HIV in Prisons in Zambia
I've just returned from a fascinating, if frustrating, workshop on HIV and AIDS prevention in prisons run by the United Nations Office of Drugs and Crime (UNODC). One of the big areas of debate was around the legality of condom distribution to prisoners. The law is actually pretty clear on this. Prisoners have a right to health protection and treatment no matter what their HIV status or sexual behaviour. New prison policies back this up and explicitly mention the provision of condoms, post exposure prophylaxis and morning after pills. But many people at the prison service were uncomfortable with the idea of providing condoms because 'sodomy' and 'unnatural sexual acts' (and indeed all sexual activity in a prison context) are illegal in Zambia. They saw provision of condoms as tacit acceptance of homosexuality, something which is definitely unacceptable in Zambia society.
There were passionate calls for further research to be conducted into the the prevalence (and even reality) of men having sex with men in Zambian prisons despite agreement from all (and evidence from almost every other country in the world) that this is definitely happening. There is a huge evidence base to suggest that men who have sex with men are at higher risk of HIV infection than any other group of individuals. In a country where HIV is endemic this individuals are at particular risk. There is also a huge evidence base showing that condoms are the most effective way (after abstinence) of preventing HIV transmission. And there's loads of evidence to suggest that ignoring small high-risk populations (like prisoners, sex workers and injecting drug users) can quickly lead to HIV spreading into the general population (through sex work clients, prisoners returning to their communities etc.).
Surely then as a quick, cheap and easy intervention Zambian prisons could at least pilot a scheme of condom distribution in prison. There are no legal implications for prison guards or managers and at worst the condoms will have no effect. The likely outcome however will be a significant improvement in the sexual health of prisoners (see HIV and AIDS in places of detention).
The biggest challenge to this scheme will be the social/moral implications. But if the idea of men having sex with men is too uncomfortable for Zambian society then they can at at least view this as a public health move. Healthy prisoners lead to a healthy society and there can be no moral objection that.
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