Ensuring access to comprehensive prevention and treatment services in prisons

1. Ensuring access to comprehensive prevention and treatment services in prisons Addressing stigma and discrimination: Jonathan Berger Senior researcher, AIDS Law Project Honorary research fellow, Wits University Tuesday, March 11th 2009 Regional workshop on HIV/AIDS and vulnerable Groups, Cape Town

2. Overview of presentation • EN and Others v Government of the RSA and Others • Policy under attack • Development of a comprehensive policy for addressing HIV/AIDS within correctional centres • Contextualising confidentiality, stigma and discrimination • Stigma and discrimination in general • Condom distribution • Creating an appropriate environment for VCT • Regional guidelines for the prevention and treatment of HIV in arrested, detained and sentenced persons • Builds on prior work following court judgment • Further contextualises confidentiality concerns

3. EN and Others v Government of the RSA and Others • Policy under attack • Removal of obstacles to treatment at Westville Correctional Centre (WCC) • Development and implementation of reasonable plan to provide treatment in accordance with Operational Plan • Development of comprehensive HIV/AIDS policy • Court orders barriers to be removed and reasonable plan to be developed • Order suspended upon application for leave to appeal • Applicants apply for interim execution orders • Second execution order leads to some implementation of order (late ’06) • Out-of-court settlement sabotaged (mid-March ’07) • On-off settlement talks morphed into revision of new DCS plan • Narrowed the differences between agreed framework and revised DCS policy • Unclear if proposed amendments incorporated and implemented

4. Contextualising confidentiality, stigma and discrimination • Stigma and discrimination • The parties recognise the need to address stigma and discrimination within the correctional centre setting. In particular, they recognise the need to mitigate the negative impact of stigma and discrimination on all efforts to prevent and treat HIV infection. • Condom distribution • The parties recognise that … the inability of offenders to access condoms confidentially and in a non-stigmatised environment … may undermine condom usage in correctional centres • Creating an appropriate environment for VCT • Monitoring –and addressing identified –breaches of confidentiality and acts of unfair discrimination that may arise following HIV testing

5. Southern African HIV Clinicians Society regional guidelines • Further contextualising confidentiality • Inadvertent disclosure … is common, especially where HIV-specific care is provided … Provision of special diets, attendance on certain days and at certain clinics, calls for medication, legal consultations and storage of medication within cells may all lead to inadvertent disclosure. • Prisoners should be … encouraged to disclose relevant medical information to allow the staff of the facility or the [health care worker] to take the necessary steps to allow for appropriate medical care • [S]ecurity staff [should also] be trained to deal with sensitive and confidential medical information. • Personal safety of the [health care worker] should not be placed at risk in the interests of protecting confidentiality. • Written communication to other[s] … at distant sites should be sealed, to ensure that medical details are not available to guards and couriers.

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