An Age of Hope: Initiatives on HIV/AIDS and Medical Parole

1. PRESENTATION TO THE SELECT COMMITTEE ON SECURITY AND CONSTITUTIONAL AFFAIRS CURRENT INITIATIVES ON HIV AND AIDS AND AN OVERVIEW ON MEDICAL PAROLE An Age of hope: a National Effort for Corrections, Rehabilitation and Social Re-integration of Offenders

2. TO BRIEF THE SELECT COMMITTEE ON SECURITY AND CONSTITUTIONAL AFFAIRS ON CURRENT INITIATIVES ON HIV AND AIDS AND AN OVERVIEW ON MEDICAL PAROLE PURPOSE

3. Introduction Current projects / initiatives: Mandates Comprehensive HIV and AIDS Program Partnerships - Prevalence Survey Medical Parole Challenges CONTENTS

4. The core business of Correctional Services is the safe and secure custody of offenders in a humane environment that enhances rehabilitation DCS commitment to support government initiatives in the management of HIV and AIDS (putting more emphasis on prevention) is not without challenges Part of the fulfilment of the mandate DCS works in collaboration with external stakeholders to strengthen rehabilitation and to address the challenges INTRODUCTION

5. Mandates: HIV and AIDS Policy for offenders available Post Exposure Prophylaxis Guidelines available Correctional Centre Based Care Policy approved CURRENT PROJECTS / INITIATIVES

6. Comprehensive HIV and AIDS Program: Prevention: Invited services providers to bid for the training of 320 professional personnel (Health Care workers, Social Workers, Psychologists and Spiritual Care) in Voluntary Counselling and Testing (VCT) Lay counsellors seconded from Dept. of Health to assist with VCT 120 Offenders to be trained as HIV and AIDS Master Peer Educators Commemoration of calendar events e.g. World AIDS Day 2006 in Eastern Cape Region Ongoing awareness and training sessions on healthy lifestyles and positive living CURRENT PROJECTS / INITIATIVES (Cont..2)

7. Care and Support: Rendering of Correctional Centre Based Care by offenders to terminally ill offenders Ongoing therapeutic interventions Establishment of support groups 250 Health Care workers as Master Trainers in Correctional Centre Based Care Facilitation of the process of release on medical parole Encourage the “buddy support system” for offenders who are on antiretroviral and TB treatment (DOTS supporters) CURRENT PROJECTS / INITIATIVES(Cont..3: Comprehensive HIV and AIDS Program)

8. Treatment: Development of National Guidelines for DCS to facilitate access of offenders to antiretroviral treatment Assessment of identified Correctional Centres to be accredited as sites for the roll-out of the Comprehensive Plan (including antiretroviral treatment) 3 Correctional Centres already accredited as ARV sites (Grootvlei, Pietermaritzburg and Qalakabusha) Training of 250 nurses in the Comprehensive Management of HIV and AIDS related diseases Training of professional nurses in the management of Sexually Transmitted Infections and Tuberculosis (TB) Training of health care workers in the electronic TB register for record keeping in collaboration with Dept. of Health CURRENT PROJECTS/ INITIATIVES(Cont..4: Comprehensive HIV and AIDS Program)

9. Partnerships Received donor funding from the US Government: Presidential Emergency Plan for AIDS Relief (PEPFAR) Government departments e.g. Health, Home Affairs, Social Development, etc. Non-governmental, Community Based and Faith Based Organizations Private Sector CURRENT PROJECTS / INITIATIVES (Cont..5)

10. Prevalence Survey: Impact of HIV and AIDS epidemic felt globally Extent of infections in Department not known Department embarked on HIV and Syphilis Prevalence Survey in 2005 Survey conducted scientifically to ensure validity and reliability - External Service provider to undertake survey - Voluntary participation CURRENT PROJECTS / INITIATIVES (Cont..6)

11. Purpose of the survey is to: Assist Management to make informed decisions Mitigate the impact of HIV and AIDS epidemic Address speculations Obtain scientific data on HIV and Syphilis prevalence among staff and offenders CURRENT PROJECTS / INITIATIVES (Cont..7: Prevalence Survey)

12. Approval granted by Minister and Commissioner Donor funds obtained from US Presidential Emergency Plan for AIDS Relief (PEPFAR) External service providers invited through bid processes Awarded bid to Limu’vune Consulting Ethical approval obtained from HSRC Pilot project undertaken in Gauteng Completed pilot project on 24 May 2006 Report presented to National Steering Committee CURRENT PROJECTS / INITIATIVES (Cont..8: Prevalence Survey)

13. Methodology Scientifically 10% of the total Random sampling Anonymous and unlinked Coding system used to ensure confidentiality Briefing session to inform about the project Written consent sought before commencement CURRENT PROJECTS / INITIATIVES (Cont..9: Prevalence Survey)

14. Findings: Sample of 10% expected to participate in survey (768 staff and 2770 offenders) Participation rate: 67 staff and 746 offenders Very disappointing participation rate CURRENT PROJECTS / INITIATIVES (Cont..10: Prevalence Survey)

15. Findings: No correlation between Syphilis and HIV Prevalence of Syphilis not significantly associated with the presence of HIV Pilot project demonstrated HIV and Syphilis is prevalent Active Management participation and offender involvement led to better participation level CURRENT PROJECTS / INITIATIVES (Cont..11: Prevalence Survey)

