Can current interventions curb HIV prevalence in prisons?

By Kenneth Bainomugisha

The fight against HIV /AIDS in Uganda has registered tremendous progress over the last three decades. Since the discovery of the disease, popularly known as "slim" in the early 1980s, the prevalence of HIV among adults in Uganda has reduced from 15% in 1991 to 6.2% in 2016.

Whereas HIV/AIDS fight is registering success, there are particular groups of people within the country that are more at risk of getting the disease. According to the Uganda Population Based HIV Impact Assessment 2016/2017, prevalence in high-risk populations was estimated to be 37% among sex workers, 22% among fishing communities, 16.7% among people who inject drugs, 15% among prisoners and 13% among men who have sex with men (MSM). These figures present a worrying picture that necessitates renewed and urgent action.

Prejudices and social discrimination are some of the key factors preventing utilisation of health care services including HIV testing among some high-risk populations. Limited access to health care and treatment services drives the prevalence higher in populations such as prisoners and fish folk communities.

According to the Uganda Prisons Service sero-behavioral survey, 2013, some of the factors for high prevalence among prisoners include risky behaviors such as sharing sharp instruments, unsafe tattooing, men who have sex with men, age at first sexual intercourse, multiple sex partners, tattooing and sharing tattoo instruments. In-addition, limited knowledge on prevention, depression, hopelessness, substance abuse, drinking alcohol and misconceptions were some of the reported risk factors.

The Uganda Prisons Health Service with support from Ministry of Health and development partners such as the US Centers for Disease Control and Prevention provide enhanced HIV/AIDS service delivery to both prisoners and staff. Notably, more HIV/AIDS anti-retroviral therapy clinics have been established with an ongoing exercise to accredit more health facilities to be able to offer HIV/AIDS care and treatment within prisons across the country.

However, to consolidate achievements so far made in HIV/AIDS care in Uganda Prisons Service, known interventions such as HIV Testing Services should be reemphasized so that prisoners and staff know their HIV status and access care and treatment early. Linkage of discharged inmates who are HIV positive to ART accredited centres is a good practice that should be applauded.

Writer is a Fellow with Uganda Public Health Fellowship Program, Ministry of Health