Nairobi — The Kenya Prisons Service has won praise for its HIV programmes, including education, testing and the provision of anti-retroviral drugs to prisoners, but specialists say unless the issue of unprotected sex is addressed, HIV transmission will continue unchecked.
"The truth is there is sex going on in prisons; research shows that sex among male prisoners happens through different ways, including coercion, forced, and consensual sex," Lorna Dias, the men-who-have-sex-with-men (MSM) coordinator at the NGO, LVCT Care and Treatment, told IRIN/PlusNews. "The government should recognize this and provide condoms in prisons."
According to a study, Sexual Health and HIV Knowledge, Practice and Prevalence among Male Inmates in Kenya, conducted by LVCT, the Kenya Prisons Service and the African Medical and Research Foundation in 2008, of the 9 percent of male prisoners interviewed who admitted having sex in prison, 74.6 percent said it was unprotected.
Kenya's government has long argued that because both homosexual sex and sex in prison are against the law, its hands are tied when it comes to condom distribution in jails.
"There are numerous HIV-related services that are being offered to prisoners... but we cannot provide condoms because the law as it is today regards them as contraband; you can't take condoms into prisons because you will be breaking the law," said Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme.
"Prisoners are very transitional ... if they leave infected then they stand a chance of infecting others in the wider population," he added. "Condoms would be more effective, but there is no policy on them as regards to prisons ... we target them with the services like testing and treatment."
Robert Onyieno*, 30, walked free in 2009 after serving a five-year prison sentence for theft in the Kenyan capital, Nairobi. He has since discovered he is HIV-positive, and suspects he contracted the virus through unprotected sex in prison. "I had sex with older prisoners. Later one of them took me as his 'wife'.
"I had no choice but to agree, because that is the only way I could get food and even water to bathe. He acted as my protector and I provided sex in return," he added. "Before he finally took me, I had engaged in sex with two other prisoners... my partner was not faithful; he had sex with other prisoners too."
The Kenya National AIDS Control Council's Modes of Transmission survey reported that MSM and prison populations were responsible for about 15 percent of new HIV infections. HIV prevalence rates in prison are about 10 percent - against the national average of 7.4 percent.
"The slow response to high HIV/AIDS levels in prison is mainly due to weak and outdated legislation, as well as religious and cultural inhibitions," the study reported. "It is recommended that in the immediate and short term, ways be examined that will improve and hasten provision of services; in the long term, discuss changing policies and laws that criminalize and discriminate against these groups."
"Let us not talk [openly] about distribution or provision if the law is against it; condoms can be made available in a manner the prisoners can access them," Dias said.
"It is time the government realized that using punitive measures will not work," she added. "It is incumbent upon policy makers to push for the removal of the legal hurdles that prevent provision of condoms in prisons."
Aside from sexual activity, inmates in Kenya's prisons - which are estimated to hold as many as 47,000 prisoners, three times their intended capacity - risk HIV through shared needles for intravenous drug use, razors and tattooing needles. Overcrowding also puts prisoners at high risk of tuberculosis.
The recently launched third Kenya National Strategic Plan for HIV/AIDS 2009-2013 highlights the need to scale up interventions among "most-at-risk" populations, including prisoners, but notes that the criminal nature of the activities of these populations posed a serious challenge to programming; the strategy aims to "alleviate" the constraints that have hampered programmes for these groups.
"Condoms can help because many engage in sex with fellow prisoners; just give them the condoms to save others," Onyieno said. "Many of them have wives and they go back to them and they infect them - I did that to mine."