16. Obstacles: Lack of cooperation and participation of Management in Management Areas Non-visibility of Management before and during pilot project Members and offenders not informed timeously Offenders only identified on the morning of survey CURRENT PROJECTS / INITIATIVES (Cont..12: Prevalence Survey)

17. Obstacles continue: Participation of offenders in other activities prioritised above survey High level of stigma and fear around HIV and AIDS Lack of vigorous communication and marketing Posters not displayed and pamphlets not handed out CURRENT PROJECTS / INITIATIVES (Cont..13: Prevalence Survey)

18. Proposed Solutions: Embark on vigorous communication and marketing Launch prevalence survey Encourage participation of Senior Management in Regions and Management Areas Create opportunities for open discussions CURRENT PROJECTS / INITIATIVES (Cont..14: Prevalence Survey)

19. Proposed solutions continue: Utilization of prominent external people and / or NGO’s during information sessions Combine prevalence survey with other HIV and AIDS Awareness raising event, e.g. voluntary counselling and testing, etc Establish task teams in each Region to manage prevalence survey CURRENT PROJECTS / INITIATIVES (Cont..15: Prevalence Survey)

20. Proposed Way Forward Survey to be rolled out nationally Proposed solutions to be considered and implemented upon approval of national roll out Embark on mass communication and marketing strategy CURRENT PROJECTS / INITIATIVES (Cont..16: Prevalence Survey)

21. Action Plan for National Roll-out Finalize project plan for national roll-out by service provider Identification of Correctional Centres to draw sample Finalize Communication strategy Briefing / information sessions Distribute list of National Head Office teams led by Deputy Commissioners to support Regions Establish Regional teams Launch at Head Office on 02 October 2006 CURRENT PROJECTS / INITIATIVES (Cont..17: Prevalence Survey)

22. Mandates: Constitution of the RSA Section, Act 108of 1996 Section 35 (2) (e): Everyone who is detained, including every sentenced prisoner, has the right to conditions of detention that are consistent with human dignity, including at least exercise and the provision, at state expense, of adequate accommodation, nutrition, reading material and medical treatment . MEDICAL PAROLE

23. MEDICAL PAROLE (Cont..2) • Correctional Services Act 111 of 1998: Section 79 – • Correctional supervision or parole on medical grounds • Any person serving any sentence in a prison and who, based on the written evidence of the medical practitioner treating that person, is diagnosed as being in the final phase of any terminal disease or condition may be considered for placement under correctional supervision or on parole, by the Commissioner, Correctional Supervision and Parole Board or the court, as the case may be, to die a consolatory and dignified death

24. Process of identification: - A registered nurse initiates the process by submitting a detailed report to the medical practitioner regarding the offender’s medical condition. The medical practitioner can also initiate this process. - The medical practitioner will assess the offender’s condition and complete a G 337 form (Medical Status Report of offender) and attach a specialists report together with any other medical reports (if any). - A medical practitioner must indicate if the illness is terminal and also whether the offender is in the final phase – life expectancy MEDICAL PAROLE (Cont..3)

25. Process of consideration: - Once the medical practitioner has concluded his/her finding the medical report (G337) must be submitted to the Head of the Correctional Center for comments, recommendation to the Case Management Committee. - If the medical practitioner recommends medical parole proper after care must be arranged for the offender. This is normally the family but may also be a hospice or other suitable institution. A written undertaking must be provided by the after care responsibility. MEDICAL PAROLE (Cont..4)

26. Consideration by Parole Board (1) - A parole profile report (G326) is generated by the Case Management Committee together with a recommendation where after it is forwarded to the Correctional Supervision and Parole Board. As no legislative minimum period has to be served regarding a submission for placement on medical parole, this is the first time the Board is aware of a submission for medical parole. - As the submission is urgent the Parole Board must schedule a sitting as soon as possible. Parole Boards even convene over weekends and after hours if necessary for this purpose. MEDICAL PAROLE (Cont..5)

27. Consideration by Parole Board (2) If the medical report is not clear additional information may be requested from the medical practitioner on an urgent basis. Should medical parole be approved pertinent and clear conditions must be set by the Board which the offender must accept in writing. Whilst on medical parole the offender is subject to monitoring by officials from the Community Corrections Office in the Area where he/she is placed on medical parole. Should the offender’s medical condition improve once released on medical parole he/she cannot be re-admitted to a Correctional Centre unless the conditions as referred to above are violated. MEDICAL PAROLE (Cont..6)

28. Balancing the protection of the community with the medical condition and life expectancy of the offender. Risk of recommitting of crimes especially sexual and aggressive. Prevalence of HIV and AIDS and uncertain life expectancy. In some instances the second opinion is not provided timeously CHALLENGES

29. Lack of sufficient after care by families – poverty and lack of resources e.g. distance to health facilities, transport, proper nutrition, etc. Lack of sufficient community structures and hospices to provide after care. Increasing need for palliative care puts an extra burden on the limited resources of hospices. CHALLENGES (Cont..2)

30. HIV is not a notifiable disease No compulsory testing for HIV and therefore no early detection for prevention, care and management of the disease DCS not a health competency Facilitation of access to external accredited sites vs. Security risks Inadequate resources, e.g. professional personnel, HIV and AIDS coordinators, finances, etc Stigma and discrimination CHALLENGES (Cont..3)

31. Thank you An Age of hope: a National Effort for Corrections, Rehabilitation and Social Re-integration of Offenders