PANOS; Wednesday, February 4, 1998
Mario Scheffer and Marcelo Marthe

"I didn't know the reason for all the tests they gave me. One afternoon, the doctor, who had not appeared for several days, came and told me 'you're going to die, because you have AIDS.' It was the worst moment of my life."

Da Silva's story is typical of the treatment meted out to thousands of HIV-positive inmates in Brazil's overcrowded jails. According to a document signed in 1997 by 30 patients in Brazil's largest prison, Carandiru, "We never see a doctor. We are treate d by other prisoners, while we suffer from terrible wounds caused by lack of hygiene and mobility."

Although there are no official statistics to prove it, AIDS, according to Ricardo Marins, an epidemiologist at the University of Campinas, is the leading cause of death in Brazilian prisons -- it kills more than violence or tuberculosis.

For example, of 25 deaths registered at the prison hospital in Porto Alegre Prison, 21 were from AIDS. Recent research revealed that 17.3 percent of the detainees in Carandiru are HIV-positive; at Sorocaba prison in Sao Paulo state, the rate was 12.5 per cent.

The Health Ministry believes that the prevalence of HIV in Brazil's prisons is about 15 percent -- an astonishing one in seven prisoners. According to a Ministry of Health official, Pedro Chequer, "In fact, we don't know the real scale of the problem. T he number of prisoners with HIV could be more than we imagine."

But prison conditions in Brazil are far from unique. The United Nations AIDS Programme (UNAIDS) says in a recent report, "several factors make prisons an ideal breeding ground for onward transmission of HIV infection. Overcrowding is one such factor. In 1995, the prison population of the United States was 1.6 million, a doubling over ten years. In a major Eastern European prison, individual cells hold up to 35 prisoners each."

The AIDS block in Carandiru has 65 beds and receives patients from various prisons. In June 1997, 33 prisoners were interned there, 15 deaths were recorded and seven prisoners in terminal stages of the disease were released. Medical care for sick prisone rs is often non-existent. During an inspection by the Brazilian Medical Council, none of the 10 doctors who work at the prison were present.

A report compiled by members of Brazil's Congress and others reveals that prisoners who can hardly move treat themselves by applying sugar and coffee to their wounds, in the belief that this helps the healing process. Those who need intravenous drips imp rovise with plastic straws. "The State meets neither the minimum United Nations recommendations nor our own country's laws," the report says.

There are some 250 prisons scattered across Brazil, with a similar number of police stations acting as improvised prisons. According to official figures, there are approximately 150,000 men and women in jail, out of a population of 175 million. Overcrowd ing is endemic, especially in the police stations. Little research has been carried out into just why HIV is spreading so rapidly among Brazil's prisoners. Most experts agree that, given the very high discrepancy between infection rates in the general population and in prison, however, it is almost certa in that the majority of prisoners contract the disease behind bars. The two main routes of transmission appear to be unsterile equipment used to inject drugs, and sex between prisoners.

Cocaine is the drug most heavily implicated in the transmission of HIV. Cocaine is usually inhaled but in prison the small quantity of drug available makes injecting it into the veins more attractive to optimise its effects. "A harpoon (slang for needle ) in here is a valuable commodity, which ends up being used 20 to 25 times," explains Joao da Silva.

Research with 180 drug-users in Porto Alegre Central Prison reveals that many wash out syringes with hot water, which is insufficient to prevent transmission of the virus. According to another study of 115 HIV-positive prisoners carried out by virologist Jose Ricardo Pio Marins of the University of Campinas, 20 percent injected cocaine.

According to the same research, about half of the prisoners had had a sexually transmitted disease in the last five years and most of them acknowledged that they had had sexual relations in prison. Sexual relations between prisoners are forbidden in Braz il and subject to severe punishment such as solitary confinement and a diet of bread and water.

A significant part of such sex is likely to take the form of rape, although there is little evidence of the scale. Conjugal visits, during which the prisoner can have sex with a female companion from outside, are also allowed, although they are treated a s a privilege.

Prison authorities are beginning to respond to the growing epidemic. In 1996 the state government of Sao Paulo began distributing about 100,000 condoms a month in its prisons. Last year, the federal government -- with support from the World Bank -- initi ated nine HIV/AIDS prevention projects which also include distribution of condoms in prisons. This year, the government has promised to finance a further 15 such projects.

Providing condoms -- together with lubricants -- in prisons is recommended by UNAIDS as key to containing HIV in prisons.

The appalling treatment of prisoners is not universal in Brazil. The Penitentiary Hospital in Niteroi in Rio de Janeiro state, with 28 beds for 200 patients a year, is considered a model of good treatment. Doctors are present at all times, as are nurses, a psychologist and social worker.

Basic materials, diagnostic tests and medicines, including a range of anti-HIV drugs are available. However, if the patient's health improves, he is returned to the prison, where the continuation of treatment is uncertain. (END/PANOS/MS-MM/DDS/98)

Copyright (c) 1998 - PANOS. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, PANOS, panoslondon@gn.apc.org.

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