Interventions to the Improvement of access to HIV & TB testing & treatment for prisoners in Zambia

1. Presented by: Christopher Mumba Jr.Advocacy & Communications OfficerPrisons Care & Counselling Association (PRISCCA), Lusaka - Zambia • HIV & AIDS are a very serious threat in Zambia, a poor-resource developing country of 13.5 million inhabitants in sub-Saharan Africa and presents significant challenges to the 17,328 prisoners, public health authorities and the state. • In this presentation is the information collected by 254 prisoners working as peer educators on HIV & AIDS, TB, paralegalism & human rights on pre-admission & post-discharge psychosocial counselling desks (PPPCDs) set up by PRISCCA at all of the 10 major provincial prisons in Zambia

2. Interventions to the Improvement of access to HIV & TB testing & treatment for prisoners in Zambia • Accommodated in prison cells/dormitories designed to house 5,235 inmates in the pre-independence colonial era more than half a decade ago, Zambia’s 87 correctional facilities currently hold 17, 328 inmates as by mid June 2013. • Lack of space as only one major prison has been opened over the 49 year old period also deny inmates space for isolation of active TB patients from the rest of the healthy inmates

3. Interventions to the Improvement of access to HIV & TB testing & treatment for prisoners in Zambia….cont’d • With a national adult HIV prevalence rate of 13%, TB has turned into the leading killer disease of Zambians living with HIV, inmates in particular • Statistics from the newly created Zambia Prisons Service Medical Directorate indicated a TB case infection rate of 5,285 cases per 100,000 inmates annually • Cases of drug resistant & multi-drug resistant TB (MDR-TB) among prisoners were also reported though not exactly estimated apart from two at Lusaka Central Prison as the suspected cases were usually referred for specialized testing & treatment to public hospitals

4. TB & HIV cases among inmates in Zambia • Zambia records about 48,000 to 50,000 cases of all forms of TB on an annual basis • 48,594 cases of TB were notified by the Ministry of Health in Zambia by December 2012 • About four to seven per cent of Zambians with TB die annually. Prisoners have been worst affected • Cases of extra pulmonary TB have been rising tremendously among inmates in Zambian prisons other than pulmonary TB due to high prevalence of HIV, depression, stress & poor nutrition, causal factors of a compromised immune system • About 27.4% of the 17,328 inmates were reported to be living with HIV

5. Possible solutions • The number of prison clinics have now been increased from 17 to 22 with an increased number of trained prison health officers of 28 providing various medical services • Prison health is now being seriously considered as public health • The Zambia Prisons Service Medical Directorate was established through the prison amendment Act of 2008 and now actively functional

6. Possible solutions…cont’d • The Prisons medical directorate working to ensure a healthy & productive Zambia Prisons Service through provision of an effective & efficient health service to inmates, prison officers & the defined prison communities • A total of 881 prisoners are currently on ART and 182 inmates countrywide are on TB treatment • About 31,019 inmates have been sensitized on communicable diseases including TB & HIV & AIDS • A total of 254 prisoners trained as peer educators & working on PPPCDs on supervision from trained offender management prison officers, the prison chaplaincy and prison reception officers • Funding to run the desks sourced from the Global Fund, European Union, & Open Society Initiative for Southern Africa (OSISA) in collaboration with the Open Society Foundation

7. Possible solutions…cont’d • PRISCCA, a locally based prisons NGO also working in partnership with UNODC on the ‘stakeholder engagement on policy and legal reforms in relation to HIV prevention in prison settings in Zambia • The partnership acknowledges that prisoners and prison staff are part of the broader community and that the health threat of HIV & TB within and outside prisons are linked • Nonetheless, prisons, prisoners and prison staff and NGOs are often neglected in efforts intended to tackle the two diseases • The UNODC Regional Office for Southern Africa is running a regional programme entitled ‘HIV prevention, treatment, care and support in prisons settings in Southern Africa

8. Possible solutions…ends • The UNODC programme covers Zambia, Tanzania, Swaziland, Namibia, Mozambique, Malawi, & Ethiopia • Objectives are to prevent new HIV & TB infections specifically related to incarceration in selected countries in sub-Saharan Africa • Programme also supporting efforts to engage relevant stakeholders advocating for legislative & policy framework reforms that are human rights-based & that promote effective & sustainable responses to TB, HIV & AIDS in prisons. • This is based on a report disseminated in 2011 from the “Review of Legislation, Rules & Policy pertaining to HIV & AIDS Prevention, Treatment, Care & Support in Prison Settings in Zambia.”

9. Possible solutions • UNODC, the Zambia Prisons Service & PRISCCA have a programme to meet with relevant Parliamentary Committee and make submissions for policy and legal reform in prisons • They will also identify partners & stakeholders to work with on HIV and TB related legislation, with specific focus on the prison setting • A consultation meeting will also be held on policy & law reform and other interventions that include sensitization on public health and human rights for addressing HIV and TB in prison settings ends…Thank you so much for your attention! For any contact email: prisccazm@gmail.com & mumbamumba64@yahoo.co.uk Tel: +260 211 230 386 Mobile: +260 955 230 386 +260 0966 77 80 21