Prison boss says no discrimination against HIV inmates

Dear Editor,

The article in last weekend's Sunday Observer does not paint a true picture of the status/treatment/condition of the HIV positive inmates currently being held in the various institutions of the Department of Correctional Services (DCS). I will address each of the issues:

1. HIV testing of our inmates is done on a voluntary basis and our officers/staff are not permitted to force inmates to submit to testing. Efforts are made to coax unwilling inmates to get tested, but there are many who refuse and therefore the Department does not have complete statistics on the HIV/Aids Status of all inmates in our care. Some inmates enter our institution knowing they are HIV positive, refuse testing and keep their status secret. It is only when the symptoms of Aids become obvious to our doctors that the inmate admits to his condition and by then, medication may have only limited success in prolonging that individual's life. Currently we have a total of 98 HIV positive inmates. For 2010 we had 3 AIDS related deaths. The St Catherine Adult Correctional Centre (STCACC) presently has 29 HIV cases. The majority of HIV positive inmates are located between the Tower Street Adult Correctional Centre (TSACC) and STCACC where a doctor visits at least 3 times weekly. All 3 full time medical practitioners employed to the Dept of Correctional Services have been trained in managing HIV cases and all were recently updated in May/June during a 2 day perceptorship at the Comprehensive Health Centre.

2. Every effort is made by the Department to prevent discrimination against HIV inmates. For this reason their status is kept quite confidential and only a few members of staff have access to that information. Staff members with that clearance include only very senior staff members and specially trained medical orderlies. To aid in ensuring no discrimination, inmates are not isolated or segregated but remain in general population. They are only placed in special areas if they are known homosexuals or mentally ill, not based on their HIV status. Homosexuals are segregated because of safety concerns if they are housed with the general population. Mentally ill inmates are segregated for similar reasons and also so they may be more adequately controlled and treated.

3. Your article gave the impression that our HIV patients are being neglected and singled out for poor treatment. This is untrue. In fact, even in the face or severe overcrowding in our institutions, some HIV positive inmates have cells to themselves while others (HIV and general population) are housed three (3) to a cell built for one (1). It is true that some HIV inmates do not have mattresses and sleep on the floor on improvised beds. This is also true for the general population and is not unique to HIV patients. Please note that there is also a cultural issue with many Jamaican inmates who are reluctant, or refuse, to use mattresses which have been previously used. Some inmates even reject used
mattresses donated to our institutions. Inmates prefer to get new mattresses and when issued with previously used mattresses they destroy them in the hope of getting a new one. The coverings of mattresses are frequently torn off the mattresses to leave only the sponge exposed for a host of reasons best known to them. My staff spends a lot of time and effort trying to ensure that items issued to inmates are properly cared for, and to minimize waste. The Department's budget is unable to provide new mattresses to each inmate entering our institutions. Even if our budget could cater to that wish, it would not be the best way of using scarce resources.

4. The DCS has an HIV/AIDS treatment program that is monitored and supported by the Ministry of Health. Ministry of Health guides with policy and protocol. They provide regular training opportunities for staff, and our Medical Director attends all updates sessions and most conferences, to ensure that we, as a Department are updated. They provide staff for our testing programme, lab equipment, testing kits, hardware and software for data management. They provide ALL antiretroviral medication available to the general public for the inmates. The needed medication is provided free of cost to the DCS and to the inmates from the Ministry of Health. The National HIV/STI programme experiened severe challenges in receiving supplies of two of the antiretroviral drugs for the months of January to June. These were Aluvia and Truvada. Indinavir, Combivir and Duovir were the substitutes. This shortage affected all HIV positives patients in Jamaica as well as the inmate population. The DCS however was not affected until April this year because we had adequate supplies in storage which were only depleted in April. Regular supplies resumed in late June. Our inmates were therefore actually better-off than the Jamaican population at large. Generally, it is not recommend to switch medication once you are on a particular regime unless it fails, as this can cause the development of a resistance to medication. However, we had no choice and we followed the directives the Ministry of Health sent out to all treatment sites. The allegations that medication is withheld from the inmates is not true. Some inmates are reluctant to collect their medication as they fear that their cellmates may become suspicious if they are seen taking so much medication and not know what it is for. The medical Staff resort to creative methods to disguise the medication in order to minimize the potential for discrimination if an inmate's status is revealed. So far, the DCS has had tremendous success in keeping the status of HIV/Aids inmates confidentional.

5. The Ministry of Health through its Behavior Change Team and Regional teams, as well as international agencies, have had numerous sensitisation sessions with both staff and inmates in all institutions, trying to reduce the stigma and discrimination. This has helped considerably. This year, HIV awareness was added to the programme for new DCS recruits.

6. Unfortunately, most of the HIV medication prescribed should be taken with food and the meal times in the institution do not coincide with the night dose which should be taken between 7pm and 10 pm. Efforts are made at our various institutions to make food items available to inmates after hours so that they may take their medication with a light snack.

7. Your article made mention of the poor quality of the meals provided to HIV inmates. The DCS currently provides three (3) meals per day to inmates on a limited budget. Efforts are made to supplement meals with items grown at our institutions. While there is room for improvement, it is demonstrably clear that our inmates are adequately fed. Efforts to increase the fruit and vegetables provided to inmates are ongoing.

8. Shown below are a few DCS Medical Guidelines For HIV Inmates:
a. All new inmates are counseled and offered testing on a voluntary basis, HIV positive inmates are informed and their CD4 done, based on the value of the CD4 they are placed on medication according to National Adult or Pediatric treatment guidelines for 2011.

b. Pregnant women who are positive are refered to High Risk antenatal clinics just as the general population would be and infants born to a positive female , put on medication and given formula just as the population following PMTCT guidelines.

c. On discharge from an institution they are referred to the treatment site in their community and given a months supply of antiretroviral therapy.

Yours sincerely,
Sean Prendergast
Lieutenant Colonel
Commissioner of Corrections (Acting)

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