HIV in prisons, or how a society treats its criminals

The problems in our prison systems are well-documented. These include severe congestion and extreme delays in courts. Another issue is the acute lack of care for their health.

As the overwhelming prison population are poor this is a cause for continued incarceration — no money to post bail as small as P500, and no resources to engage effective counsel and gather evidence in their defense. This also means no financial capacity to take care of their state of well-being. The top five diseases upon entering jails are upper respiratory tract infection, acute gastroenteritis, influenza, and tension type headache.

How bad is the situation? For people who are jailed pending trial and who enjoy the presumption of innocence, there are less than 15 medical officers in the entire Bureau of Jail Management and Penology (BJMP) to attend to more than 200,000 persons deprived of liberty.

This translates to one medical officer for about 15,000 prisoners. If each officer checks on 10 prisoners a day for a calendar year, it will take 40 years to see all of them. That is just an ordinary check and assumes that all medical officers have the requisite skills and training.

The medicine allowance for detention prisoners is P15 per day, or less than P500 a month. Every year, the BJMP makes the case for an increased budget for the needs of the prisoners and each year, the problem festers.

Coupled with congestion and inadequate support facilities, and given that a majority of detention prisoners are arrested for substance abuse, one particular issue that is reaching epidemic level is the transmission of the human immunodeficiency virus (HIV) and other blood infections, including hepatitis, among prisoners because of the sharing of needles for drug use.

High-risk behaviors like instances of male-male sex without the use of condoms compound the problem.

We have an HIV law which was passed in 2018 — the Philippine HIV and AIDS Policy Act (Republic Act No. 11166). Voluntary testing is encouraged. Compulsory testing is allowed when necessary to test a person who is charged with serious and slight physical injuries, rape and simple seduction; or in cases of blood or organ donations.

Informed consent of prisoners is required for HIV testing. Religious beliefs of some prevent their participation in voluntary testing. The stigma, fear, and ignorance around HIV and AIDS are barriers to the need for openness and understanding to address the HIV epidemic in the prison population. Clear laws and policies backed up by competent personnel and adequate paraphernalia are essential to health management of prisons.

Any results of testing are confidential in nature to protect the privacy of those tested. Non-discrimination is enshrined in law but awareness of the causes of HIV that can cause AIDS is low. The public health dimension requires data on persons infected with HIV/AIDS to inform the general populace of the prevalence of the disease.

The recent passage of the Universal Health Care Act is another pillar of support that may include package for drug abuse and use treatment. The affordability of health care remains a key determinant for the maintenance of the health of any cohort anywhere.

In developed economies, no one dies of AIDS anymore. HIV and AIDS are officially treatable diseases that come with a price tag. Early detection is important to refer the infected persons to the properly equipped medical institutions for treatment and care. Too late and it becomes a sentence of death.

Prevention is still the best solution, but with the conditions in our jails with the hodgepodge of regulations, it seems that the HIV epidemic will join the cluster with dengue epidemic and the resurgence of polio.

Truly, Dostoevsky’s observation that “a society should be judged not by how it treats its outstanding citizens but by how it treats its criminals” is amplified by how we treat innocent detention prisoners whose lives are wasting away waiting for their day or night in court that may never come, especially for those who are sick.

Physical death may be a comfort. Mental illness may dull the pain. But suffering is not to be justified by our inaction. Neither should it be institutionalized in our systems that are called to treat and to rehabilitate, to care and to reform.