A South African high court judge has ordered the country's prisons department to immediately hand over a secret report about the death of a prisoner who was given antiretroviral treatment far too late and died within just weeks of starting treatment.
As part of its ongoing battle to get free antiretroviral treatment for South Africa's tens of thousands of HIV-positive prison inmates, the AIDS lobby group Treatment Action Campaign (TAC), has now been granted legal access to this controversial report, that may shed light on whether or not treatment delays are costing lives in South African prisons. Only some 5,000 of the more than 163,670 inmates now received ARV treatment - and the TAC claims that the inmates are getting treatment far too late.
Most overcrowded prisons on African continent
South Africa has the most overcrowded prisons on the African continent, and HIV-AIDS infection is rampant due to the permeating culture of male-rape among inmates. see
For a close up and very brutal look at the South African prison system's culture of rape, try to view the above video with the UK actor Ross Kemp inside a prison. Ít's a frightening portrayal.
The AIDS-epidemic has over the past three years, also been turbo-charged by the co-infection of Extremely-drug-resistant Tuberculosis, (XDR-TB) which kills AIDS-infected people within just weeks in South Africa.
South Africans refer to this co-infection as Turbo-AIDS because of its rapid kill-rate. Of particular concern, medical experts say, is the country's overcrowded prison system because TB is an airborne, highly infectious disease which spreads quickly inside prison cells crammed with prisoners.
The country now has some 163.670 prisoners crammed into a prison system which has a total capacity of only 114,800.
It was announced in the SA parliament in July 2008 that the number of HIV-positive prison inmates on antiretroviral was expected to rise by 76% in 2009.Its deputy commissioner for prisoner development and care, Subashini Moodley, said in March 2008 that while there were only 2,718 prisoners on ARV- treatment that month, but this was expected to rise to 4,800 within that year. However by December, there were more than 5,000 prisoners on ARVs.
Moodley said the HIV-infection rate among sentenced offenders now was estimated at 19.8%, "a little bit higher than the national average of 16.25%." Many of the terminally-ill prisoners are now given an early release on medical grounds, to 'allow them to die at home, in dignity', he testified.
His statistics came from a limited survey between November 2006 and April 2007 among 8,649 offenders and 3,042 correctional service staff members.
It found 19.8% of offenders were HIV positive, as were 9.9% of the staff. He also warned however that they didn't know the true extent of the co-epidemic of AIDS-TB in the entire prison system - and wanted more funding for an all-encompassing investigation.
The Treatment action campaign launched its law-suit after discovering that inmates were put on ARV-treatment far too late -- often months after tests indicated that they needed the expensive drug-cocktails to stave off development of full-blown AIDS.The main problem with the co-epidemic of XDR-TB and AIDS are the overcrowded conditions and the culture of rape.
Most of the sex among the male prisoners - only 2.1% of the SA prison inmates are women, and 1.1% are children -- was highly coercive, and described as 'blatant rape', by researcher Sasha Gear.
According to this prison culture, anyone who had been "sexually penetrated in a power-defined interaction", was considered a woman, and it was then their job to provide men with sex. "A 'marriage' begins with the act of rape (penetration), and the 'wife' is then the constant target of humiliation," according to researcher Sasha Gear of the Centre for the Study of Violence and Reconciliation (CSVR).see
The situation was aggravated by warder involvement. Gear said warders took part in the "trade" of prisoners for coercive sex and rape. "A sense of resignation among officials to the fact of sexual abuse is reported, as well as fear for their own safety should they intervene," Gear said, noting that overcrowded prisons made the problem worse. see
Justice Southwood said in his ruling that the correctional services department behaved against the constitution when it refused to hand over the report about the death of the HIV-+ inmate known only as MM.
He has now ordered this "MM-report' handed over at once, together with all the unedited copies. Moreover, he also rejected the claim by the department that 'the privacy of the late patient would be violated' by disclosing the report,', pointing out that this was 'pure speculation' -- as all the individuals' names were already blacked out. In addition, the AIDS Law Project and the Treatment Action Campaign have always used the initials MM in order to protect the privacy of the deceased's family. Both organisations continue to do so." he noted in his ruling.
Last week's ruling was just a small part of the TAC's five-year battle to secure access to free and adequate treatment for all the inmates, said Jonathan Berger, head of policy and research at the AIDS Law Project which launched the lawsuit on behalf of the TAC and 16 prisoners from the Westville Correctional Centre .
They had already won an earlier landmark case against the government more than two years ago when the regime was ordered to give inmates access to ARV treatment.
The dead inmate, MM, had begun treatment less than four weeks before his death - at a time when his CD4 count, which measures the strength of the immune system, has been less than 100 for months.
The TAC has demanded a full investigation into MM's death, and whether or not either the minister of correctional services or the minister of health could be held liable. The ministry spokesman Manelisi Wolela said they would not comment until they have studied the court ruling.
Cracks in accountability
Berger said it was too early to tell what the report's findings might mean in the fight for access to treatment in South Africa -- but that the court battle had exposed serious failings in mechanisms like the Promotion of Access to Information Act (PAIA), which was supposed to guaranteeSouth Africans access to information.
"PAIA basically allows government departments to ignore requests to hand over documentation. The worst that happens if someone does take departments to court is that they are ordered to hand over the documentation, which they should have done in the first place," he commented.
"Ordinarily, one would think that if a minister has acted reprehensibly, you would think someone would actually have to be held accountable for that," Berger said.
A lack of accountability in the correctional system when it comes to HIV care and treatment has been an ongoing issue. Lobby groups TAC and the South African Prisoners Organisation for Human Rights have been fighting an uphill battle, said Kenny Bhoodu, head of the latter's paralegal department.
"Access to healthcare and a proper diet were just some of the issues that HIV+ inmates are facing,' he said.
He said his organisation often felt 'powerless to change these realities. "The department is unwilling to cooperate, and isn't willing to respect the provisions of the Correctional Services Act - it's not happening," he said.
The UK-based International Centre for Prison Studies notes that South Africa has more than 160,000 inmates crowded into the country's jails. They believed that more than 5,000 were on ARV treatment as of March 2008.
Only 2.1% of the inmates are female and 1.1% of these prisoners in adult-prisons are juveniles.
According to an unpublished draft document - titled HIV/Aids in Prison, and compiled by Parliament's Research Unit - South Africa's prisons created "many situations of high risk behaviour for HIV transmission".
The most common of these is homosexual activity, including rape. "Homosexual activity in prison is a regular occurrence... At Westville Medium B prison... social workers estimate that more than half the prisoners participate in sodomy, both voluntary or through threats and coercion." see