Prisoners Reducing Risk for HIV Infection Through Testing and Counseling Services

 {Photo credit: MSH}Staff at the new HTC site in Bvumbwe Prison test an inmate for HIV.Photo credit: MSH

All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community without discrimination.
~ World Health Organization (WHO) and UNAIDS

As in many prisons in sub-Saharan Africa, male inmates in Malawi’s most crowded detention facilities sleep sitting down, eat once a day, and are forced to barter sex for better conditions. Yet authorities ban condom distribution in the prisons—a place where inmates are at high risk for HIV infection—because sex between men is illegal in the country.  

A 2011 study by the University of Malawi found that 4 out of 10 male inmates were HIV-positive, compared with 1 in 10 in the general population. “Apart from sexual intercourse, other commonly reported risky practices that could promote HIV transmission included sharing of shaving razor blades and toothbrushes, tattooing, and ear piercing,” according to the study, “Prevalence and Risks Factors for HIV, Sexually-Transmitted Infections and Tuberculosis in Malawian Prisons,” which was commissioned by the Malawi Prison Service and funded by the United Nations Office on Drugs and UNAIDS.

And although Malawi’s HIV testing and counseling (HTC) services have improved in recent years, prisoners often lack access to them. As a result, many HIV-positive inmates are not diagnosed or treated and the virus spreads rapidly among fellow prisoners.

In 2012, the US Centers for Disease Control and Prevention (CDC) initiated a program designed to improve the quality, access, and coverage of health services related to HIV in seven districts of Malawi. The Service Delivery Quality Improvement and Health Systems Strengthening project, led by Management Sciences for Health (MSH), works with local stakeholders to this end, including improving HIV prevention and care at prisons in these seven districts.

Earlier this year, MSH worked with the district health office in Thyolo district to establish an HTC site at Bvumbwe Prison, where HIV testing is now available every day. Prisoners who test positive and meet Malawi’s clinical eligibility criteria are referred to a nearby health center for antiretroviral therapy.

To help stem HIV transmission in the prison, MSH is working with the district HTC coordinator to arrange monthly health education sessions so prisoners can learn about HIV prevention, the importance of timely testing, and ways to access treatment.

Inmates have expressed gratitude for the new services. One prisoner said:

This is the first time [HIV testing has] happened in our prison. We won’t take this for granted.

Prison staff members are also pleased.

“We are grateful for this [HTC] service. It’s our own and [we] will utilize this service,” said Bvumbwe’s officer-in-charge.

Building on its success at Bvumbwe Prison, MSH is working with staff and stakeholders to implement HTC sites at two additional Malawian prisons. These services will benefit the inmates themselves and help protect their families and partners from HIV infection after the inmates are released.      

Allison Zakaliya, an M&E senior advisor for the project, contributed to this content.