Left to die - HIV-positive inmates say they are neglected in prison
Some HIV inmates say medical and nutritional needs being neglected
SOME men who are serving time in maximum-security prisons and who have tested positive for HIV/AIDS say that their medical and nutritional needs are being neglected by what they feel is an uncaring, inhumane prison system.
"I am living with HIV, you understand, but I don't want to die inside here," was the impassioned plea from an inmate to the Sunday Observer from behind the massive masonry that constitutes the walls of the maximum-security St Catherine Adult Correctional Centre in Spanish Town, the country's old capital.
"I did not bring this disease on myself and now I have to live wid it. I don't want to die as yet," he said, with more than a hint of desperation resonating in his soft voice.
The inmate, whom we will call 'X', begged that the newspaper keep his identity a secret for fear of reprisals from other inmates and warders alike. Some of his fellow HIV/AIDS inmates reached out a few weeks ago to the Sunday Observer because of what they claim is neglect of their medical needs as persons living in prison with HIV/AIDS.
"We need urgent help, medication, food, fruits, being able to get a clean facility to do our time.
"Chink, roaches are also an issue, we have no proper bedding and we are exposed to disease and germs.
"Would you believe the HIV prisoners have to deal with that, while healthy, strong prisoner have mattress or sponge?
"Recently, they banned sheet and pillow from coming in here," said 'X', who claimed he had been sleeping on a towel on the floor of his cell for years.
He told the Sunday Observer that he was originally convicted in 2000 of manslaughter, for which he was sentenced to eight years behind bars.
He was fortunate and a well-behaved prisoner and got released early; after only five years, but was re-convicted on a charge of receiving stolen goods. He is also awaiting trial on the charge of larceny of a motor vehicle.
Not long after he entered the prison system, he said he was raped at the Tower Street correctional facility.
"I was in a cell with a whole heap a man and I was sleeping on the floor. I wake up with a sharp knife at my throat and hear a man say 'if you move or make nuh noise, a kill yuh'."
'X', who is not yet 40 years old, said he was raped by that man and others who crowded around him in the cell. He could not say why those not involved in the rape did nothing to help him.
He said he complained to the prison authorities and was separated from the general population until another attack from inmates, who dumped oil-laced faeces from a bucket on him as he lay inside his cell, and then threw a lit match inside.
He found out only a few years later, during a prison screening drive, that he was infected with the virus that causes AIDS and was transferred to the St Catherine Adult Correctional Centre, where many with his illness are housed.
'X' said he forced himself out of his constant depression over the diagnosis even as he lost every human connection he ever had in the outside world.
"I don't have anyone to give me anything," he said, noting that he would be better off behind bars if he had family who visited him and brought necessities regularly.
"My family all abandon me because of my crime and since they found out about my (HIV) status the whole family is upset with me and turn their back on me, also my wife lef' me and she move on. My future is damaged forever," said 'X'.
The Sunday Observer made contact with another inmate, who also insisted on anonymity and who we will refer to as 'Y'. He is on a longer prison sentence -- 25 years to life for murder.
'Y' already knew he had HIV before he was incarcerated in 2006, but said he had it under control prior to landing in prison in Spanish Town.
The Sunday Observer visited with both inmates undercover, where they elaborated on their condition.
According to 'Y', "From I reach in here, all fall down."
He said he has been getting sicker and weaker, despite his attempts to keep up his health through exercise, whatever healthy food he can scrounge, and maintaining a positive attitude.
"Prisoner living with HIV hopes is just from the hospital, to the morgue, to their grave," he said, adding that it's easy to feel that there is no point to living.
"Quite often, when you si dem drive in di ambulance, drive in and drive out, is a prisoner who is HIV-positive or have full-blown AIDS they taking to hospital, and by time dem tek dem out there, dem dead, because they not paying us no attention at all."
'X' complained that the afflicted inmates get the life-sustaining anti-retroviral medications -- in his case Truvada, Aluvca, Bactrim (an antibiotic) and vitamin B-complex -- but the prison's supply is irregular.
When he started communicating with the Sunday Observer, he said he had been without his meds for almost three weeks.
"My CD4 count (the number of T-cells in an infected person's body which says at which stage of the disease he/she is at) is down, and I am worried."
