HIV Prevalence Survey, terminally ill inmates & medical parole issues: Departmental briefing

Meeting report

HIV Prevalence Survey, inmates ill with HIV/AIDS and other terminal illnesses, and medical parole: Department of Correctional Services (DCS) briefing|
Comm Vernon Petersen, National Commissioner, Correctional Services and Chief Deputy Commissioner for Development and Care, Comm Subashini Moodley, gave a presentation on the HIV Prevalence Survey, terminal illness of inmates and medical parole issues.

The presentation was separated into ten spheres. The purpose and background of the survey were set out, followed by the HIV and Syphilis Prevalence Results, staff and offender interventions, recommendations, the treatment of terminally ill inmates, challenges posed and the crucial issue of medical parole.

It was noted that the DCS had asked LIM’UVUNE to conduct an unlinked- anonymous HIV and Syphilis Prevalence Survey for both staff and offenders. Samples for all those who partook in the survey were extracted from the demographic aspects of employee levels, gender, age, urban/rural correctional centres and regions. The pilot phase had been conducted in the Gauteng Province during May and June 2006. The survey’s roll out had taken place in October 2006 and the survey had been launched in November 2006.

The HIV prevalence results had been structured into three categories of Region, Staff and Offenders. According to the results, Kwazulu-Natal (KZN) had the highest percentage of HIV for the samples for both staff and offenders, with 22.7% prevalence of KZN DCS staff and 34.6& of the sample of KZN offenders. The Western Cape sample survey showed the lowest percentages of HIV infection for both DCS staff and offenders. Comm Moodley said that the national prevalence for DCS staff was 9.9% and 19.8% for offenders.

The National Syphilis prevalence survey was delivered at 2.9% for DCS staff and 5.6% for offenders. Gauteng Province comprised the highest infection rate for both DCS staff and offenders, KZN had the lowest percentages of syphilis infection for DCS staff at 1.7% and Limpopo Province, Mpumalanga and North West Province comprised the lowest percentage of syphilis infections for offenders at 3.9%. Detailed figures for all surveys were contained in the attached presentation.

Comm Moodley highlighted some of the recommendations that were made after the survey had taken place. She said that momentum with offenders needed to be increased. This could be done by implementing comprehensive HIV/AIDS management programmes. She added that a limited number of staff had wanted to participate and that an organisational survey was necessary. She added that the DCS needed to assess the impact drug usage had on the prevalence of HIV and Syphilis.

Comm Moodley went on to discuss issues pertaining to DCS interventions for staff and offenders. Some of the staff interventions were inclusive of World Aids Day events, held at the Pretoria Head Office in collaboration with the South African National Defence Force (SANDF). Three Regional Coordinator contract posts had also been advertised. The posts were funded by the Presidential Emergency Plan for AIDS Relief (PEPFAR). Comm Moodley said that benchmarking exercises on HIV and Syphilis programmes had occurred and that a national audit of HIV/AIDS services for employees had taken place. She added that HIV/AIDS had been placed on the DCS’s risk management strategy.

She then reported on the interventions for offenders, noting that intensified training of professional health care workers had been implemented. Sixteen Wellness Centres had also been accredited to galvanize access to Anti-RetroViral (AVR) treatment. Another significant intervention pertaining to offenders was that the reporting system had also been improved so that more accurate statistics relating to tuberculosis (TB), HIV and AIDS could be gathered. Prevention, Care and Support Programmes, including extensive condom distribution and Voluntary Counseling and Testing (VCT) were discussed as an intervention for offenders.

Comm Moodley went on to discuss the treatment and conditions of incarceration of terminally ill inmates. She said that palliative care was based on the medical condition of inmates. She added that offenders were being given spiritual as well as psychological support and end-of-life care. Nutritional support and legal aid were also being given to terminally ill inmates.

