Articles & News

July 29, 2008

Living With HIV in Uganda's Prison Cells

By Glenna Gordon, The Monitor (Kampala)

As we approached the town of Mityana, one hour's drive east from Uganda's capital city Kampala, with my translator, Maria, asked some of the other passengers on the matatu where we should get off the taxi to reach the prison.

There were hushed whispers and a bit of discomfort. What was this soft spoken Ugandan girl doing with this mzungu going to an upcountry prison?

I wondered the same thing myself. Someone told us where we should exit, and we got off and hoped on some boda-bodas for the short distance between the main road and the tucked-away prison.

When the bodas stopped, I wondered if we were at the right place. The walled compound's gate was ajar and a lone man in khaki pants and a gun stood outside. This was a far cry from Luzira, Uganda's biggest prison just outside of Kampala's city centre, a veritable citadel.

I asked to see the officer in charge and show him my permission letter, but he wasn't around. A wait ensued, and finally he arrived, inspected the letter, and ushered us into his office.

We signed the faded and tattered visitors' book.

The last visit was three weeks ago from the Uganda Human Rights Commission, but before that, no one had been to Mityana Prison since last October.

We made some small talk with the officer, Abbasi Ssenyonjo, who told us how much he liked working for the prison system, hoped his son would join as well, and then asked Maria if she'd like to join. Next followed the usual litany of needs: they didn't have enough blankets, or soap, or uniforms, and government wasn't helping with anything.

During the summer of 2006, prisons outside of Kampala were for the first time integrated into one prison system under the leadership of the Uganda Prison Services (UPS), whereas previously they had been independently administered by the local governments. The commissioner for Prisons, Dr Johnson Byabashaija, had told me that UPS had yet to even visit Mityana.

Nonetheless, they allowed Maria and me to see the facilities and speak with the prisoners. Ssenyonjo escorted us to a block of five cells, and opened the door of one. The prisoners roused slowly, light filtering in from the open door obviously an unfamiliar occurrence.

About 15 men stayed in the small cell, probably five metres by five, sitting against the walls on the concrete floor. There were no mattresses, and only a few blankets in the crowded room.

Maria introduced us and I started asking questions. I wanted to know, what did the prisoners know about HIV/Aids? At first there was silence, and then finally an older man told me that it was a disease that affected the youth and the aged, that you catch it through sex, or sharing sharp objects like razors, and there wasn't a cure.

Another prisoner, wearing a faded Nokia-emblazoned t-shirt, spoke up after some minutes passed. "Aids is a biological weapon. The only solution is that the physicians who manufactured it be kind and find medicine." Next, he spoke of the unreliability of condoms in Uganda.

Back in 2005, the government recalled Engabu brand condoms due to fears of manufacturing problems that rendered them ineffective. After the recall, the government said there wasn't actually a problem with the condoms, but the legacy of the scare remains. "We require proof that condoms sent are perfect but we've lost hope in the condoms," said the man in the Nokia shirt.

He was in prison on remand, a period of time in which an inmate awaits trial, for the past four months. Some suspects await trial for as long as a year, or even seven years, because of a clogged and inefficient justice system, according to human rights NGO, Foundation for Human Rights Initiative.

Ssenyonjo left us to a lower ranking officer, who escorted us to the next room. The morale seemed even lower in this cell, though it could just be that in the first cell the prisoners put on a show for the Officer in Charge.

I presented the same basic questions, but this time, rather than answering, the inmates started asking me questions. "If someone has not been tested, what should he do?" asked one prisoner. "If I have the disease and my wife has it as well, will our child have it?"

Maria informed them that I wasn't an Aids educator, I was just conducting research, and asked if I could take a photo. Some of them didn't want their photo taken because if they ever got out of prison, then they wouldn't be allowed in my country.

The next stop was the women's cell, where seven incarcerated female prisoners stayed. Ssenyonjo informed me that one of the ladies had Aids, and pointed her out. Again, I began just asking what they knew about Aids. Though I hadn't wanted to single out the lady I knew carried the disease, she was the first to volunteer an answer.

"First, you get tested, then retested, then they do a CD-4 [cell] count, then you take two tabs, one white and one yellow," said Zaini Kizire, 28, being held on remand because of accusations of robbery. Her trial was last month, but the man who accused her of stealing a mattress didn't even bother showing up. She has another trial scheduled for next month.

In the meantime, she goes to the local Mityana Hospital once a month for ARVs. The hospital is a kilometre and a half away, and the prison doesn't have any means of transportation.

"We don't get cases where someone cannot walk," Ssenyonjo told me. Though Kizire has yet to be so ill that this is the case, she fears that it may happen in the future. In the meantime, she'll continue heading to the hospital once a month for a supply of ARVs, though she says that often she doesn't have enough food or liquids that need to be taken along with the medicine.

