Opinion: Justice Delayed, Health Denied

African justice systems must change to help curb HIV and tuberculosis transmission in prisons.

By Joseph Amon | June 4, 2012

Convicted prisoners outside a cell at Mumbwa Prison. Inmates at prisons with associated farm facilities, like Mumbwa, often work in the fields 7 days a week, where they are frequently beaten and have no toilet facilities or water.© 2009 Katherine Todrys/Human Rights Watch

Convicted prisoners outside a cell at Mumbwa Prison. Inmates at prisons with associated farm facilities, like Mumbwa, often work in the fields 7 days a week, where they are frequently beaten and have no toilet facilities or water. © 2009 KATHERINE TODRYS/HUMAN RIGHTS WATCH

It’s not a surprise to anyone who knows anything about African prisons to hear that HIV and tuberculosis (TB) rates are staggering, and that health care is virtually nonexistent. Less intuitive is the assertion that I outlined in a recent article that governments and health donors should fund criminal justice reforms as critical HIV and TB interventions.

Disease in African prisons is incubated and spread through a perfect storm of inadequate funding, lack of political will, and a desperate need for policy change. In many African countries, prison conditions are awful, and have been for years. Prisons are often miserably overcrowded. The lack of prompt isolation and treatment or screening for TB among incoming prisoners means that the disease is quickly transmitted in the packed, dark, unventilated cells. Sex, whether it be rape, as a barter for food, or truly consensual occurs as a result of food shortages, insecurity, and long prison sentences without conjugal visits. Without access to condoms, HIV transmission is facilitated. Overall, HIV prevalence in prisons is 2 to 50 times higher than rates outside of prisons. TB incidence in prisons around the world has been estimated at more than 20 times the rates in the general public.

Increased funding for health services is one important response. African governments need to meet the basic health needs of prisoners as a part of their obligation to respect and fulfill the right to health. Prisoners denied health care cannot turn elsewhere: they are wholly dependent upon prison officials to provide them access to care. While prison health care in Africa is desperately under-resourced, in some countries, like Zambia, international donors and the Prisons Service have recently taken some steps to expand care, notably TB screening. But donor interest and government funding is the exception rather than the rule, and it is unlikely that African prisons will ever be showered with enough funding to provide adequate care.

Prisoners in Africa, like those everywhere, are an unpopular cause, and as a group they have little political influence. Unlike other groups at risk of HIV and TB, including youth, women, and even sex workers and drug users, whose representatives are included in international conferences and policy meetings, the interests of prisoners are rarely recognized, let alone allowed to participate and give testimony of their experiences.

More fundamentally, though, is the fact that expanding funding cannot alone solve the barriers to HIV and TB prevention and treatment. Improving health conditions in prisons requires more than just investment in medical facilities. Tackling head-on the structural barriers to HIV prevention and TB transmission can also be more cost-effective.

Prisoners in the yard at Muinaina Farm Prison in Mubende, Uganda
Prisoners in the yard at Muinaina Farm Prison in Mubende, Uganda

Justice reform is particularly critical. Prisons throughout sub-Saharan Africa are often so overcrowded that inmates may be forced to sleep seated, standing, or in shifts. One reason for overcrowding is extended pretrial detention. In Zambia and Uganda, few prisoners are brought before a judge soon after they are arrested. Even when they are, they wait years in prison pending trial. In both countries, prisoners can wait 9 or 10 years for their trial, and many plead guilty to minor charges with the hope that the sentence is shorter than they would have waited for a trial. Appeals can take even longer, and even when sentences are finished, bureaucratic delays may keep people in prison. We documented the case of a juvenile prisoner in Zambia who had been ordered released by a judge a year and a half earlier, but had yet to be let go.

In some cases, detention can be due to mere association with an offender or may even be entirely arbitrary. In Zambia, for example, the police and the Drug Enforcement Commission have been known to lock up whole families when their primary targets cannot be found. In Uganda, news reports have described wide-ranging police arrests in Kampala slums of people who are then used by prison authorities as free manpower for prison farms or contracted out to private landowners, who pay the jail for the services.

Each time people are arbitrarily imprisoned, held for long periods in pre-trial detention, or denied bail, their risk of becoming infected with HIV and TB increases. They may be cleared of the charges against them, but they will nonetheless be sentenced to infection. If the pre-trial detention is long enough, and their pleas for medical attention are denied, they may even die. In Uganda in 2010, HIV and TB accounted for almost 80 percent of prison deaths. Zambian lawyers told us that prison officers carried bodies out in the night, so there wouldn’t be panic when the prisoners saw how many had died.

