REACHING THE HARD-TO-REACH The Case of HIV/AIDS Prevention Project for Kumasi Central Prison, Ghana

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REACHING THE HARD-TO-REACH The Case of HIV/AIDS
Prevention Project for Kumasi Central Prison,
Ghana

• Presented by
• Akwasi Boakye-Yiadom
• 3rd Africa Conference on Sexual Health and Rights
  4th-7th February 2008
• ABUJA

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Presentation Outline

• Introduction
• Project Goal and Objectives
• Key Strategies
• Issues addressed by the project
• Influencing Factors
• Findings
• Actions Implemented
• Key Results Obtained/Achievements
• Challenges and Constraints
• Lessons Learnt
• Recommendations
• Conclusion

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Introduction

• HIV/AIDS in prison is both a public health and
  human rights issue that needs urgent attention.
• Prisons in sub-Saharan Africa have received very
  little funding for HIV/AIDS activities.
• Loss of liberty alone is the punishment for
  prisoners, not the deprivation of Sexual Health
  and Rights.
• States have an obligation to ensure that
  prisoners are provided a standard of health care
  equivalent to what is available outside the
  prison walls. (HIV and Prisons in sub-Saharan
  Africa 2007)

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• First case in Ghana was reported in 1986
• Prevalence was 3.6 in 2003, declined to 2.7 in
  2005 and has risen again to 3.2 in 2006
• Higher rates seen among those aged 25-29, 40-49
• Ashanti Region has consistently recorded the
  highest number of AIDS cases in Ghana
  cumulatively about one third of all cases in
  Ghana.

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AIDS in Ghana

• The median HIV prevalence (ANC)
• 2003 3.6
• 2005 2.7.
• 2006 3.2

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2.0 Project Goal and Objectives

• PROJECT GOAL
• To contribute to a reduction in the incidence of
  STIs/HIV/AIDS among young prison inmates in the
  Kumasi Central Prison.
• PROJECT OBJECTIVES
• To increase knowledge on STIs/HIV/AIDS of 450
  prison inmates.
• To strengthen the range of clinical and outreach
  STIs and CT services delivered at the Kumasi
  Central Prison.
• To build the capacity of prison officers and
  other stakeholders to implement project
  activities and advocate for a continuation of SRH
  interventions for prison inmates.

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3.0 Key Strategies

• Research (Qualitative and Quantitative methods)
  for baseline/endline
• Literature review on sexual health and rights of
  prisoners.
• Behavior Change Communication
• Service Delivery
• Data Management-Formats to capture service
  statistics
• Advocacy
• Monitoring and Evaluation

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3.1 ISSUES ADDRESSED BY THE PROJECT

• Lack of concerted effort by the Prison Authority
  to provide SRH information and services to prison
  inmates.
• Inadequacy of knowledge and skills in sexual and
  reproductive health issues including HIV/AIDS
  among Prison Officers.
• The lack of information on SRH - especially on
  STIs/HIV/AIDS which is not mainstreamed into
  health delivery at the Prison.
• The need for equipment and drugs at the Prisons
  Infirmary for the provision of SRH services.
• Non existence of collaboration among key sexual
  and reproductive health stakeholders to provide
  services at the Prison.

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3.2 INFLUENCING FACTORS

• Neglect of sexual and reproductive health rights
  (SRR) of prison inmates.
• Identification of Prisons as special target in
  the National HIV/AIDS Strategic Framework.
• Recommendations by UNAIDS for Prison Authorities
  to provide prison officers and inmates with
  access to HIV-related information, education and
  Counselling and Testing (CT) services.
• Recommendations by WHO that general principles
  adopted by national AIDS programmes should apply
  equally to prisoners and to the community.

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3.3 ACTIONS IMPLEMENTED

• Consultative meetings with Prison High Command at
  both Regional and Headquarters level.
• Consensus Building Meetings with
• Inter-sectoral collaboration and partnerships
  with Ghana Health Service, WAPTCAS, Catholic
  Archdiocese of Kumasi, CHRAJ, Kumasi Metropolitan
  Assembly

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• Capacity Building for prison officers
• Training of cell gang leaders as Peer Educators.
• BCC activities (including film/video shows)
• Service Delivery (STI management, CT)
• Referrals to selected hospitals
• Documentation of project activities
• Dissemination of project activities

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4.0 FINDINGS

• Reaching prison inmates with information and
  services on SRH is not as simple as perceived, as
  even ordinary interaction with them requires
  approval from headquarters.
• Inmates are seen as having violated other
  peoples rights and, therefore, are sometimes
  denied certain rights such as advocating for
  their SRH rights.

