MEMORANDUM: Realise the right to health in prisons: we need an effective and comprehensive HIV and TB prevention, diagnosis, treatment, care and support programme in prisons now!
Today, 24 March, we commemorate World TB day and South Africa focuses its attention on the scourge of TB in prisons. TB is the leading cause of natural deaths in South African prisons and the leading cause of death and morbidity in people living with HIV. Moreover, TB that develops and spreads in prison does not stay in prison: it reaches into communities and families and affects all South Africans.
It is therefore appropriate to hold these World TB day events at Pollsmoor Prison, a prison with historical and current significance to the fight against TB.
Former president Nelson Mandela contracted TB in this prison over 25 years ago. Dudley Lee contracted TB here almost 10 years ago. Dudley Lee took his case to the Constitutional Court and won a landmark judgment against the DCS last year. The Court spoke in forceful terms and confirmed that the DCS has a duty to prevent and treat TB in prisons. Despite this history and this judgment from the highest Court in the country, conditions in Pollsmoor Prison remain much the same today as they were when Mandela walked out of here in 1988 and when Dudley Lee walked out in 2004.
- As we speak, Pollsmoor Prison is dangerously overcrowded at over 200% occupancy.
- A recent study showed that the risk of contracting TB in this prison is extremely high.
- People detained in this prison are kept locked in cells for up to 23 hours a day, this practice is not only inhumane, but also contributes to ideal conditions for TB transmission.
- Across the country, severe shortages of doctors and nurses for health care services in prisons cripple effective TB management. An estimated 360,000 inmates move through our prisons every year. Approximately 820 professional nurses and 8 medical practitioners face the impossible task of providing them health care services.
The TAC, MSF, SECTION27 and other partners have been focusing on the right to health in prisons for years. Despite our efforts, health care services in prisons are still in shambles.
We welcome the recent cooperation between the Department of Health and the Department of Correctional Services and encourage them to jointly prioritise and combat TB in prisons. The introduction of GeneXpert machines into prisons is encouraging as a sign of that commitment. We also welcome the development of the “Guidelines for the Management of TB, HIV and STI’s in Correctional Centres” that have been announced here today. However, we warn that:
- Whilst the DCS and DoH should work together to improve health in prisons, the DCS remains legally responsible for this work and must be held accountable for it.
- Whilst the guidelines are a necessary step, the DCS and DoH must remember that detailed set of Standing Orders already exists and controls health care services in prisons. These must be enforced.
- We must remind the DCS and DoH that guidelines and policy only bear fruit when enabled by budgets and implementation plans. We therefore call for a budget and implementation plan for an effective and comprehensive HIV and TB prevention, diagnosis, treatment, care and support programme in prisons.
- Finally, we call on the DoH and DCS to work with the TAC, MSF and SECTION27 to improve health in prisons.
We come here today and raise the above concerns as a sign of our commitment to the realization of the right to health both within prisons and without. We do so in a spirit of good faith and in the hope for collaboration with the DoH and DCS. Let us work together toward zero infections, deaths, stigma and discrimination from HIV and TB.