Prisoners eat posho, a maize-based starch food, bean soup, and unboiled water. However, the prisoners tell me that the bean soup is only the liquid cooked with beans, not the beans themselves.

Michael Kyomya, the medical superintendent of the main hospital at Luzira Prison situated in Murchison Bay, told me that the food is, "enough for energy but grossly inadequate for vitamins and minerals."

The situation at Luzira is different from upcountry prisons because there is a health system within the facility. Prisoners get ARVs and Septrin, a prophylaxis treatment that protects (though not completely) against opportunistic infections like pneumonia that often wreaks havoc on compromised immune systems.

Luzira is home to over 4,000 prisoners, 300 of whom are HIV positive, and about 100 of whom are on ARVs. The problem, though, is that there aren't adequate testing facilities within the prison, so many inmates don't know their status.

It's difficult to say how many people in Ugandan prisons have HIV or Aids, though Mary Kaddu, Prison Commissioner for Support Services, says that initial research in 1987 put the rate of incidence at about 25 percent. Kaddu also says they think the rate has dropped to about 10 percent, but are still in the process of undertaking surveys in conjunction with the Ministry of Health and the International Committee of the Red Cross (ICRC).

"Worldwide, HIV in prisons is much higher than outside population," says Kaddu. She explains the prevalence by saying that people in prison have a background of high risk behaviour.

The prison system in Uganda, however, recognises the threat posed by Aids.

"These walls are temporary. Prison can be an incubator for infection, and it will spread to the community," says Kyomya, the doctor at Murchison Bay Hospital.

Though Kyomya and his staff try to serve the vast needs of the prisoners and the community (who also visit Murchison Bay as a referral clinic), he says they are grossly under-funded. Their budget of Shs130 million per annum is about half what a centre their size usually receives - about Shs250 million.

However, at Luzira, there are efforts being made to boost the level of services to meet international humanitarian standards.

"The UPS is working hard to scale up provisions of care," said Megan Rock, the Protection Coordinator for the ICRC in Uganda. "There's a lot of goodwill and mobilisation of external partners." Currently, ICRC is working in active partnership with the UPS and the Ministry of Health on a joint pilot project to address the problems of Malaria, Tuberculosis and HIV/Aids.

The fact that UPS acknowledges the Aids epidemic is a big step forward towards curbing its spread. Prison Commissioner, Dr Johnson Byabashaija, says, "All the inspiration for Aids control follows from the strong political commitment of His Excellency, President Museveni. In Uganda, we call him the father of Aids."

Uganda's President Museveni was one of the first African leaders to acknowledge the epidemic, and in so doing blazed the trail for treatment. The prevalence rate of Uganda has dropped to about 8 percent, but some critics say there is currently a backslide as the rate increases, after a shift in Aids education from emphasising condom use to emphasising abstinence.

Though condoms are available to prisoners upon exit from the system, no condoms are available within the prison. This is despite an admission of the occurrence of homosexuality by officials. "Although [homosexuality] is not culturally accepted, one cannot deny that it is there," says Kaddu. "If infected prisoners don't get information, they will infect others through homosexuality."

The occurrence of homosexual sex was also confirmed by Michael Kyomya, the superintendent of Murchison Bay Hospital at Luzira Prison.

Despite the factors of goodwill and open acknowledgement of the epidemic, UPS still lacks adequate counselling and educational capacity. Charles Bagenda, the prisoner in charge of Aids control activities within Luzira's Upper Prison (the maximum security unit reserved for the most heinous of crimes), says that the ratio of Aids counsellors to prisoners is one to 160.

"Living with HIV in prison is different than outside," says Bagenda. "People who are incarcerated are alienated from their families, so all the support comes from within the system."

One of Bagenda's duties includes running a support group for HIV positive prisoners called the "Post Test Club," which meets every Friday.

At a recent meeting, prisoners clad in yellow uniforms with thin black stripes complained about a paucity of Septrin, the prophylaxis, lack of proper nutrition, blankets, and other supplies. Yet, they also seem to have come together in the weekly meeting to solve some of the problems of living on ARVs in prison.

"We watch when the Muslims begin to pray to mark time to take our ARVs," said one prisoner, who declined to give his name. He later added, "The club gives us courage and we don't worry because you know you are not alone suffering. We get confidence and it gives us a go-ahead to tell our friends about the disease."

However, Zaini Kizire, the HIV positive female prisoner at Mityana prison, has no such support system. When she first entered the prison, she says, "The other ladies feared me, didn't want me to touch the cups and plates."

Now, with her next trial date approaching, she fears spending an extended period of time in prison while she is ill, but she also fears an outside world where the government won't necessarily give her ARVs once a month.