Feedback and Implementation of Revised Policy on Aids and Nutritional Services

CORRECTIONAL SERVICES PORTFOLIO COMMITTEE
(WITH COMMITTEE ON HEALTH)
22 April 1998
FEEDBACK AND IMPLEMENTATION OF REVISED POLICY ON AIDS AND NUTRITIONAL SERVICES.

The main purpose of the meeting was to provide feedback and information on the implementation of the revised policy on AIDS and Nutritional Services. Speakers from the Department of Health and the Department of Nutritional Services reported on the ongoing problems with AIDS and nutrition in prisons, gave feedback on measures being taken and proposed possible future strategies and solutions. It was agreed by all that the current inter-departmental cooperation should be encouraged and continued.

Dr Vada, the Director of Health, provided feedback on the HIV/AIDS problem in South African prisons:AIDS is a great concern, and accordingly there is a need to adopt management committee strategies aimed at the entire prison service.

The chief thrust of these strategies is education. There is a need to inform prisoners on the basics of HIV/AIDS, and this is done by way of pamphlets and other information made available to prisoners on admission. Further emphasis is being placed on increasing the number of trained personnel. A pilot program to train prisoners in peer group education is underway, although Dr Vada pointed out the sensitiveness of such a programme. An approach of 'universal precautions' is being encouraged, according to which all bodily fluids are automatically assumed to be HIV infected and are treated as such.

Dr Vada referred to the February 1998 DAKAB conference on AIDS in African prisons which dealt with issues such as mandatory testing, the availability of condoms and counselling. The conference found the South African strategy on AIDS/HIV in prisons to be thorough and well researched.

Implementation of the strategies is to take place by means of focal point persons, Provincial Coordinators in each province who will work together on the issue. Furthermore Sexually Transmitted Disease Clinics are to be set up to implement plans.

Dr Vada however acknowledged the problems and difficulties with implementation. There is a daily turnover of 2000 prisoners and this makes education and distribution of information difficult. The prison population also fits directly into the high risk group :
- prisoners are between 15 and 45
- the majority are male
- overcrowding leads to increased risk
- generally poor socio-economic backgrounds
- the practice in prison of tattooing
- sexual behaviour practices in male prisons.

It is difficult to monitor HIV/AIDS statistics in prisons because of confidentiality, the lack of mandatory testing, the constant admissions and transfers and the difficulties caused by repeat testing. This leads to a loss of accuracy and reliability in available statistics.

Further problems in implementation were stated as:
- shortage of qualified personnel and qualified nursing personnel
- acceptability to personnel
- infrastructure problems- desegregation of prisoners
- availability and disposal of condoms
- stigmatisation attached to the disease itself and STD clinics.

Action plans currently underway are the participation of Correctional Services in an inter-departmental forum, the establishment of departmental forums and the establishment of an HIV/AIDS office at head office.Plans on the cards are the appointment of focal point persons at all larger prisons, an HIV/AIDS specific budget instead of a general health budget and the formation of a database on HIV/AIDS. Feedback is awaited on the peer group training pilot programme.

In conclusion Dr Vada stated that the present management strategy of the Department of Correctional Services should be continued, and that support for the action plans as stated would assist with the control of the problem.

It was decided by the committee members that representatives from the Department of Health, Rachel Gumbe and Stephen Hendricks, should speak before members posed questions on the issue.

Ms Gumbe from the Department of Health praised and encouraged the collaborative activities between Health and Correctional Services, and referred to the White Paper on Health that proposed an integrated health service linking all levels. She continued that a partnership was needed as the service to prisoners should be based on their Constitutional rights, and that the Department of Health was excited by the National HIV strategy plan. HIV impacts on the quality of life of both the patient and the family, and accordingly the department encourages the partnership model and the Correctional Services education strategy. The need has been recognised within the system for support and guidance and a caring and compassionate system of health care. Furthermore, Health Science Faculties must ensure that education prepares students for working within the area of HIV/AIDS competently. Ms Gumbe concluded by encouraging ongoing integration and joint working.

Questions raised by Members:
Dr Gouws: Is AZT being used in prisons, and why is there no system of mandatory testing?

