“Our goal is to test every prisoner in the system,” said Ann Motsa, who is running the first HIV testing and counselling centre to be located in a jail at Matsapha Central Prison, a maximum security facility 25km east of the capital, Mbabane. A testing facility for each of the country’s 12 correctional centres is planned.  

The centre opened a few months ago, with funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and technical support from the non-profit social marketing organization, Population Services International (PSI). The organization provides condoms to the main clinic at Matsapha Central Prison, but at present they are only given to prisoners who are being released.  

So far, 447 of Matsapha Prison’s 678 inmates have been tested, as well as several hundred inmates from a small prison in Malkerns, a town 20km south of Mbabane, and from a remand facility in Manzini, the country’s commercial hub, about 30km southeast of the capital.  

Previously, prisoners were taken to government hospitals in Mbabane or Manzini for testing, but there were security and logistical problems, said Jethro Ndzingane, who is in charge of the national Prison HIV/AIDS Programme.  

The government declared AIDS a national emergency in 1999; 10 years later, the prison population of about 3,000 reflects the AIDS numbers in Swaziland, where the infection rate in sexually active adults aged between 19 and 29 is 26 percent, according to the Ministry of Health.  

Testing in prison is done on a strictly voluntary basis – as elsewhere in the country – so it is difficult to calculate what percentage of the inmate population are living with HIV.  

“The challenge is getting inmates to come here [to the centre]. We have trained dozens of peer educators, who go out and talk to their fellow inmates; they hand out literature and make appointments for testing,” said Motsa.  

“Mandatory testing is not okay,” said Ndzingane. “Health groups and the Ministry of Health are not for it, but we must find a way to collect data on the extent of HIV in the prisons – one way is to test every inmate confidentially, and only give them their results if they request them.”  

He hoped that a programme not only to test, but also continuously to retest inmates who were initially found HIV negative, would also provide data to support or refute claims by released inmates that they had contracted HIV while incarcerated. “When they make these claims it is hard to confirm or deny because we don’t have the testing evidence,” said Ndzingane.  

Released prisoners insist there is sexual activity in prisons, while prison authorities refer to their claims as “allegations”, but the Coordinating Assembly of NGOs (CANGO), an umbrella body, said this week that such stories were too widespread and persistent to ignore.  

HIV-positive inmates with serious medical problems, and those needing antiretroviral (ARV) medication, still go to the main hospital in Manzini for treatment, but there are peer educators to help them adhere to their medication.  

Tracking HIV-positive inmates after their release to ensure they stay on treatment presents a serious challenge. “The problem is that so many prisoners give us wrong information,” said Motsa. “So if they are HIV positive and we’ve been treating them here, when they are released we don’t know where they live.”  

Ndzingane said that one possible solution would be to revive the Community Referral Service – a lapsed programme in which rural health workers kept track of HIV-positive former inmates.  

Persuading inmates to reveal their HIV-positive status to partners and family members is another challenge. “Conjugal visits are not permitted in our prisons, but partners of inmates are still at risk if the inmates test HIV positive,” said Motsa.  

“Many prisoners tell us they don’t wish to inform their partners until they are released – maybe they think their partners will abandon them or their families will stop visiting them.”