Comm Moodley then addressed issues pertaining to medical parole. She explained that health care professionals made recommendations for those offenders who were to be considered for medical parole. No fixed period was deemed necessary to be served by such an offender before he or she could be considered for medical parole. She added that the medical parole of offenders had been approved by the Chairperson of the Correctional Supervision and Parole Board. She tabled statistics of offenders who had been placed on medical parole for 1 July 2007 to 30 June 2008. KZN had the lowest statistic, of one person with Limpopo Province/ Mpumalanga/ North West Province the highest at 24. Comm Moodley quoted Section 79 of the Correctional Services Act 111 of 1998, which related to correctional supervision or parole on medical grounds.

Comm Moodley highlighted some of the challenges faced by the DCS. She said that the prevalence of HIV/AIDS had created an unusual life expectancy and that there was an overt lack of after care by offenders’ families. She added that there was also a lack of after care community structure and hospices and that due to financial constraints hospices were reluctant to cater to those offenders in need. The problem of inconclusive medical reports also posed as a major problem as in many instances a second medical practitioner needed to be consulted, which was time consuming. She added that in some instances second reports had also been inconclusive and that this often placed Parole Board in a position where they were unable to approve placement within the designated time frame.

Discussion
The Chairperson said that the term “terminally ill” had often been misused to refer mostly to those who had HIV and AIDS. He said that the DCS needed to understand that terminal illness included broader spectrum of illnesses and that the debate did not have to revolve around HIV and AIDS sufferers only. He made reference to Colin Stanfield who was not HIV positive, but had been placed on medical parole. He displayed concern that the DCS was focusing more on offenders as opposed to DCS staff members.

Mr Petersen agreed that the term terminally ill did not only pertain to those with HIV/AIDS. He was not sure how many of those released on medical parole were HIV/AIDS sufferers. Therefore those included in the medical parole statistics in the survey were not only suffering from HIV/AIDS but included all those who were classed as terminally ill within the broader spectrum of terminal diseases.  He added that a proactive and humane approach needed to be adopted and that the Constitutional values that all citizens, including all inmates, had the right to die with dignity must be upheld. He added that the effective management of HIV/AIDS was a crucial priority and that it must be recognised and dealt with.

Ms L Chikunga (ANC) agreed with the Chairperson’s comments on the terminally ill. She enquired what the DCS was doing about syphilis prevention. She also asked the DCS about the funding for the survey and wanted to know if it was sponsored by a United States (US) donor. She displayed concern about KZN’s high HIV/AIDS prevalence and wanted to know if there were specific reasons pertaining to that specific trend.

The Chairperson added that those reasons could be discussed in the Committee’s next meeting with the Parole Boards and their reports.

Comm Moodley noted that KZN’s larger percentage of HIV/AIDS could be attributed to the fact that KZN was a port of entry for many, including those seeking employment. She added that these statistics from the DCS also correlated with national statistics and assumed the reasons were also applicable for the national statistics.

Mr S Mahote (ANC) displayed concern about the DCS’s allocated annual budget and wanted to know if it catered for HIV/AIDS programmes. He also wanted to know if the DCS had a strategy in place to motivate the voluntary testing of DCS staff. Mr Mahote was concerned about the re-offending of those released on medical parole and asked it there were monitoring mechanisms in place. He also wanted to know what the DCS was doing about paroled offenders who had been not been taken back by their families due to stigmatisation or financial constraints.

Comm Moodley said that when inmates were released on parole they were still subject to the rules of parole and that extensive follow ups on those on medical parole were conducted on a continuous basis. She added that medical parole violators were dealt with according to parole rules and that they were not exempted from parole violation repercussions.

Mr E Xolo (ANC) was concerned about the expense imposed on offender released on medical parole who would now have to pay for hospices. He enquired if there was any way that inmates could be encouraged to get tested so that they could improve their health and life expectancy.

Comm Moodley said that there was a lack of hospices and places of after care and that this posed a tremendous problem for those released on medical parole. Insofar as the families of those on medical parole were concerned, the DCS had put into effect specific structures, such as the provision of food hampers. However, due to the numbers of financially burdened families, this simply had not been sufficient. Comm Moodley added that if families were unable to take the inmate back into their care, the DCS simply took them back.

