Distinguished ladies and gentlemen,

I would like to extend my gratitude to the Africa HIV in Prisons Partnership Network and UNDOC for their invitation to be a panellist at this satellite session tonight.

I believe this session provides an important opportunity to highlight the role that prison health plays in reaching our universal access and Millennium Development Goal objectives. It further highlights the realities of the over 650,000 incarcerated men, women and juveniles across Sub-Saharan Africa. As the key over-arching principle, espoused by UNDOC, AHPNN and others working for the rights of prisoners notes: “Loss of liberty alone is the punishment, not the deprivation of fundamental human rights. States therefore have an obligation to implement legislation, policies and programmes consistent with international human rights norms to ensure that prisoners are provided a standard of health care equivalent to that available in the outside community.”

Indeed, the respect and protection of human rights is a necessary condition, if we are to have successful and sustainable HIV prevention, treatment, care and support programs for prisoners. It’s simple, “People are more vulnerable to infection when their economic, health, social or cultural rights are not respected. Where civil rights are not respected, it is difficult to respond effectively to the epidemic. ”

Unfortunately, this lack of respect for human rights of prisoners has so far been the overwhelming reality across Sub-Saharan Africa. While until recently, data has been limited; with the studies that have been conducted; we now have a better understanding of the appalling situation facing prisoners which makes them vulnerable to infection with HIV or any other transmittable disease.

The main mode of HIV transmission in prisons in Sub-Saharan Africa is through unprotected sex be it coerced, negotiated or voluntary.  Infection rates range from 9% in Nigeria (compared to 4% in the general population) to 40% in South Africa (as compared to 25% in the general population).

Sexual activity occurs predominantly among men who have sex with men: be it, prison staff with prisoners, or among prisoners themselves. It should be further noted that one in five men has been sexually assaulted in prison. Among prisoners, the rate of sexual abuse is as high as 27 percent. Given that force is exercised and that condoms are not used, victims of rape and other forms of sexual violence are at higher risk of contracting HIV.  Additional factors, that render prisoners in Sub-Saharan Africa, at greater risk of HIV, include weak criminal justice systems, social stigma, institutional and societal neglect, poor food and nutrition, overcrowding,  the trading of sex for food & other necessities; lack of health care, and so on. 

Given such conditions, the creation and importance of networks such as the African HIV and AIDS in Prisons Partnership Network cannot be over-emphasised.  AHPPN provides a vital space for sharing of best practice, of furthering the agenda for evidence-informed HIV programming for prisoners, in what is undoubtedly politically sensitive and complex topic as prison health.

In the UNAIDS Executive Director’s recent letter to partners, Michel Sidibe, not only alluded to the importance of the AHPPN for Africa but called for similar Networks to be established in other parts of the world. This in recognition, that this platform provides an ideal environment to support a multi-sectoral approach to HIV prevention, treatment, care and support for prisoners that is equivalent to that available to people in the community outside of prison. It further fosters dialogue, and innovative responses to preventing the spread of HIV (and other infections) among prisoners, to prison staff, and to the broader community even where legislation may be restrictive. This network provides an opportunity to share best practises and should therefore be encouraged.  Such a multi-sectoral approach is also critical in ensuring and promoting an integrated approach to healthcare within prisons to tackle wider public health issues and reaching our AIDS+ MDGs objectives, both through improvements in health care in general and through improvements in general prison conditions and management.

Political leadership is a prerequisite in ensuring that prisoners are given opportunities towards universal access. Many governments recognise the challenges that are posed by HIV and AIDS and have signed on to many declarations such as the Africa Declaration of Commitment for HIV and AIDS Prevention, Care, Treatment and Support in Prisons (signed by 27 countries in Sub-Saharan Africa). This presents opportunities to ensure that rights of prisoners as well as Universal Access are attained. While it should be celebrated that so many countries have signed onto this declaration, it remains but a piece of paper, as long as action isn’t taken by the signatories. We in Africa, have become a continent adept at signing declarations of commitments, and far too often fall short at the level of implementation. There is need for declarations such as the one I have mentioned to be translated into action and meaningful positive change for prison health across the continent.

Legislative and Policy Reform is another important area in as far as Universal Access is concerned. The role of legislators remains pivotal in the fight against HIV and AIDS. Parliamentarians for example can play a big role in holding governments accountable to their HIV/AIDS pandemic responses. Bodies such as the Coalition of African Parliamentarians against HIV and AIDS (CAPAH) which is a pan African Network should be engaged in dialogue. Dialogue should be initiated with such bodies for purposes of reviewing national guidelines on prison management and ensuring that existing guidelines address issues of HIV in prisons.

Human rights of all prisoners should by all costs be protected. Prisons need to be managed within acceptable frameworks and should be guided by regional and international standards that are developed to protect human rights i.e. “Body of principles for the Protection of all Persons under any form of Detention and Imprisonment” . This and other guidelines further highlight the importance that is being accorded to tackling HIV in prisons and in reaching universal access objectives.

Strengthening the rights of women and girls is a priority area for me during my tenure as the UN Special Envoy for AIDS in Africa. Alluding to the fact that of the over 650,000 prisoners that I had mentioned, around 2% are female, I would like to see a situation were there is a special focus on incarcerated women and girls. Conditions for women and girls in prison need to be improved so that they are not susceptible to exploitation, including sexual exploitation which can increase their vulnerability to HIV. I have decided to move beyond the lip service of discussions on the empowerment of women and work closely with governments and legal groups, lobbying them, to make sure that legislation and policy is reformed to actually protect women. 

Finally, I wish you courage, and assure you of my, and indeed the continued support of the UNAIDS family, in sustaining the momentum of this partnership, so as to ensure access to comprehensive HIV prevention, treatment and care services for prisoners across the continent.

Thank you.