In our prisons visits over the last three years we have come across several challenges, both administrative and resource based. It has come to our attention that, prison staffs, prisoners and the surrounding communities are placed at risk of HIV infection, TB and other opportunistic infections due to several predisposing factors.
Some prison staff, due to disposable income and the availability of local liquor in the surrounding communities (London, Hilton), engage in binge drinking that leads to risky sexual encounters in the form of transactional sex and regular community based sex work with women in low income settings. Some of the prison staff have come to develop extra-marital relationships with members of the surrounding community because of the condition and nature of work that leads them to be away from their spouses and family in terms of transfers and shift changes.
According to the Kenya AIDS Indicator Survey findings 2007, ¾ of men and ½ of women have had more than one sexual partner in their lifetime. 12% and 2% of men and women respectively have had more than 2 sexual partners in the last 12 months. Compared to year 2003, more Kenyans have been tested for HIV; however, about 2/3 of adults have never been tested. 50% of those who do not test perceive themselves at low risk while 84% of those who test positive are unaware of their sero-status.
The Kenya Prisons Service HIV/AIDS policy points out that gender disparity, biological, socio-cultural, economic and segregational circumstances affect men and women differently which leads those who are averse, to engage in transactional sex with their colleagues. Such behavior leads to STI infection. Despite there being an operational health facility situated in the prison, there is low uptake of medical services due to fear associated with stigma and lack of confidentiality yet The Kenya Prisons Service HIV/AIDS policy spells out clearly issues of treatment, stigma, discrimination and confidentiality among its guiding principles. Though there was a positive response towards Counseling and testing during previous theatre outreaches in the Nakuru GK prison there was a drop in numbers tested when REPACTED took a break from outreach activities to develop a comprehensive strategy. Those who know their status and those of their spouses are still relatively few compared to those who do not.
Inmates/prisoners face different challenges compared to the staff and the communities outside. They are confined within prison walls and are not likely to encounter risk in the same context. Prisoners face a similar problem as the others in terms of lack of current information on changing trends on HIV/AIDS and other opportunistic infections, relationships between male circumcision (uncircumcised men are three times more likely to be infected with HIV(13.2%) than circumcised (3.9%) : KAIS 2007), TB, Malaria, HSV-2 and syphilis co-infection with HIV. Their living conditions are not conducive for people living with HIV/AIDS, where access to ARVs, ART and psycho-social support is either restricted or non existent altogether. Prisoners living with HIV/AIDS face a lot of discrimination and stigma because of their skin condition (Kaposi’s sarcoma) or TB symptoms like persistent coughing. Counseling and testing is viewed favorably by the inmates and they turn up in numbers for the test but our target of 90% tested has remained elusive to date. It is also important to impart skills in prevention including abstaining, being faithful and correct and consistent usage of condoms in preparation for the prisoners’ eventual release back into society where they are bound to face the same challenges as those in the surrounding community.
