Homosexuality ruled out as cause of high HIV prevalence in Ugandan prisons 

Uganda Prison Service (UPS) has blamed the high HIV/Aids prevalence rate among inmates on failure to adhere to HIV prevention messages.

At least 15 per cent of surveyed inmates in Uganda’s 269 prisons are HIV/Aids positive according to the 2019 UPS sero-behavioral survey report. Uganda has about 76,493 inmates handled by 14,461 across the different prisons in the country.

UPS spokesman, Frank Baine said most of the prisoners are either illiterate or semi-illiterate and therefore are not easily convinced about the risk factors and HIV/Aids prevention messages.

Baine said recently that some prisoners still believe that those with signs and symptoms of HIV were simply bewitched. Others, he said, still think messages about HIV prevention were a myth. Some prisoners according to Baine are negative deviants’ who are not scared of contracting HIV.

“There is a correlation with a person who doesn’t get scared of being shot with a bullet [not] to be scared that he’s going to get HIV that is going to manifest in 10 years…And the behaviour itself is that if I have robbed money, where do I go? I will go to the bar. Which people will get in the bar? The sex workers and then chances of getting it [HIV] is so high. So we find that somebody who is reckless with other parts of life finds it very easy to do the other one. Remember the sensitization can go on, but there is one big component about people behind bars, there is deviance. They are in prison because they don’t want to listen to what you tell. When they say thou shall not steal, for them they think when you close your eyes, they should steal. Even when you tell them please don’t share a razorblade, you will get Aids, he thinks if he does, he will get away with it like he does in stealing,” said Baine.

MPs on the parliamentary HIV/Aids committee last month expressed concern that some prisoners were contracting HIV in prisons suggesting that there could be high incidents of homosexuality in the cells. Ibanda North MP, Xavier Kyooma went to the extent of suggesting that all prisoners remanded or sentenced to jail terms be subjected to HIV/Aids tests so that they are isolated. 

Though he was mindful of this kicking off a wave of stigmatization, Kyooma said those who get into prison HIV-free should get out without the virus. High court judge, Margaret Mutonyi said recently that all inmates, not just those charged with sexual offenses, should be checked for HIV, hepatitis, and TB. She suggested that young offenders particularly, risked violence including sodomy by hardcore offenders with whom they share cells.    

The national HIV prevalence is estimated at 6.5 per cent. The prison report said about a fifth (20.5 per cent) of prisoners had comprehensive knowledge about HIV/Aids, and this was less among female than male prisoners. The report said 56.8 per cent consistently used condoms while 61.6 per cent knew that having only one uninfected sex partner can reduce the risk of HIV infection.  

According to Baine, prisoners facing or convicted of rape, and aggravated defilement charges constitute 65 per cent of the prison population living with HIV/Aids. While UPS has ruled out possibilities of co-infection of the virus among male prisoners, in 2020 the Uganda PEPFAR office in Kampala said prisoners are key population members, mostly men, who move within both prison and community settings, including approximately 150,000 prisoners cumulatively per year in Uganda.

CDC Uganda Associate director for science, Dr Lisa Mills told PEPFAR Uganda Science Summit that prisoners and prison staff have double or higher the national adult prevalence of HIV (15.0 per cent and 12.0 per cent versus 6.2 per cent).   

She said the excess burden of related infections was among those involved in illicit drug use and MSM behavior than national estimates. Dr Mills said prisoners had high HIV incidence (1.46 per cent), especially men less than 30 years.

“More than 50 per cent of recently infected prisoners had been in prison less than 6 months, suggesting ongoing transmission in prison settings. Epidemic control efforts in Uganda may fail if 90-90-90 targets not achieved in prisons,” she said.   

She suggested the need for systematic HIV & TB prevention, testing, treatment, and related services tailored to the challenges of prison settings. As part of the finding, the Uganda Prisons Service PEPFAR program strategy was revised, enabling direct government-to-government funding for more than 200 prisons to provide HIV testing, care, and treatment services for all prisoners within the prison system using the hub-and-spoke model.  

The model decentralized ART management. More than 30 UPS sites are supposed to receive accreditation to administer antiretroviral therapy directly. From the prison’s point of view, Baine revealed that 80 per cent of the prisoners admitted understand that they have HIV when they are being tested. He insisted that HIV was more among female inmates than their male counterparts.

“But of course, this thing is not only affecting prisoners, even our staff. The prevalence is high because they are askaris. Askaris you know our problems. Actually, what was shocking is that for the female staff, the prevalence in female staff is double compared to the male. And of course, maybe the economic conditions, maybe the working environment all those things are involved. So one of the drivers could be homosexuality and yes, why? Because as long as there is homosexuality in the public, when they are arresting you, it is not written on your face that this is a homosexual, please don’t take him to prison. And as you come in as husband and wife, you will start because sex in Africa is discreet. Actually, we said well, homosexuality could not be the main driver [since] we found women having a higher prevalence than men,” said Baine. 

Dr Nelson Musoba the director general of the Uganda Aids Commission does not rule out the fact there could be homosexuality practices in Uganda’s prisons. He said there are laws that prohibit the prison service from providing some preventive measures like condoms to inmates to fight the spread of the virus.

He added that there are several other prevention interventions that the prisons can access like HIV testing and counseling, circumcision, and creating awareness to manage the spread of the disease among prisoners. He said 99 per cent of HIV diagnosis is done at inmates’ point of entry into detention centers.

The 2013 survey indicates that the national prevalence of HIV on average is 6.5 per cent where men constitute 5.9 per cent and 8.3 per cent for women. The same survey shows that there is a high prevalence rate in prisons with 11 per cent for men and 13 per cent the women which is higher than the national prevalence. The survey also showed that places that are highly populated in the country have higher prevalence rates.