Dr Vada replied: AZT is not given, prisoners at advanced stages of the disease are referred to provincial hospitals for advanced treatment. Mandatory testing does not take place because of the financial logistics of testing every prisoner. The daily turnover of prisoners as well as the difficulties of follow up testing are further reasons for the lack of testing. The DAKAB conference did not recommend a system of mandatory testing.

Ms Gumbe replied: Other means of dealing with HIV/AIDS are being explored. AZT cannot be used currently, but a team is investigating drugs used in other countries to treat HIV/AIDS.

The question of tattooing in prison was raised:

Dr Vada replied: The dangers of tattooing and the use of unsterile instruments is included in the education prisoners receive about HIV/AIDS. Plans are underway to provide prisoners with sterile instruments.

The problem with high levels of illiteracy was raised by an ANC MP, as well as the question of separate wards and treatment for HIV/AIDS patients:

Dr Vada replied: The department was aware of the problem of semi-literacy, and that the material provided to prisoners was largely diagrammatical. Programmes were also underway to explain the basics of HIV/AIDS to prisoners orally.

Mr Fihla pointed out that gangsters were controlling the prisons and that their practices were perhaps the root of the problem. The issue of a social policy for orphans of AIDS was also raised.

Dr Vada replied: He agreed that the problem of gang violence in prisons was a serious one and that focus was being placed on rape, assault and violence in prisons.
Ms Gumbe replied: Support systems were being set up for orphans of AIDS to ensure that they received opportunities for life skills education.
Mr Hendricks replied: Separate wards for HIV/AIDS patients were being considered and pilot programmes were being set up, but that cost calculations were necessary and that the matter was under scrutiny.

Further questions raised concerned the availability of condoms and whether prisoners should have to ask for them, the issue of privatisation and facilities provided for prisoners, the involvement of District Surgeons and pending legislation on the issue.

Dr Vada replied: Nurses in Correctional Services were allowed to take voluntary transfer and there is a move towards having professional nurses. At this stage there are problems because funds are transferred interdepartmentally between Health and Correctional Services and thus specific hospitals where treatment takes place are not receiving the benefit. He continued that overcrowding in prisons did increase the risk of AIDS but that education was being used to increase the awareness about AIDS. Special dietary arrangements were made for prisoners with HIV/AIDS and gloves would be supplied to prisoners for tattooing. District Surgeons are being used to combat the disease in that they are heads of the management teams in health services. Workshops are also planned for District Surgeons.

Ms Gumbe replied: Condoms should be made available at pick up points to avoid the embarrassment of having to approach nurses. At present female condoms are not available, and ongoing education is needed in this area. She continued that health care was a right to all and that HIV/AIDS is being prioritised in the RDP and in the Health Department. As encouraged by the National Strategy for AIDS, outreach and ongoing cooperation is necessary.

Dr Ramamoto as Deputy Director of Nutritional Services then reported on the present status of Nutritional Services and problems experienced. These problems were seen as:
- the increase in the prison population
- problems with financial planning
- under qualified caterers who are incorrectly allocated and utilized
- management structures
- the infrastructure, ie old, poorly designed kitchens
- poor hygiene
- lack of ration scale for juveniles and separate ration scale for females
- special diets

Dr Ramamoto stated that privatisation as in America and Britain was being considered. He saw the way forward as consisting of :
- the appointment of Provincial head caterers
- the training of personnel
- the revision of ration scales
- the serving of three meals per day
- the implementation of cleaning schedules
- the upgrading of kitchens

He concluded that the above suggestions were possible solutions and requested further input.

A number of questions were raised by the members, but it was stated by the Chairperson for Correctional Services that she did not feel Dr Ramamoto was particularly well informed or aware of what was actually going on in prisons. She therefore raised her concern about the inadequacy on information before the committee and suggested that it would be a waste of time for the committee to continue with the questions. The questions were recorded to be sent to Nutritional Services for reply.

Dr Nkomo, Chairperson for Health, then thanked the portfolio committee and the chairperson of Correctional Services for the opportunity to investigate health, nutrition and HIV/AIDS in the prison context and encouraged further cooperation. Dr Nkomo furthermore urged Nutritional Services to have appropriate respect for the portfolio committee and not merely attempt to fob them off with empty information and lack of expertise.