HIV/AIDS Prevalence Survey, Current Treatment Initiatives & Medical Parole: briefing by Minister & National Commissioner

CORRECTIONAL SERVICES PORTFOLIO COMMITTEE
12 September 2006  
HIV/AIDS PREVALENCE SURVEY, CURRENT TREATMENT INITIATIVES AND MEDICAL PAROLE: BRIEFING BY MINISTER AND NATIONAL COMMISSIONER

Chairperson: Mr D Bloem (ANC)

Documents handed out:
HIV Prevalence Survey
Current HIV and AIDS Projects and Initiatives
Medical Parole Presentation to Portfolio Committee

SUMMARY
The Minister, National Commissioner and officials from the Department of Correctional Services discussed its HIV Prevalence survey and noted that the report on this would be available in October. Using the pilot study in Gauteng, the Department had outlined a comprehensive plan for tackling HIV/AIDS including prevention care, support and treatment. It spoke briefly about its reason for appealing the Durban High Court judgment that ordered all restrictions preventing prisoners from accessing antiretroviral treatment be removed with immediate effect. The process and diagnostic mechanisms for medical parole were also outlined. The Committee was largely satisfied with the steps being taken by the Department on the issue of HIV/AIDS.

MINUTES
Deputy Minister of Correctional Services, Ms Loretta Jacobus, and her team addressed the Committee on the progress of the HIV Prevalence survey, current HIV and AIDS projects and initiatives and medical parole (see documents). 

Briefing on HIV and Syphilis Prevalence Survey
Ms Jabu Shishuba (Department Chief Deputy Commissioner: Development and Care) outlined the purpose and background to the prevalence survey, the response by offenders, findings of the pilot study being conducted in Gauteng as well as the action plan for national roll-out.

Briefing on current HIV and AIDS projects and initiatives
Ms Shishuba also outlined the Department’s current projects and initiatives. Those included prevention, treatment and the use of partnerships with other institutions to assist in the  implementation of those initiatives.

Briefing on Medical Parole
Ms Shishuba outlined the Department’s procedure for the attainment of medical parole on the grounds of terminal illness. The procedure was mandated by Section 35(2)(e) of the Constitution, and spelt out in Section 79 of the Correctional Services Act of 1998. The procedure included a process of identification of the offender’s medical condition and consideration of the condition by a parole board.

Discussion
The Chairperson asked the Department to clarify why it had appealed the provision of antiretroviral (ARV) treatment to prisoners at the Durban's Westville Prison.

National Commissioner, Mr Linda Mti, explained the reason for its appeal against the Durban High Court judgment that ordered all restrictions preventing these prisoners from accessing ARV treatment be removed with immediate effect. The appeal was not to resist the judgement but only to draw attention to the administrative problems that implementation would incur.

The Chair was satisfied with this reason but called for another meeting devoted to that issue entirely.

Mr N Fihla (ANC) noted that since the pilot study response was not as effective as hoped, it would be prudent to spread treatment sites according to areas that have higher inmate numbers.

Deputy Minister L Jacobus explained that this was due to the reluctance by inmates to participate as the stigma attached to HIV/AIDS was high. Once the results from the pilot study were collected the DCS would spread out this initiative to the remaining provinces. Gauteng was chosen as the pilot area due to the high prisoner density.

Ms Shishuba noted that it was scientifically necessary to get the required ten percent level for the study to be valid.

Mr L Tolo (ANC) enquired about the use of education in preventing the spread of HIV/AIDS.

Deputy Minister Jacobus stressed that the importance of education in preventing transmission was of paramount importance.

Ms W Ngwenya (ANC) stated that the way forward must take into account society as a whole and provide a solution that reached all spheres. She asked whether the new generation of prisons being built would be able to incorporate hospices. The question of whether inmates were getting infected before or during their sentence was raised.

Deputy Minister Jacobus replied that as HIV/AIDS testing is not compulsory it is very difficult to determine where infection was actually occurring.

National Commissioner, Mr Linda Mti, added that he could guarantee hospitals in the new prisons but that hospices were under the ambit of the Department of Social Development and that the DCS had no mandate to run hospices.

Ms Mabena (DCS) noted that it would be extremely costly to employ the necessary staff to run hospices.

The Chair agreed that there was always a shortage of nurses.

Mr S Moatshe (ANC) asked about the rate of infection with regards to race and gender.

Ms Shishuba replied that they would only be in possession of these figures after the Prevalence Survey had been completed and the results should be available during October.

Ms L Chikunga (ANC) questioned what the DCS comprehensive plan actually meant in light of having been taken to court. She asked why the DCS employed registered nurses and not staff (or enrolled) nurses and how much it spent on ARVs.

Ms Maria Mabena (Director: Health and Physical Care) replied that the DCS did not pay for ARVs, they are sourced from ARV roll-out centres. The employment of registered nurses was to due to the adherence to government policy as it was believed that the 30 day ARV training given to staff nurses was not comprehensive enough.

Ms Z Nawa (ANC) asked what happened to an inmate before the secondary diagnosis was made by a physician.

Ms Shishuba responded that treatment would occur as per the primary diagnosis and, if in harmony with the secondary diagnosis, treatment would continue.

Mr E Inkosi (ANC) asked what caused inmates to disclose or undergo status testing at such a late stage in the course of their illness.

Mr Gustav Wilson (DCS Director: HIV/AIDS Unit) replied that the stigma attached to treatment was great and contributed to the lack of willingness to be tested and assisted.

Mr M Shah (DA) enquired about the measures in place to safeguard against the abuse of medical parole.

Commissioner Mti replied that all systems were subject to abuse and that they would seek verification from a second medical healthcare professional.

Mr L Tolo (ANC) commented that if a new prison was built and some of the inmates had AIDS it did not necessarily mean that they were infected there. He wanted to know what the DCS said about deaths in this context.

The Deputy Minister responded that AIDS related deaths in prisons were due to the reluctance of offenders to seek treatment in the early stages of the syndrome due to the fear of stigmatisation.

Mr Fihla stated that he did not believe society objected to offenders being handcuffed during treatment at public hospitals as they represent a significant security risk. He also called for the institution of hospitals in all prisons in order to prevent having to take offenders to civilian facilities.

Ms Shishuba replied that the public did not object to prisoners being handcuffed but rather objected to being in close proximity to offenders at public hospitals. She cited the fact that medical resources across correctional service facilities were not equal, but that ARV centres would be identified near those facilities that lacked the capability.

Ms Chikunga asked what the implementation of ART guidelines and establishment of 66 support groups actually meant. She also enquired why all classes of nurses were not considered eligible for employment.

Mr Shah asked the percentage that donor funding provided for the total cost for the Presidential Emergency Plan for AIDS Relief (PEPFAR).

Mr Wilson replied that the PEPFAR funding was allocated to three individual programmes within the comprehensive programme including prevention, support and services. He did not specify the total donor funding.

The Chair thanked the DCS delegation and expressed his resolute belief that the government, through the DCS, had an effective strategy for combating HIV/AIDS in prisons and lamented that the Durban High Court appeal had been misconstrued by the public. He noted however that the issue of treatment in prisons should not be out of proportion to that of national treatment for all.

Meeting adjourned.