Ruth Ansah Ayisi

MAPUTO, Nov 16 2006 (IPS) – Like most other Southern African countries, Mozambique battles a high HIV prevalence rate, with those in need of anti-retroviral medication experiencing difficulty obtaining it at the best of times.
For HIV-positive prisoners, however, the situation can be worse: even those who are simply awaiting trial can find that their time in jail amounts to a death sentence. Ahead of getting their day in court, detainees can spend years in prisons where treatment for HIV/AIDS has typically not been available, enabling AIDS-related illnesses to take their toll.

Although there are no statistics available on HIV and AIDS prevalence in jails, prisoners are obviously an extremely high risk group, says Americo Assan, chief of the Department of Medical Assistance in the Ministry of Health.

According to the Joint United Nations Programme on HIV/AIDS, prevalence in Mozambique s general adult population stands at 16.1 percent. This is subject to geographical variation, however, with the rate as high as around 25 per cent in the central city of Beira.

But, things are gradually improving. This year, government assigned a medical specialist in the Directorate of Prisons to draw up a plan to address HIV and AIDS.

It was never a question that prisoners should have access to anti-retroviral treatment, says Assan. We have always supported health care in prisons, but now the government is scaling up this support following a request from the Ministry of Justice, which is concerned about the seriousness of the situation.
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So far, only a few prisoners are receiving anti-retroviral drugs (ARVs), mostly in the capital of Maputo. Officials plan to make them available in all jails.

Countrywide the government, with support from various organisations, has managed to put 34,000 people on ARV treatment; it aims to reach 50,000 by the end of the year against the estimated 250,000 people who require the drugs, Assan told IPS.

Mozambique s health service was designed to treat acute illnesses, not chronic ones like HIV and AIDS, which needs treatment for the rest of a person s life, he noted.

According to Assan, lack of human resources presents the biggest obstacle to ARV treatment, followed by the difficulties of reaching people in this large, sparsely-populated country and other logistical challenges.

Yet, an initiative underway in at least three prisons in the southern province of Maputo shows ARVs can be administered successfully to inmates.

In Matola, the second largest city in Maputo province after the capital, a group of young men dressed in casual clothes can be seen chatting to each other as they sit on a bench outside a clinic. They are in handcuffs; nearby, three police officers, one of them armed, keep a watchful eye on them.

Thirty-year-old Jorge* is tall and athletic, with a charming smile. While the father of two shows no sign of illness now, he came close to death a while back having become ill with AIDS-related diseases a few years ago before he was sentenced to five years imprisonment for receiving a stolen vehicle.

My wife left us four months after I was sent to prison. She told me during her visit that I wouldn t survive, he says in the good English he learnt while working as a truck driver in neighbouring South Africa.

I tried to convince her that I would, but it was no use. It was very painful. I also thought I would die in prison.

But Jorge was placed on anti-retroviral treatment just before he was imprisoned and has been able to continue taking the drugs while in jail this under the auspices of a programme known as Drug Resource Enhancement against AIDS and Malnutrition, run by the Italian Community of Sant Egidio: a non-governmental organisation.

A young, vibrant Mozambican doctor, Noorjehan Abdul Majid, treats HIV-positive prisoners each Saturday morning when civilians are not present, thanks to the project. Music plays in the background and the atmosphere is relaxed. A nurse weighs each prisoner before they see Noorjehan.

The doctor takes her time with the inmates, talking warmly to them about their diet and clinical problems they may have. She listens attentively, demonstrating an interest in each patient, and has even pinned a photograph of Jorge s youngest daughter on the wall.

Noorjehan says she is especially impressed with Jorge, who is punctual with his medication and takes care of himself as best as he can in prison. But his mother worries a lot about him. She sometimes comes barefoot to the clinic, asking me about him. She lives far, so after I talk to her I give her money for transport to go home. What can I do? She is so poor, she adds.

The Sant Egidio community now treats 25 prisoners with ARVs, from two prisons for men and one for women in Maputo province. The programme began in 2003. At first we had lots of deaths after the first month of treatment, because they were so sick when they started, says Noorjehan. Now most of the prisoners are doing well on the treatment.

Because good nutrition is essential for those on ARVs, inmates attending the clinic are given monthly food packages; they each find a way to cook their rations inside the prison premises.

I enjoy cooking. I know I must eat well and keep fit, says Jorge. Each morning as the sun comes up I run around the prison grounds. I used to play football with the other prisoners, but they began to discriminate against me when they saw my sores on my legs, saying ugly things to me, he adds, lifting up his jeans to show how his legs are covered in scars.

However, Jorge, does not complain: he s simply thankful for being given a new lease on life. I am just so much better. The doctor is like a mother, he says, smiling.

The plight of prisoners with AIDS has also come to the fore elsewhere in the region.

Earlier this year, several inmates at Westville prison in the South African coastal city of Durban started a hunger strike in protest against lack of ARV treatment. Shortly afterwards, a case was brought against government by 15 prisoners in urgent need of the drugs, to compel authorities to provide them with treatment.

At present, inmates confront a number of obstacles in their efforts to access anti-retroviral therapy; these reportedly include a lack of identity documents needed to begin the therapy documents which many prisoners say they are unable to afford. Prison medical facilities are not accredited to supply ARVs directly.

The court ruled in favour of the inmates in June, prompting hopes that this would set a precedent resulting in nation-wide treatment for prisoners. However, government appealed the decision. Since then, one of the group of 15 from Westville has died from AIDS-related complications.

According to an August 2006 fact sheet issued by the Kaiser Family Foundation, a California-based non-profit, approximately one million people are in need of ARVs countrywide in South Africa (some 5.5 million have been infected with the HI virus).

Government has embarked on a programme to provide the public with AIDS treatment. A statement issued Sunday by the Department of Health said that the number of people who were receiving ARVs through the Comprehensive Plan on HIV and AIDS had reached 235,378 by the end of September this year.

* Certain names have been changed to protect those concerned.