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The challenge of implementing prisoner guidelines Living with AIDS # 358

Written by Health-e News

Last week we reported on the launch of guidelines developed by the Southern African HIV Clinicians’€™ Society to prevent and treat TB and HIV in prisons. Their implementation will not be easy.

Members of the panel that drafted the guidelines, say what they have put together is merely a document that provides a gold standard of care for the control and treatment of HIV and TB in prisoners. But whether countries in the southern African region can meet these guidelines is a matter they have no control over. Dr Juno Thomas, a specialist physician at Chris Hani Baragwanath Hospital, the largest in the southern hemisphere, lent her expertise in AIDS treatment to the process of drafting the guidelines.    

‘€œWe’€™ve drawn up guidelines that advocate optimal management for HIV and TB in prisoners. However, there are numerous logistical and economic and administrative obstacles to implementing many of these guidelines. My hope is that the departments of correctional services will buy into these guidelines and start some kind of reformation in terms of their current policies for treating HIV and TB in prisoners’€, she said.

The Department of Health has said it will study the guidelines and investigate how to apply them within the correctional services context. This will possibly take place under the auspices of the South African National AIDS Council (SANAC), involving both departments of health and correctional services. One of the biggest challenges in the drafting of the guidelines, says another expert panel member, the AIDS Law Project’€™s Jonathan Berger, was the question of how to deal with HIV prevention in prisons. In all SADC countries except South Africa, sex between people of the same sex, particularly men, is a criminal offence.

‘€œIn that context, how does one ensure that condoms are provided; they’€™re provided in a sensitive manner; that they’€™re also provided with lubricant because condoms without lubricant in the context of anal sex invite a whole range of other kinds of unsafe lubricants to be used’€, he asked.

But the guidelines come out quite clearly to address the matter.

‘€œRegardless of whether or not consensual sex is criminalised or not, if your concern is about preventing HIV transmission, then you need to put certain things in place ‘€“ provision of condoms, provision of lubricant. The other key issue which comes up in relation to sex between men in relation to non-consensual sex is the issue of dealing with coercive sex and rape within prisons; and that having to be an integral part of any HIV prevention programme within prisons’€, he said.    

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