Expanding resources for HIV and TB prevention and treatment are critical, but interventions—such as reforming bail guidelines, expanding the availability of community service and parole programs, increasing the number of judges, and improving access to legal representation—are critical to a sustainable, cost-effective approach to improving prisoner health. It is not rocket science: keeping people who aren’t dangerous out of prison will reduce overcrowding and make adequate provision of health care in prisons more affordable. In addition to protecting health, these changes would advance human rights and justice.

Prisons are not a separate world. Every day prisoners are released back to their families and into our communities. Prison officers also form a bridge between prisons and communities. Protecting prisoners’ health is an important part of protecting public health. It is also a way of recognizing that prisoners, even if they have committed a crime, are still human, and are entitled to human dignity and rights.

Joseph Amon is the director of the Health and Human Rights Division at Human Rights Watch.

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Avatar of: MAGS01


Posts: 25

June 5, 2012

In poor developing countries if there is a choice between a school/children's hospital and an improved prison guess what is going to be built.

Avatar of: Charles Kristensen

Charles Kristensen

Posts: 1457

June 5, 2012

Leave the knee jerk reactions out of it, check out the the consequences and run the numbers. As stated: "not rocket science".
Then again, if you're profiteering from the current system ...
whole 'nuther story

Avatar of: glenn398


Posts: 15

June 5, 2012

It goes to show that when blacks are in charge of their own people they just still use them in what is really slavery. No amount of money will ever help and never has as we have been giving to Africa since I can remember in the 40s. If man really got started in Africa as stated than they should be the most advanced people in the world, especially since they have great mineral wealth.   

Avatar of: TheSciAdmin


Posts: 56

June 5, 2012

On the contrary, glenn398. Discussion and respectful disagreement are encouraged in our forum. Racist invective, however, will not be tolerated. That is why your previous comment was deleted.

June 5, 2012

This is my comment on Justice Delayed

Avatar of: Edward R. Mikol

Edward R. Mikol

Posts: 1457

June 5, 2012

Isn't this a step in the rehabilitation of Lamarck?

"The transmission of acquired characteristics" is his central proposition.

If this information is independently verified, the scientists who vilified Jean-Baptiste should issue a mea culpa.

Avatar of: olmstedhomested


Posts: 4

June 5, 2012

In the countries being described, prisons certainly are the last to be funded. But for Mr Amon, the only answer is more money; he offers no solutions as to how to raise it. Just give me more money. MAGS01 is correct in suggesting a school is more likely to be built the a prison improved. Would Mr Amon take away education (the only opportunity to escape), or perhaps take away the food for these children? It's a very typical and expected response to an immense problem - play on the heart of the reader and while picking their pockets for dollars.

Avatar of: John Collier

John Collier

Posts: 2

June 5, 2012

I live in South Africa, which has better prisons than many sub-Saharan countries, but there is still a lot to be desired. I would like to emphasize that many of the prisoners are eventually released into the general population, with their diseases and all. The prisons become a breeding ground for HIV and tuberculosis for the wider population.

Avatar of: glenn398


Posts: 15

June 5, 2012

Since I don't see my comment it looks like unless a person totally agrees with the article it is deleted. Good way to always push your opinion no matter how bad it is.

June 5, 2012

This is my comment on Memory Tools

Avatar of: paulrwalsh


Posts: 1

June 5, 2012

 Other instances of 'inheritance of acquired characteristics' have previously been reported.  But, in each of these cases, it is an atypical method of inheritance.  Darwinian (or Mendelian) inheritance remains the primary agent, with ancillary instances of Lamarckian (or quasi-Lamarkian) being the exceptions to the rule.

For example, three medical conditions previously classified (by some authors) as evidence of transmission of acquired characteristics include Fragile X Syndrome, Kennedy's Disease, and Huntington's disease.   Each of these genetic diseases is caused by duplication of short DNA sequences.  As the number of the repeats increases, so does the severity of the inherited disease.  Successive generations have, in many cases, been shown to have an increased number of short tandem repeats and more severe symptoms.  More information can be found in the links below.

1.  Fragile X Syndrome is caused by duplication CGG trinucleotide repeats in the 5' untranslated region of the FMR1 gene.)

2.  Kennedy's disease is caused by duplication of CAG trinucleotide repeats in the first exon of the androgen receptor gene.

3.  Huntington's Disease is caused by duplication of a CAG trinucleotide repeat in the translated region of the HTT gene, leading to production of a polyglutamine tract within the the Huntingtin protein.  

-paul r walsh

Avatar of: glenn398


Posts: 15

June 6, 2012

Since when is the truth racist

Subject: [the-scientist] Re: Opinion: Justice Delayed, Health Denied

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