Ms W Ngwenya (ANC) was concerned whether the DCS could deliver the recommendations made in the survey within the designated time frames. She also was concerned about the number of professional nurses and social workers available to render services.

Comm Moodley said that the DCS was facilitating meetings to address crucial issues on not only prevention, but also meetings to address the key issue of treatment and care. In this regard she outlined the information sessions that were conducted by the DCS as well as the Health and Wellness days that had been convened by the DCS.

Comm Alfred Tsetsane, Chief Deputy Commissioner for Corporate Services, DCS, added that the DCS had put into place strategies to motivate staff on a monthly basis. It focused on the totality of “wellness”, because it did not want to single out those with HIV, owing to stigmatisation. He added that the DCS had trained 457 of its members to assist in peer education. He added that the DCS was also addressing staff issues by making a two-thirds contribution to the staff members’ medical aid schemes.

In relation to questions about funding, Comm Petersen said that the US donor had helped but that there was no excuse not to have a dedicated budget for HIV-specified expenses. He displayed concern at the current trend of provincial departments now charging the DCS for AVRs and said that the DCS needed a dedicated budget for ARVs.

The Chairperson added that the projected R10 million that would be necessary for ARVs was an alarming amount of money.
 
Comm Moodley said that the figures were a projection based on historical factors, and that the numbers of those in need of ARVs would double by the end of 2008. She concluded that at present ARVs cost R284.84 per month per offender.

The Chairperson asked the DCS how it was catering for the ARV needs of infected staff members.

Comm Tsetsane said that the ARV treatment of DCS staff members was their own responsibility, as the DCS were liable to pay two thirds of specified medical aid schemes. He added the DCS predominantly focused on wellness, prevention and lifestyle education, and that the investment lay rather in educating staff.

Ms Chikunga was concerned whether the same samples had been used for both the HIV/AIDS and syphilis prevalence survey. She noted an overt relationship between Sexually Transmitted Infections (STIs) and HIV/AIDS. She was concerned that not enough syphilis infections were diagnosed on inmate admission or arrival. She noted that syphilis was a far easier disease to manage. She also wondered what the benefits would be to inmates on confidentiality of the surveys. She felt that non-confidentiality would in fact be more beneficial, as it would allow those who were infected with HIV/AIDS or syphilis to know their status, as they could then take the necessary measures to improve their health. She added that it seemed that the survey was primarily done for the purposes of garnering statistics and not for the benefit of the infected people.

Ms Ngwenya was concerned whether the DCS had the Human Resource capacity to deal with the challenges.

The Chairperson asked if the process of medical parole was the same as other types of parole.

Bishop L Tolo (ANC) was concerned about time wasted on talking and whether there were enough interventions to address the challenges.

The Chairperson noted that since Comm Petersen had taken leadership there had been notable improvements. However, he also agreed with Bishop Tolo’s stance that too much time was spent on discussion and too little on intervention.

Mr Mahote was concerned that there was not enough parole education within communities. He added that effective community liaison and communication needed to take place prior to and during the release of those inmates on parole.

The Chairperson noted that the Committee would be having an interactive meeting with the parole commissioners on 12 August 2008. He agreed that more community interaction and liaison was necessary within communities around the issue of inmates being released on parole.

Comm Petersen noted that there was a shortage of parole board chairpersons. He agreed that effective community liaison was necessary regarding the parole processes. He went on to explain the structure of the community safety forums, which in essence could address issues through local community leaders. He noted that community education would take place gradually within the DCS.

Comm Tsetsane added that the parole boards comprised four officials from the community. He added that many nurses, counselors and psychologists were employed from within the DCS to address medical issues.

Comm Petersen said that in 2010 the Auditor-General would be more prescriptive on what departments must do regarding interventions, and would be assessing what they had actually accomplished. He also spoke of the DCS’s structures and programmes already in place to improve adult literacy, such as the Adult Basic Education and Training (ABET) initiatives.

The meeting was adjourned.