Subsequent to that, he managed to convince a friend of a friend to fill his prescription, and got a month's supply.
He claimed in general, directives for medical treatment given by the medical officer of the prison are ignored.
He said the doctor sometimes recommends supplements and a special diet for the inmates with the deadly disease, depending on what their bodies can absorb.
"Persons living with HIV, after a while, your CD4 count goes down... your body eventually start reject certain kind of food," he said. "You have to eat properly, but they don't provide the necessary food, it's just the regular food they give to the general population, that's what they give to us.
"If the doctor recommend certain kind of treatment or anything towards your health, whatever the doctor recommend, they have to seek permission from the superintendent. The superintendent would normally overrule it, you understand mi.
"Their statement is always, 'A nuh di doctor a run di prison', a dem (warders) run it," he said.
"The superintendent don't know what is right for our health, and we are persons living with HIV, some of them is full-blown AIDS," said 'X'.
Inmates are allowed to receive food on certain days per week, or visitors can leave a certain amount of cash at the prison commissary to cover the inmate's fruits or food.
"If the doctor said allow him (the inmate's) parents or family or whoever to bring him fruits, or food, or whatsoever, whichever thing his system can contain, they don't approve it. The superintendent and the people that are in high place constantly try to turn it down," said 'X'.
The food is often unpalatable, he insisted, especially for the HIV/AIDS victims whose stomachs cannot keep down the 10 or more anti-retroviral medications that they must take on average every 12 hours, without good, healthy meals.
He described the meals as generally consisting of either kidney, or liver, or chicken neck with rice.
"Once a week you might get yam or dumpling or porridge, but the food is not cook properly. It is half-cook and can get sour within three hours," he charged.
"The minute you consume that along with the medication, you bring back up everything by vomiting," he said. "You don't get any fruits, we have to buy at the commissary or get someone to bring for us."
'X' said he doesn't get many visitors, so he often takes his meds on an empty stomach and fights to get them down.
"I often have diarrhoea and they only give us one tissue and one soap per month. Sometime we HIV inmates have to pass our faeces in newspaper and put it in plastic bag, old jug or bucket," he said.
Similar claims are made by formerly incarcerated men in a recent documentary prepared by Panos Caribbean, a not-for-profit organisation that works to amplify the voices of the marginalised in the region, and which champions the rights of all Caribbean people to fair and humane treatment.
That documentary is accompanied by data from research conducted in the Jamaican prison system in the form of a paper written by freelance writer for Panos Caribbean, Andrea Downer, entitled No Sex or Condoms Here: HIV Prevention, Treatment and Care in Jamaican Prisons.
Overcrowding and the practice of holding several men in a single cell is a recipe for prison rapes it reads. This is supported by comments from Jamaicans For Justice.
In the 2007 document, based on interviews with prison and other officials and experts, along with prisoners themselves, respondents describe being packed into the cramped quarters.
The study quotes former prison physician, Dr Raymoth Notice, as confirming that several factors, including poor nutrition, contribute to the poor health of inmates with HIV/AIDS.
Dr Notice claimed that during the Þve years he served as the medical doctor at the St Catherine, Fort Augusta and Tamarind Farm prisons, more than 10 inmates from St Catherine prison died due to complications caused by AIDS, in addition to others who were diagnosed with the disease in other prisons. He added that many inmates who are diagnosed with HIV while they are incarcerated were HIV-positive prior to imprisonment.
"They were infected when they came in, but when they came to prison their immune system broke down faster, as a result of poor nutrition, lack of proper medical care and high-risk behaviour," Dr Notice explained to researchers.
In 2006, then-commissioner of corrections Major Richard Reese offered very little information to Panos researchers about the diet of inmates and none about the diet of HIV-positive inmates, according to the study.
Major Reese reportedly refused to give speciÞcs, but revealed, "Regimes for HIV-positive inmates are determined by the (prison) doctor." He said a full-time nutritionist is assigned to the Department of Corrections and external local consultants in consultation with the nutritionist and medical officer develop the diets of the inmates.
However, he said that an interview with the prison doctor and the nutritionist would not be allowed.
