By Moses Magadza
WINDHOEK – A regional training of trainers’ workshop addressing issues of HIV and Sexual Reproductive Health and Rights (SRHR) in prison settings ended in Namibia last week with a call to safeguard the health of people in prison in order to protect public health.
The training workshop drew about 60 participants from 10 countries: Angola; Kenya; Lesotho; Malawi; Mozambique; Namibia; Eswatini; Tanzania, Zambia and Zimbabwe. Delegates were staff of prisons including medical doctors, Ministry of Health staff, staff of national AIDS authorities and representatives of organizations that provide SRHR and HIV services in prisons.
The United Nations Office on Drugs and Crime (UNODC) convened the training with financial support from the Swedish International Development Agency (SIDA). UNODC is supporting member states to implement a regional programme titled: “Supporting Minimum Standards for HIV, Health and Rights in Prison Populations of Sub-Saharan Africa”. The project seeks alignment of SRHR with UN regional standards. Specifically, it strives to help member of states make SRHR services available to women and adolescent prison populations.
To this end, UNODC has supported the development of a module to build the capacity of non-medical staff of prison or correctional services to deliver comprehensive SRHR and HIV services to inmates under their care.
Speaking at the beginning of the three-day training, the Commissioner General of the Namibian Correctional Service (NCS), Raphael Hamunyela, argued that prisons or correctional services should provide health care that is similar or better than is found in the general community because of the unique vulnerabilities of people in incarceration.
“We believe in the principle that good correctional health is good public health. Since those under our care often come from backgrounds of higher exposure to a variety of diseases and unhealthy conditions, there is need for correctional services, prisons or penitentiary services to deliver equal or better health care services than are in the community,” he said.
He hailed the training and expressed optimism that it would throw a light on HIV and SRHR issues that need attention in prisons as member states strive to comply with the Nelson Mandela Rules which prescribe a minimum package of services that Member States should make available to people in prisons or correctional services. The Nelson Mandela rules acknowledge the rights of inmates. Hamunyela said NCS was also implementing the regional programme on supporting minimum standards for HIV, health and rights of offenders and called for integration of relevant services.
“We must acknowledge that HIV and SRHR should be integrated within our policies plans and operations,” he said.
He said NCS would this year integrate the new SRHR and HIV module in its training curriculum to ensure that all officers gain relevant skills and knowledge.
Also speaking at the start of the training, Signe Rotberga, the Regional Coordinator for UNODC in Southern Africa, said the training was timely given that UNODC was implementing a regional project on promoting compliance with international standards for HIV and SRHR services and rights.
“Recently, we did an assessment in 10 countries that are participating in this project. This survey identified several gaps that need to be addressed. Other gaps are related to policies and laws. In some countries, certain behaviors such as those of commercial sex workers, people who use drugs or engage in same sex relationships are still criminalized. This drives some people underground and away from essential health services at a time when the world has set targets to end HIV and AIDS,” she said.
She said due to criminalization, many members of key populations end up in correctional facilities. She hoped that the training would provide an opportunity for exchange of views on how best to meet the needs people in custody and to embrace best practices such as the use of non-custodial sentences for non-violent crimes.
Rotberga said that the UNODC-initiated survey had shown, also, that there was insufficient training on human rights related issues and SRHR in most of Member States.
The training took place against the backdrop of reports that the world is grappling a growing prison population. The International Center for Prison Studies reports that approximately 10 .35 million prisoners are behind bars at any given day, leading to chronic overcrowding of prisons in some countries.
Many other authoritative peer-reviewed sources say that prisoners, who form part of key populations, remain extremely vulnerable to infectious diseases. Additionally, prisoners must contend with stigma, denial and violence. The Lancet and other sources report that the population of female inmates has increased by 50% since the year 2000 globally in the face of lack of integration of prison health care into public health systems.
Professor Heino Stover from Frankfurt University of Applied Sciences was one of the facilitators during the training. He said women inmates bear a disproportionate burden of infectious diseases in many prison settings and thus require targeted interventions.
“Women are highly susceptible to infection with HIV and other sexually transmitted infections in prison as they often come from socially marginalized groups and are vulnerable to sexual abuse and exploitation in the prison environment,” he said.
Discussions during the highly interactive training touched on a variety of issues that included mental health; the use of uniforms by staff and inmates; prevention of harm; continuity of care; human rights; Sustainable Development Goals, especially SDGs 3, 5 and 16; global commitments to prison health; HIV and AIDS prevention in prison; as well as sexually transmitted infections.
Among the highlights of the training was a visit by participants to the Windhoek Correctional Service in Namibia where UNODC helped set up a clinic in the female section of that facility.
In separate interviews, participants expressed gratitude for the training and said they had acquired knowledge and skills for use in their various workplaces to improve the welfare of inmates under their care. Magren Paul, a registered nurse and an inspector at the Malawi Prison Service’s headquarters in Zomba, described the training is an eye-opener.
“The training had a positive impact on me. I had never attended training on SRHR and HIV. It became clear that we have been neglecting issues related to the health of female inmates. During the training, it struck me that there are many issues that I did not properly consider in the past. I feel empowered,” she said.
Olivia Obell, the Director of the AIDS Control Unit in the Kenya Prisons Service, also hailed the training and called for more similar capacity building initiatives.
“The prison communities – inmates, staff members and families- are currently witnessing unprecedented challenges implementing effective interventions in HIV prevention, treatment, care and support. There are new cases of HIV and TB infections. Besides, the prison fraternity is witnessing increased new cases of missing TB patients who should have been screened and put on treatment. This is mainly because of inadequate understanding and skills in screening, management and support for these particular patients,” she said.
She added that prison conditions such as poor infrastructure, inadequate medical infrastructure, low funding and inadequate skills may thwart the attainment of desired outcomes.
She added: “This training came in handy and will likely capacitate prison administrators including healthcare providers and practitioners with relevant skills and knowledge to reduce new infections and provide care for those already affected. All prison officers interact with inmates and fellow employees and with the skills that the training provided, they are now crucial in providing and strengthening services and removing barriers.”
Moses Magadza is the Communications Officer for the Pretoria-based UNODC Regional Office for Southern Africa.