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• HIV/AIDS policies that exist at national levels
  are often inconsistent, inadequate or not
  implemented in prisons.
• Appalling prison conditions, including
  overcrowding, poor food and nutrition.
• Health services/facilities are generally poor,
  ill equipped and understaffed, or non-existent.

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• There are high turnover and mobility rates among
  the prisoners during festive occasions like
  Christmas.
• The inmates held strong views on sodomy and said
  it was not practised in the prison.
• Efforts to enrol those who tested positive on
  Anti-Retroviral Therapy could not materialize
  owing to a track record of non- compliance by
  inmates to previous therapies.

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5.0 KEY RESULTS OBTAINED/ACHIEVEMENTS

• Commitment and support of the Prison High Command
  both at headquarters and in the region.
• Increased knowledge in SRH issues including
  STIs/HIV/AIDS among inmates.
• Capacity of prison officers and inmates built on
  issues related to STIs/HIV/AIDS

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• Stimulating behaviour change among inmates
  particularly in the area of common use of sharp
  objects. Practice of one person one disposable
  razor blade policy was preached among
  themselves.
• Access to quality sexual and reproductive health
  information and services especially on
  STIs/HIV/AIDS and CT enhanced. For instance, 107
  inmates (70-males 37-females) CT. Out of the
  number, 7 males and 3 females tested positive.
• 50 cases of STIs were treated.

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• Infirmary renovated, drugs supplied and attendant
  was trained to provide SRH services.
• Project staff gained experience in working with
  high security establishments.
• Partnership and collaboration with other
  stakeholders strengthened

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• Inmates who were released soon after the
  inception of the project promised to practise
  what was learnt.
• Project succeeded in creating the necessary
  awareness about HIV/AIDS not only among inmates,
  but among the entire prison establishment. The
  resultant effect was that, on request, the
  project was extended to cover two cover more
  prisons.

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6.0 CHALLENGES/CONSTRAINTS

• Security Consciousness of the Establishment.
• Difficulty in advocating for SRH Rights for
  prison inmates
• Dealing with a fluid target group rate of
  turnover was high as they were lost to follow-up
  after release.
• Confidentiality in doing CT as prison officers
  wanted to know the outcome of test results.
• Handling of positive cases by the prison.

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7.0 LESSONS LEARNT

• Prison inmates have the potential to address
  their sexual and reproductive health and other
  challenges when exposed.
• The selection and training of gang leaders as
  peer educators facilitated BCC activities
  implementation.

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• Prison officers support activities that are
  implemented within the rules and regulations of
  the Prison Service.
• Effective collaboration is a necessary
  pre-requisite for effective HIV/AIDS programmes.

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• Reaching prison inmates with SRH information and
  services is difficult because of the high
  security considerations. Need to start
  sensitization with the national authorities
  before implementation.
• Providing stand-alone CT services with the hope
  that other institutions would follow with the
  requisite treatment, care and support services
  can be disappointing.

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8.0 RECOMMENDATIONS

• Expand project to cover other hard-to-reach
  groups and prison facilities across the country
• Integrate comprehensive HIV/AIDS programmes into
  the health delivery services within the Prison
  Service.
• Engage in a long-term, coordinated, strategic
  planning process and collaborate more closely
  with other NGOs and religious groups to support
  HIV activities in the prisons.

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• Prison medical services should collaborate with
  community health services to ensure medical and
  psychological follow-up of HIV-infected prisoners
  after their release if they so wish.
• There should be discharge planning, which is
  especially important for HIV ex-offenders in
  need of health related services.

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9.0 CONCLUSION

• The results of the project provide strong
  evidence to support the pursuit of the SRH rights
  of prisoners.
• Evidence from Kumasi Central Prison as reported
  in the 31 December 2007 issue of Daily Guide
  newspaper by the Deputy Director of Prisons in
  charge of Ashanti Region indicated that 7
  prisoners died of AIDS in 2007 sending strong
  signals that the issue of HIV in prisons should
  be given the attention it deserves.

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Male inmates assisting in setting up the yard
for an outreach activity
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Project staff, prisons officers and inmates work
together during an outreach session
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Past president of PPAG (Former Chief Justice of
the Republic of Ghana) interacts with Prison
command on the importance of the project
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Female inmates taking away their share of a
donation of cleaning supplies
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The following articles appeared in THE PIONEER -
a local newspaper
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• THANK YOU

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