When Jackson* first set foot in Kamiti Maximum Security Prison more than three years ago, one of the first things he did was get tested for HIV, hepatitis and tuberculosis. He tested negative.
Two years later, he tested positive for HIV, becoming one in the number of new HIV infections that happen in Kenya’s prisons every year.
In 2009, a study by the National Aids Control Council, UNAIDS and the World Bank, found that inmates and men who have sex with men account for 15 per cent of Kenya’s new HIV infections, leading the government to designate prisoners as a “most-at-risk” population.
A 2016 study on the global burden of HIV, viral hepatitis and tuberculosis in prisoners and detainees published in The Lancet, found that 16 per cent of prisoners in East and Southern Africa were HIV-positive, and estimated that in Kenya, five to 10 per cent of prisoners were HIV-positive.
Since finding out his changed HIV-status, Jackson has kept it to himself because “HIV-positive inmates are treated like the plague.” And beyond fighting stigma behind bars, Jackson says, there is also the issue of getting access to treatment.
“Thank God, I am still healthy. My fellow inmates don’t know my status because I have not started taking medicine. However, those who take medicine don’t do it diligently because a prison warder might not be available on the day they need to go to the clinic,” Jackson, who is still serving his prison term, told HealthyNation.
Wilson Kinywa, a former inmate who was released from Kamiti in February, says that in recent years, access to medication has become problematic, noting that before the prison became heavily indebted, inmates used to get their drugs on time and there was a special diet for the sick. But by the time he left two months ago, he claims, medication was not available.
“Not even the basic ones. Even patients with HIV went without drugs. I talked to the officer in-charge and he said the situation was temporary, and that they were looking for possible solutions,” Mr Kinywa, who was the spokesperson for prisoners for 21 years, told HealthyNation.
The issue of access to treatment by HIV-positive prisoners, is playing out in court in a case by two prisoners who are suing for being denied the right to treatment.
In court papers, James* one of the two prisoners, who describes himself as a HIV and tuberculosis patient, claims that he was transferred from Embu Prison to Kamiti, under a doctor’s recommendation, so that he could be closer to the Kenyatta National Hospital for treatment for various ailments.
However, James claims that prison authorities have been reluctant to facilitate his hospital visits, which has seen him occasionally run out of medicine that should be taken every day.
James notes that he has occasionally been forced to seek financial support from his struggling family to buy medication for survival.
“They (prison authorities) are aware of my health conditions, but they have blatantly ignored and/or denied me access to medication, notwithstanding the seriousness of the ailments,” said James* in court papers filed on March 7, 2017.
This action he said, is a violation of their rights (he has sued jointly with another inmate) as Kenyan citizens and people in custody, and asked the court to direct the prison management to immediately and continually facilitate their visits to the Kenyatta National Hospital (KNH) for medical attention as demanded by their health status.
However, in response to the suit, the officer in-charge at Kamiti Maximum Security Prison, argues that James has regularly had the opportunity to visit KNH for treatment, and that the prison authorities complied with a order by High Court Judge John Mativo dated February 20, 2018, directing him to facilitate James to visit KNH.
The officer further explains the challenges correctional facilities face in handling patients – an acute shortage of officers to escort patients due to overwhelming movement of other inmates to court and other hospitals; the fear that a prisoner will smuggle in contraband while returning from hospital; and the prisoners’ lack of cooperation with prison procedures such as searchers and display of unruly conduct while being searched at the prison’s main gate.
“Despite all these challenges, the prison authorities made efforts to escort James* to hospital for treatment, bearing in mind that it is his right to be accorded medical attention,” says the officer in-charge in court papers.
However, he requests the court to appreciate that James could not go to KNH whenever he demands, because security considerations are paramount.
“Medical treatment should not be perceived to be at KNH only. Our medics are attending to him,” said the officer in court documents.
The case is still pending in court, and their lawyer has persistently mentioned to the court that his clients are not being allowed to regularly attend treatment at KNH. Hearing resumes on June 24, but the case opens the lid on the issue of access to treatment for prisoners with HIV.
The 2016 Lancet study on HIV and tuberculosis in prison, noted that there were barriers to healthcare services in prison, due to lack of integration of prison healthcare into the public health system, and lack of coordination between health services and the criminal justice system, which led to interrupted health services for prisoners.
The study noted that interventions are rarely fully available in prisons in African countries due to barriers such as financial constraints, inadequate infrastructure, lack of transport to off-site clinics, fragmented care due to facility transfers and release back to the community, and scarce human resources for health.
The researchers warned that without proper management of HIV (and tuberculosis) in prison, the larger community control efforts would be affected as people move in and out of prison. They called for treatment and care for HIV-positive prisoners, adhering to national guidelines and linked to national programmes.
While the National AIDS Control Council says it does not run any programmes in Kenyan prisons, Alphonce Okello, the Kenya Prisons AIDS Control Unit Coordinator at Kamiti, told HealthyNation there is no cause for worry as drugs are available at the Kamiti Sub-County Hospital, and no inmate has ever been denied access to treatment, as the Kenya Medical Supplies Authority supplies them on a monthly basis.
“There is a lot happening inside prison as far as interventions on HIV/AIDS are concerned. We have comprehensive care clinics and the inmates are given antiretroviral drugs,” he told HealthyNation, adding that the drugs are dispensed differently for different categories of patients.
“We have three categories of patients. Newcomers are given drugs to last them two weeks at a time; those who adhere to their drugs are given on a three-month basis, and those who don’t adhere to medication are given on a daily basis,” he said.
“Why would they prefer going to KNH yet the same services are available at the hospital in the prison?” he posed.
He added that inmates are also given post-exposure prophylaxis because there are cases of sexual assault and sodomy in prison.
“These are not allowed, but we stock the drugs because anything can happen. Men have sex with men in other populations. Prison is not an exception” he said.
At Kamiti prison, he added, 160 HIV-positive prisoners have formed 12 support groups, for each of the 10 blocks that make up the prison.
“We have a programme which enrols youths in prison, with 12 inmates in each cluster. They are taken through 12 steps both visual and audio on HIV eradication and what to do to remain safe,” he says.
There are also support groups with HIV-positive ambassadors, and this is part of the nationwide programme established to deal with HIV prevention and mitigation.
“With the group, they are able to support, encourage and train each other on how to stay safe. They are also able to enlighten others on what is expected of them, what to do to remain safe, and engage positively to reduce stigma in prison,” said Mr Okello.
*Names have been changed