WEPHREN’s focus in December 2018 is on HIV in women in prisons in sub Saharan Africa for World AIDS Day 2018. Below Professor Marie Claire van Hout describes a project in Malawi and Zimbabwe addressing the sexual and reproductive health inequalities of women in prison, who are a particularly vulnerable population.
Promoting positive sexual and reproductive health and accessible HIV Prevention, Treatment, Care and Support (PTC&S) services for women prisoners in Zimbabwe and Malawi
by Professor Marie Claire van Hout
The Sub Saharan (SSA) region remains at the epicentre of the HIV epidemic with two thirds of all people infected with HIV living in this region, and disproportionately affecting women 1 2. There is a concentration of HIV/ AIDS amongst those who are incarcerated 3 4. HIV prevalence in women in prisons is higher than for men because of sub-standard hygiene, limited access to services and interruption of the necessary health services during internment 3. in Zimbabwe and Malawi, the public health challenge centres on the sexual and reproductive health (SRH) care needs of women in prison, who constitute a vulnerable HIV/AIDS risk population, and experience dual disadvantage according to gender and incarceration, and whose special SRH needs are neglected in prisons.
Adequate health services in prisons are required under the Sustainable Development Goals (SDG 3, 5, and 16), as well as under the ‘Mandela Rules’ covering the UN Standard Minimum Rules for the Treatment of Prisoners (A/RES/70/175) and the Bangkok Rules for Female Prisoners (A/RES/65/229). In the SSA region, the Southern African Development Community (SADC) Minimum Standards for HIV in Prisons have also mandated minimum requirements for prisons to be able to effectively prevent, treat and control HIV/AIDS in prisons. Current provisions for women prisoners and their children in Zimbabwean and Malawian prison systems however fall far short of these equivalence care standards according to a 2017 UNODC evaluation 3 and also a recent scoping review 5. There are currently no robust monitoring systems for HIV/AIDs in prisons in Zimbabwe and Malawi, and little strategic information available around women’s experiences and their health care needs 3 4.
1 " UNAIDS (2014) The Gap Report. Geneva: The Joint United Nations Programme on HIV/AIDS (UNAIDS).
2 Telisinghe, L., Charambous, S., Topp, S., Herce, M., Hoffmann, C., Barron, P., Schouten, E., Jahn, A., Zachariah, R., Harries, A., Beyrer, C., & J Amon, K J (2016). HIV and tuberculosis in prisons in sub-Saharan Africa The Lancet http://dx.doi.org/10.1016/S0140-6736(16)30578-5.
3 Van Hout, MC., Mhlunga, R, & Rusakaniko, S (2017). Independent project evaluation of the HIV Prevention, Treatment, Care and Support in Prisons Settings in Sub Saharan Africa XSS V02 Sub-Saharan Africa (Angola, Ethiopia, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Tanzania (+ Zanzibar), Zambia & Zimbabwe). Vienna: United Nations Office on Drugs and Crime (UNODC)
4 UNODC/UNAIDS/WB (2007). HIV and Prisons in sub-Saharan Africa: Opportunities for Action Vienna:UNODC
5 Van Hout, M.C., & Mhlanga-Gunda, R (2018). Contemporary women prisoners health experiences, unique prison health care needs and health care outcomes in Sub Saharan Africa: A scoping review of extant literature. BMC International Health and Human Rights. 18(1):p31.
The AHRC/MRC Project
The funded AHRC.MRC Global Health Partnership project (2018-2020) led by Van Hout, and underpinned by a unique AHRC/MRC partnership of UK, Zimbabwe and Malawian academics and NGOs will investigate the sexual and reproductive health inequalities of women prisoners, who are a vulnerable HIV/AIDS population in Zimbabwe and Malawi. The partnership and its project activities will set the scene for a strong international collaborative effort to monitor, investigate, understand and promote women in prison’s human rights and SRH needs in Zimbabwe and Malawi. Understanding prison cultures which shape prison staff and wardens’ understanding and responsiveness to female prisoners’ SRH and HIV PTC&S needs in both countries is vital to inform policy change and improved standards for women prisoners and their children.
The issue of HIV/AIDS in prisons is both a human rights and public health issue, which requires a strategic approach in these countries to prevent HIV transmission and improve health for all, whilst at the same time ensuring the respect of human rights and dignity of those infected and requiring treatment. The partnership represents a form of international sustainable development work which will create a first step in both countries towards addressing female prisoner SRH disparity, and ensure that their views are utilized to contribute to reframing of gender sensitive and human rights based prison responses and prison health policies, and enhance their access to high-quality and stigma-free health and HIV prison services when needed. The partnership sits within the global aim of leveraging the end of AIDS through working and collaborating in an interdisciplinary and multi-sectoral partnership (sustainable development goal, SDG 17).
About Marie Claire Van Hout
Marie Claire Van Hout is Professor of Public Health Policy and Practice at the Public Health Institute, Liverpool John Moores University, United Kingdom. She has over 17 years research, education, community development and clinical practice experience in various fields of public health and drug policy and practice, and concentrated in the area of prescribed and illicit substance abuse, prison health rights, HIV/HCV prevention, treatment, care and support in Europe and Sub Saharan Africa, and vulnerable populations. Read more about her and her work here.
Principal Investigator Professor Marie Claire Van Hout.
Team Liverpool John Moores University; University of Zimbabwe; University of Malawi
Funder: AHRC-MRC Global Public Health Partnership Fund.
UNODC (2017).. Independent Evaluation of Project XSS V02 HIV Prevention, Treatment, Care and Support in Prison Settings in Sub Saharan Africa. The UNODC project aimed to support responses to HIV in prisons in Angola, Ethiopia, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Tanzania (+Zanzibar), Zambia & Zimbabwe. United Nations Office for Drugs and Crime (UNODC), Vienna, Austria. http://www.unodc.org/documents/evaluation/Independent_Project_Evaluations/2017/XSSV02_independent_project_evaluation_report_2017.pdf
- Crowley, D., & Van Hout, MC (2016). Effectiveness of pharmacotherapies in increasing treatment retention and reducing opioid overdose death in individuals recently released from prison: a systematic review. Heroin Addiction and Related Clinical Problems. 19 (2), pp25-42.
- Van Hout, M.C., & Mhlanga-Gunda, R (2018). Contemporary women prisoners health experiences, unique prison health care needs and health care outcomes in Sub Saharan Africa: A scoping review of extant literature. BMC International Health and Human Rights.18(1):p31.
- Crowley, D., Cullen, W., Lambert, J., Van Hout, MC (2018).Hepatitis C Virus (HCV) screening in people who inject drugs (PWID) and prisoners - a narrative review of extant literature. Heroin Addiction and Related Clinical Problems. In press.
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