Bangkok Post - February 3, 2009
Arusa Pisuthipan

"I would have been dead by now if I had not been penalised with imprisonment here," says Jeab, beaming.

Jeab, now 44, identified herself as a heroin addict when she was only 15. She started by taking the highly addictive drug via intravenous injection. The financial crisis in her family, she says, forced her to go beyond just a mere heroin user. She got involved in heroin trafficking - the crime that eventually landed her in jail in 1988.

The sad, yet predictable, by-product of her using heroin intravenously was that Jeab became infected with HIV/Aids.

Before she was transferred to Min Buri prison, Jeab's blood sample had tested positive in another prison where, unfortunately, the fact of being an HIV-positive was absolutely unacceptable at that time. She was then compelled to live and do everything separately from the rest of the prisoners. It was like being detained in a prison within the prison.

"We HIV/Aids-infected patients had to face enormous hostility from other prisoners as well as from prison guards," Jeab recounts. "We had different work shifts. We ate at different times. Other prisoners took a shower at 8 o'clock, but we had to wait until 9."

Worse, nobody paid even scant attention to prisoners suffering from HIV/Aids, she says. No one offered them treatment or emotional support. For ill convicts, there was nothing but doom and gloom.

Jeab's life changed completely, however, after she was shifted to Min Buri prison, where Medecins Sans Frontieres, or MSF, has been providing treatment and support to prisoners infected with HIV/Aids since 2003.

Also known as Doctors without Borders, MSF is an independent humanitarian organisation that helps to provide medical aids to the needy in many countries around the world. Before MSF started lending its hand in Thai prisons, prisoners with HIV/Aids had been excluded from the access to antiretroviral therapy. Although the life-saving drug was widely available, sick prisoners had no choice but to suffer and die behind bars.

Min Buri prison is the first prison in Thailand where MSF stepped in and helped to improve the care and treatment of infected prisoners.

"When it comes to HIV/Aids-infected criminals, in the past we usually thought that they deserved delayed priority. So, prisoners lacked information as well as experience [in coping with the disease]. The goal of MSF's project is to tell them that they do not have to die in jail," says Verapun Ngammee, HIV/Aids project coordinator.

According to Verapun, the programme aims at providing prisoners suffering from HIV/Aids with proper medical treatment and care, including antiretroviral therapy, as well as cures for consequential diseases that occur as a result of the damaged or weakened immune system in HIV/Aids cases.

Apart from medical aid, the project also aims to make information available to infected and non-infected prisoners regarding the prevention of HIV/Aids transmission.

"In the past, prisoners infected with HIV/Aids did not have sufficient knowledge about the disease. When they found out that they were infected, they felt hopeless and thought that they had nothing left but death. But now the situation has changed. Infected prisoners know how to take care of themselves. Some of them are given antiretroviral medication. They know that they do not have to die of HIV/Aids in prison anymore," says Suchada Phoking, head nurse at the medical centre in Min Buri prison.

According to Suchada, there are currently 43 HIV/Aids prisoners at Min Buri prison. Nine of them are female and the rest are male. Notwithstanding the reported figure, Suchada assumes that there must be others who are infected but who choose not to have their blood tested.

Like Jeab, Pong (not his real name) also feels fortunate that he is sentenced to imprisonment at Min Buri prison. When he was diagnosed last year as suffering from HIV/Aids, Pong first felt nothing but despair. The 25-year-old thought the prison would certainly be his burial ground.

Today, with support from the MSF's project, Pong is now on antiretroviral medicine. He is physically and emotionally healthy, he says, and feels that infected prisoners can live like the unaffected inmates.

"They [MSF] set up a counselling group in the prison. Now I can share my experiences with other infected prisoners. The non-infected prisoners do not discriminate against us. I feel that I can live my life normally like the rest of the people here if I remain strong," says Pong, now serving his last two years of imprisonment for robbery and attempted murder.

Apart from providing convicts with support, according to the project coordinator, it is equally important to raise awareness and understanding regarding HIV/Aids among prison guards.

"In every prison, prison guards play an extremely significant role. They control prisoners. Consequently, it is a must to make prison guards understand HIV/Aids perfectly, its treatment as well as its prevention," explains Verapun.

Every year, MSF arranges an annual training session for prison staff so that they are well-equipped with knowledge of HIV/Aids and so that they can handle prisoners without inequity.

"Mention HIV/Aids and people usually think of it as a disgusting, serious and often fatal epidemic illness. But to us prison staff, there is no use thinking of the disease that way. Let's think of how to control the transmission. With a proper preventive scheme in place, we know that the disease is not easily transferred to others. More importantly, infected prisoners can live like healthy persons if we give them a chance to do so," comments Nittaya Intha, a registered nurse at Min Buri prison.

Though sex behind bars is not allowed, according to Verapun, this is admittedly difficult to control. The use of condoms should therefore be promoted, especially among male prisoners who have sex with men.

"Some prison wardens believe that giving prisoners condoms is like promoting sex in prison and is like they are giving the green light to sex among prisoners. However, this is not true. In the matter of HIV/Aids, prevention is paramount, and the use of condoms is one of the most effective ways to control its transmission. So, our job is to raise awareness among prison guards. We first need to change their attitudes," Verapun explains.

Suchada echoes the sentiment. According to her, staff's attitudes are one of the important weapons used to fight HIV/Aids among prisoners. The control and treatment of the disease will never be successful if prison staff, especially prison guards, remain prejudiced against prisoners who have fallen victim to HIV/Aids.

In addition, MSF has set up a volunteer programme in which healthy prisoners are able to participate. They can be volunteers to help infected prisoners cope with the sickness.

Mote (not his real name) is now serving the last two years of his nine-year sentence at Min Buri prison. Having joined MSF's volunteer programme last year, Mote has now become one of the prison's volunteer staff who help to provide knowledge to other male prisoners regarding HIV/Aids. He is trying to make every day in the prison count.

"My responsibility as a volunteer staff in the HIV/Aids awareness programme here is to tell my friends that HIV/Aids is not easily transmitted and that there is no need to be afraid of those who are infected. Instead, we should try to understand and support them as much as we possibly can," says Mote, 31.

"This volunteer programme does not only benefit me. It also benefits other prisoners, regardless of their HIV/Aids status," he adds.

In 2005 and 2007, MSF extended its HIV/Aids project to two other penitentiaries, namely, Bang Khwang prison and Pathum Thani prison. However, this initiative is now being progressively handed over to the Ministry of Public Health. MSF has finalised a blueprint to help in the development of this model in other prisons around the country.

Today, Jeab shows no sign of being HIV-positive. She looks physically fit and is looking forward to being given back her freedom in just under a year so that she can spend the rest of her life taking care of her two little grandchildren. She has learned her lesson, and she says she will make her days outside the prison part of a hopeful future.

"In the past, I used to see infected prisoners dying one after another. Now nobody dies in prison. We can live here in jail with friends who do not hate us. I do not know what my future out there will be like when I am released, but I am sure that I will be strong because I have not only my life but also two other small lives to take care of."

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