â€œThere are 22 of us in our cell, and two of my cell mates have juveniles as â€˜wivesâ€™. They got them by bribing the prison officers at the main gate. These juveniles agreed to have sex with these men because they had no clothes and no blanket and they were hungry.
â€œOne day these boys started to cry and refused to have sex. The men took away their blankets and after spending a night in the cold, they agreed to allow the men to have sex with them again. We try to tell these boys that they will die of Aids, but what can these boys do?â€
This is a quote from a prisoner, taken from a study on HIV and Aids in Malawi Prisons by Penal Reform International. By denying or ignoring same sex acts in prisons or other places, we put the lives of many at risk, from the young male inmates who get coerced into sex for food to the partners of inmates after their release.
Sexual transmission of HIV in prisons is not restricted to same-sex practices; research at Zomba Central Prison has revealed that some female prison officers get paid to have sex with adult male prisoners. HIV transmission in the female blocks can also be high if women prisoners have previously practised prostitution.
HIV prevalence in Malawi prisons stands at an astonishing 40 percent. The commissioner of prisons might have you believe that the prevalence is due to people coming to prisons already infected, but a study by Dignitas International and YouthNet and Counselling (Yoneco) found that 10 percent of prisoners, out of 50 prisoners, at Zomba Central Prison indicated participating in a sexual act (forced or consensual) while incarcerated. There are over 20 prisons in Malawi and each year, there are about 25 000 to 35 000 people pass through the systemâ€¦if you do the maths, this puts a lot of people at risk of HIV.
In the prison system, there are number of modes of HIV transmission: injecting drug use (IUD), tattooing, violence and sexual transmission. IUD is less likely than sexual transmission in the Malawian system. If sexual transmission is more common, then condoms should be made available.
The World Health Organisation does not advocate for compulsory HIV testing of prisoners, but in the US, a number of prisons have mandatory testing. Voluntary HIV testing of prisoners should be encouraged as it provides opportunities to provide treatment and care for those in need and also identify those at risk. There are a few prisons around the world that segregate prisoners with HIV. In America, there are two prisons that require inmates with HIV to wear an armband or badge to signify their statusâ€”a gross violation of human rights which increases stigma!
Prisons are notoriously overcrowded, have poor diets, a shortage of clean water, inadequate ventilation and inadequate facilities for personal hygiene: this worsens the situations for persons with HIV.Â