On Life, love and Politics

"Random musings about Life, love and Politics. Just my open diary on the events going on in the world as I see it."

How to stop HIV spreading in Zambia’s prisons May 2, 2010

Lusaka Central Prison gates [Photo by Kieron Humphrey]

Moral concerns are stopping condom distribution in Zambia's prisons

Bright spent two years in Zambia's Lusaka Central Prison for selling cannabis but fears he now faces a life sentence.

"I did it because of hunger," says Bright softly.

"There's not much food in prison. Sex has become the way of payment."

The wall prevents an inmate from going outside, but the disease has no boundary

Dr Chisela Chileshe
Zambia Prisons Service medical director

"Conditions were bad," he remembers. "We had nshima [maize meal] and beans two times a day. I never felt full."

One day, the cell "captain" gave Bright extra food, then asked him for sex.

had never had sex with a man, but I did it. The first time it was
painful, but I joined a group of maybe 20 men who did that.

"Mainly they were people who were condemned, or who had been jailed for 25 years. They hadn't seen women for a long time."

Biggest risk factor

He fidgets as he talks, swallowing his words.

ex-Zambian inmate Bright [Photo by Kieron Humphrey]

I'm scared. When I came out of prison I was sick with malaria, headaches, diarrhoea

Former inmate

His nervousness is understandable – it is illegal in Zambia for men to have sex with each other, and socially unacceptable.

A survey of prisoners in 1998 suggested that 27% were HIV-positive – eight points higher than the national rate at the time.

organisation which carried out the research, In But Free, is updating
its figures but is anticipating a similar discrepancy.

Many men
will already be carrying the virus when they are imprisoned, but once
inside it can be spread by tattooing and sharing razors.

The biggest risk factor, though, is sex.

Sex legislation

we gathered the prisoners in focus group discussions and asked how many
had taken part in male-to-male sex, the answer was 'all of us'," says
Dr Simooya, who heads In But Free.

"Most said it was because of
boredom. But some mentioned that it was a form of exchange. You could
give sex in return for soap, food, salt and so on.

T-shirt with slogan saying "HIV is not a life sentence, Treatment works" [Photo by Jo Fidgen]

Some inmates apparently want to spread HIV

"You can't legislate against sex," the doctor says.

"It's better to be practical and ask how we can prevent the transmission of HIV. We must consider putting condoms in prison."

is a view shared by the medical director of the Zambia Prisons Service,
Dr Chisela Chileshe. He refers to the ABC approach to HIV-prevention –
abstain, be faithful, use a condom.

"Abstinence is the best,
but I don't know how long you can be faithful if you spend 10 years in
prison. Inmates are dying, and we need the well-established and
recognised methods of prevention."

He has been lobbying politicians to allow condoms into prison but says moral concerns are getting in the way.

are talking about public health here. People must understand that
health in prison is health in the community. The wall prevents an
inmate from going outside, but the disease has no boundary."

Elizabeth Mataka, the UN Secretary-General's special envoy on Aids in
Africa, the solution is straightforward: do away with the law against

"By stopping condoms getting into prison, we are
actually allowing transmission of HIV to go on unabated and losing
control of the epidemic."

But the political will is lacking.

Short cut

Aids Council (NAC) documents clearly state that "legislation to
decriminalise homosexuality is urgently needed" so that condoms can be
distributed to prisoners.

But when pressed, NAC admitted that the statement does not reflect government policy.

Lusaka Central Prison Health Centre [Photo by Kieron Humphrey]

Activists believe that the answer lies in making homosexual acts legal

"Amending the law might take two or three years," worries Godfrey
Malembeka, a former prisoner who is now a human rights activist.

not only the Zambian government that needs to change. It's the whole of
Zambia. We all believe in just one kind of sex – you must marry and
beget children. These others types, we look at them as foreign,
imported into our country.

"So we have the chiefs refusing this, we have the headmen refusing this, the church, the political leaders.

"But people are dying. We need to find a short cut."

One African country that has found a short cut is Lesotho.

Empty box

Homosexuality is illegal there too.

The prison authorities can't distribute condoms, but they can make them available.

So they simply leave boxes of condoms in strategic places and refill them when they are empty.

Does it work?

success story is that the condom box is usually empty," says Sharon
Lesa Nyambe, who heads the United Nations Office on Drugs and Crime in
Zambia. "Now they're trying to see how that translates into reduction
in seroprevalence [the number of people with HIV]."

prison inmates [Photo by Jo Fidgen]

Would prisoners use condoms if they were made available?

She is hoping a similar scheme could be applied here.

But a big question remains. Even if condoms were made available to prisoners, would they use them?

most prisoners we've surveyed have said no," says Dr Simooya. "They
think male-to-male sex is un-Christian, un-Zambian, and will promote

Bright has other reasons for thinking condoms
might not be favoured by some of the prisoners, especially those
serving long terms.

"One man told me he was HIV-positive and
threatened to kill me if I didn't have sex with him. Those people don't
want to use condoms. If your sentence is short, they want you to be
positive like them and go and spread the disease outside."

Bright was tested for HIV when he left prison but never followed it up.

"I'm scared," he admits, catching his breath.

I came out of prison I was sick with malaria, headaches, diarrhoea. I
was very scared that maybe they would find me with HIV, that's why I
didn't go back."


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