HIV/AIDS matters
- No record of misconduct or bad track record
- Longer sentences
- Sense of maturity
- Each province must make provision for HIV/AIDS budget.
- Each province and prison must work hand-in-hand with the Department of
Health, Education, Welfare, etc to share expertise and resources.
13. PROMOTION OF THE RIGHTS OF OFFENDERS AND PERSONNEL TO PROTECTION
- Both the offenders and personnel in all prisons should be trained in human Rights.
- The custodial staff must take responsibility to protect offenders against sexual assaults by fellow offenders and to report the occurrence of such Practices.
- All sexual assaults must be reported and recorded and criminal action is taken against the perpetrators.
- Offenders should be empowered to be able to protect themselves and fellow offenders.
- Offenders raping others should be separated from other offenders.
- Offenders have the right to privacy, bodily autonomy, integrity and safety
and these and other rights shall be protected.
- The deliberate spread of HIV infection by offenders to fellow-offenders
should be regarded as a serious crime for which action should be taken.
- CONTACT TRACING
- Measures should be taken in each prison to trace contact of HIV, STD s and Hepatitis B and C infections.
- Contacts should not only be limited to sexual contacts, but also include sharing of shaving contacts and others where there is a possibility of coming into contact with the blood of another person.
15. PLACEMENT ON MEDICAL GROUNDS
- It is important to identify early the relatives and other service providers for HIV/AIDS offenders to facilitate placement after release. This can be achieved through partnership with other service providers including the families.
- Each prison must identify community structures to assist with placement after release. Such services should include hospice care, social workers and others to assist in tracing relatives.
16. FUNERAL ARRANGEMENTS
should under no circumstances be handled without appropriate protection.
- Such precautions should also apply to offenders dying from other diseases.
- The undertakers should be sensitized about the proper handling of all dead
bodies to prevent the spread of infection.
17. CARE OF CARE GIVERS
- COMPLIANCE WITH POLICY
- Any person who will be found not supporting or observing the provisions of
this policy will be subjected to disciplinary procedure of the Department.
- All offenders and personnel must be informed about this policy and must
have access to it at all times.
MANAGEMENT STRATEGY: HIV/AIDS IN PRISONS
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