Reese, according to the Panos report, also told researchers that a new study being conducted at the time would lead to improved testing, identification and treatment of infected prisoners.
The Sexual and Reproductive Health Study, which was undertaken in 2006 by the Correctional Services, the Ministry of Health, Johns Hopkins University, Health Through Walls (a US-based group), and Jamaica AIDS Support, found a 3.3 per cent HIV prevalence rate among the island's prison population. The study aimed to determine the prevalence rate for HIV and other transmissible diseases such as Hepatitis A, B & C among inmates. Major Reese said from the information gathered, a medical database on the island's prisoners would be developed, which will guide the treatment of inmates when they are referred to medical facilities outside the prisons for treatment.
However, inquiries of the current prison administration as to the status of this programme have yet to yield results.
Based on the claims of inmates 'X' and 'Y' and those highlighted in the Panos documentary, the Sunday Observer made a series of queries of the Acting Commissioner of Corrections Lieutenant Colonel Sean Prendergast.
Specifically, we requested information on the size of the prison population diagnosed with HIV/AIDS, how their medications were disbursed, how often they were seen by the medical team and how many infected inmates had died over the past year.
We were told over a week ago that the authorities were unaware of the complaints of the HIV-positive inmates regarding allegations of poor treatment, and the matter was being researched. This story was held while we waited on a response. Subsequent checks with the prison administration again bore no fruit as we were told the official responses were not yet ready. Up to press time, no response was forthcoming from Prendergast, who was said to be overseas.
However, sources inside the prison system claim that there has been little follow-up to the initial HIV/AIDS treatment programme.
Some years ago, the separation of the mentally-ill and homosexual population from the general prison population was deemed a good start. However, inmate 'X' said today, the infected inmates mix with the general prison population and are forced to hide their status for fear of being lumped with the ostracised homosexuals.
This fear of stigmatisation was the case in previous years, according to the Panos paper.
"For the most part, prison officials maintain a stony silence in adherence to a code of secrecy, which is part of their conditions of employment. Many inmates also remain silent about some aspects of life in prison, even after they are released, sometimes because of shame and fear of retribution," the report read.
We also learned that the National HIV/STI Programme at the Ministry of Health is not involved directly in the treatment and care of inmates beyond the provision of medication, as care and treatment are administered and documented by doctors hired by the Department of Corrections.
In 2006, Major Reese told Panos researchers during a tour of the renovated medical facility at the Tower Street prison in Kingston, that the Department of Corrections is in need of between eight and 10 more nurses to assist the one full-time nurse who is assigned to the Tower Street prison. He said because of the staff shortage then, correctional officers assist in performing some functions of the medical staff. He said those officers were classiÞed as Medical Orderlies trained by the Ministry of Health and at the University of the West Indies, while others were trained within the prison system.
Since the Sunday Observer's initial queries, sources inside the prison system have reported that the inmates at the Spanish Town facility were treated to an unusual and relatively healthy Sunday dinner consisting of chicken and fish. Additionally, the inmates' blocks were sprayed with insecticide and treated to a paint job, and inmates given used mattresses.
A United Nations Office on Drugs and Crime report (2006) on HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings provides an international framework for the treatment of incarcerated persons with the disease.
The document notes that every country's response to HIV/AIDS in prisons is influenced by economic and social conditions, as well as by cultural, social, and religious traditions.
"However, these national and local conditions do not reduce or negate government obligation to meet recognised international prison, health and human rights standards. International law is clear that a lack of resources does not excuse a State from its obligations to provide proper and humane prison conditions.
"The UN framework builds on legal obligations, commitments, recommendations, and standards on HIV/AIDS, prison health, prison conditions, and human rights articulated in the following:
* Universal Declaration of Human Rights 
* United Nations Basic Principles for the Treatment of Prisoners 
* World Health Organisation's Guidelines on HIV Infection and AIDS in Prisons 
The report states further:
"Prisoners are entitled, without discrimination, to a standard of health care equivalent to that available in the outside community. "The fear of HIV/AIDS, and the social stigma of being known to be (or suspected of being) HIV-positive has negative effects on individuals and on the success of prison health programmes," said the report.
— Additional reporting by Donna Hussey-Whyte