Hiv and Tuberculosis Infection in Sub- Saharan Africa

Prisons in sub Saharan Africa continue to experience major increase in the number of incarcerated individuals among all genders. This problem arises as a result of increased crime rates in the region, high rates of pre-trial detentions, inadequate and poor infrastructures as well as weak criminal justice systems in the region. (Van Hout & Mhlanga-Gunda, 2018). These factors have contributed immensely to the existing problem of overcrowding in the prison systems in sub Saharan africa (SSA).  Overcrowding in prisons have led to increase deteriorating conditions in the prison such as unhygienic sanitation, food insecurities, sexual and physical abuse with limited access to health care further compounding  the spread of communicable diseases such as HIV and Tuberculosis among the incarcerated populace.  (Van Hout & Mhlanga-Gunda, 2018).

Though most countries have made strides in reducing the prevalence of communicable disease among inmates, Africa continues to face increase spread of HIV and TB among its prisoners. for instance, in Spain, prevalence of HIV among prisoners declined from 0.7% to 0.04% within a 14-year period. (Dolan et al., 2016). The prevalence of HIV and TB were less than 1% among inmates in Latin America and Western Europe. (Dolan et al., 2016). However, in SSA, the prevalence of HIV ranges from 2.3%- 34.9% while that of TB ranges from 0.4%-16.3%. (Telisinghe et al., 2016). Female inmates in SSA were twice at risk of HIV than male inmates (13.1% vs 7.1%). (Dolan et al., 2016). This could be attributed to the increased vulnerability of females to HIV and other sexually transmitted diseases as well as majority of incarcerated females tend to be sex workers.

Factors contributing to the high prevalence of HIV and TB in prisons in SSA cut across multiple levels. At the individual level, certain risk taking behaviors such as unsafe sexual practices and illicit intravenous drug use compounded with their limited knowledge on prevention and availability of treatment are contributing factors. At the national level, lack of adequate medical care, severe financial limitations in the region, poor prisons infrastructure, food insecurities as well as absent policies regarding continuity of care and treatment protocols have also contributed immensely to the high prevalence of these communicable diseases.

The high prevalence of TB and HIV among prisoners may have been contributed by the effects of the life-course theory as many of these prisoners usually have few social protective factors during their most sensitive period. Prisoners are often incarcerated for criminal offences such as murder, theft, use or trade of illicit drugs, rape and many others all of which could have been avoided if they had protective factors during the course of their lives. Exposures in childhood can have great impact on the choices made by these prisoners, for example an inmate that is exposed to illicit drug use and trade, prostitutions etc. has an increased risk of indulging in such behaviors during their adolescence and adulthood. In addition to that, prisoners exposed to physical and sexual violence are more likely to indulge in such acts as well as substance abuse during adolescence and adulthood which are high risk behaviours making them more susceptible to imprisonment.

Being incarcerated for criminal offences restricts certain liberties but that should not violate the human rights of the prisoners including their right to health. In SSA, the right to health is being violated through the overcrowding of prisons, insanitary conditions of the prisons, inadequate medical care, lack of access to preventive and treatment programs as well as break in the continuity of treatment. All these factors exacerbate the spread of these communicable disease. Furthermore, failure of the criminal justice systems has also contributed to the overcrowding in the prisons further compounding the spread of HIV and TB.

Thus, in order to deal with the health issues affecting prisons in sub Saharan Africa, there is the need for reforms in the justice systems to decrease the rate of imprisonment as well as reforms on policies regarding the management and health services of the prisons. Also Government of African countries should aim at reducing spread of communicable diseases among prisoners by eliminating barriers to prevention and treatment as well as ensuring equitable access to health care for this vulnerable population in terms of accessibility, quality, acceptability and availability.   

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