“We have adopted new measures of sensitizing people in correctional facilities as high-risk sexual behaviour in Rwandan prisons seems to be a major contributing factor to the increase in the spread of HIV,” said Anita Asiimwe, executive secretary of the National AIDS Control Commission, CNLS.
The new strategy will use peer educators to teach prisoners about HIV; they will also encourage prisoners to attend voluntary counselling and testing for HIV so that those who are already HIV-positive can access treatment.
“We put emphasis on providing care to those inmates that are HIV-positive,” said Antoine Semukanya, deputy executive secretary of CNLS.
Like other countries in the region, including Kenya and Uganda, Rwanda’s HIV policy regards prisoners as a group that is “most at-risk” of contracting and transmitting HIV.
Risk factors
“Prison grounds offer ideal conditions for the transmission of HIV, especially through homosexuality,” Dative Mukanyangezi, director-general of Kigali Central Prison – where 16.5 percent of imprisoned women and 15 percent of male prisoners were HIV-positive, according to 2006 data – told IRIN/PlusNews.
She noted that practices such as intravenous drug use and the sharing of non-sterile sharp instruments for tattooing were widespread in Rwanda’s prisons.
According to a 2009 study by the Ministry of Health and its partners, prisoners in Kigali’s Kimironko Prison reported having sex with sex workers, girlfriends and wives while out of prison on work detail.
“Considering all these practices and [the fact that] most prisoners are sexually active males between the ages of 19 and 30, this could explain why prisoners are a most-at-risk population for HIV,” Mukanyangezi added.
The study also found structural issues such as over-crowding – Rwanda has one of the highest prison populations in the world, with an estimated 604 out of every 100,000 people in prison – short and complicated visitation rights, and insufficient food to be risk factors for HIV in prison. It recommended conjugal visits for some prisoners
The case for condoms
CNLS’s Semukanya noted that the illegal nature of sex behind bars meant that the new strategy would not include the provision of condoms or water-based lubricants, recommended for use along with condoms to prevent lesions during anal sex.
However, experts recommended the use of condoms in prison. A 2009 report by TRAC-Plus, the Centre for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics, found there was a need to strengthen HIV prevention in prisons, especially condom promotion.
“Behaviour change communications could be more appropriate than sanctions to prevent MSM [men who have sex with men], and should focus on increasing risk perception, de-stigmatizing condoms, and promoting other strategies for sexual gratification,” said the ministry’s study.