Improving African justice systems essential to prevent spread of HIV and TB in prisons

In order to reduce HIV and TB in African prisons, African governments and international health donors should fund criminal justice reforms, experts from Human Rights Watch say in this week's PLoS Medicine.

"Overcrowding is driving HIV and TB transmission in African prisons, and alleviating overcrowding by increasing the availability of non-custodial alternatives including community service and bail and improving access to legal representation should be understood as essential public health measures for HIV and TB prevention and control," say Joseph Amon and Katherine Todrys from the international human rights organisation.

Rates of HIV and tuberculosis in sub-Saharan Africa are many times higher in prison than in non-prison populations, due in part to overcrowding and a lack of adequate prevention and treatment services in the prisons. Almost all prisoners eventually leave prison and, along with visitors and prison officers, represent a potential bridge for disease transmission between prison and community populations.

"Thousands of individuals are detained in African prisons unjustly and unnecessarily, including spending long periods in pretrial detention, because of weak criminal justice systems," the authors say. That contributes to the overcrowding that leads to the spread of the diseases.

The authors reached these conclusions by surveying prison commissioners and medical directors in 10 East and Southern African countries with high HIV and TB rates. They also conducted in-depth interviews with prison officials and hundreds of prisoners in Zambia and Uganda and heard many distressing accounts of dire conditions and extreme delays in sentencing, trials, and appeals. One man in a Zambian prison had been held for three years before he first saw a judge.

Furthermore, international human rights law requires countries to maintain adequate prison conditions and provide a minimum level of health care equivalent to that available to the general population. But the authors found significant gaps in the availability of HIV- and TB-related prevention and care.

The authors conclude: "Both increased resources for health, as well as structural interventions addressing criminal justice failures, are necessary to address HIV and TB and advance prisoner and public health. African governments have a responsibility to address the life-threatening conditions in prisons, which are contrary to international law and standards, and to improve prisoners' access to justice."