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prison privatisation in south africa issues, challenges and ...

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Public health<br />

While <strong>issues</strong> of security ga<strong>in</strong> more media coverage, what should be of greater concern to the<br />

public is the lack of sufficient attention to health <strong>issues</strong> <strong>in</strong> <strong>prison</strong>. Many <strong>prison</strong> conditions have<br />

an adverse effect on <strong>prison</strong>ers’ health, <strong>and</strong> many <strong>prison</strong> health <strong>issues</strong> affect the greater<br />

community to the extent that they are actually <strong>issues</strong> of public health. Overcrowd<strong>in</strong>g <strong>in</strong>evitably<br />

leads to poor sanitation <strong>and</strong> hygiene, <strong>and</strong> the stra<strong>in</strong> it adds to already limited resources impacts<br />

on the provision of basic services <strong>in</strong>clud<strong>in</strong>g adequate nutrition <strong>and</strong> health care. In South Africa,<br />

out of the 74,362 compla<strong>in</strong>ts received by representatives of the Judicial Inspectorate, one<br />

quarter were related to food <strong>and</strong> health care. Prisoners cited these two categories of compla<strong>in</strong>ts<br />

more frequently than any other category.36<br />

Understaff<strong>in</strong>g coupled with overcrowd<strong>in</strong>g also limits the amount of time <strong>prison</strong>ers are able to<br />

spend outside of their cells, <strong>and</strong> the result<strong>in</strong>g lack of movement, let alone exercise, will also take<br />

its toll on <strong>prison</strong>er health. The impact of emotional stress <strong>and</strong> psychological trauma on <strong>prison</strong>ers’<br />

physical health has also been documented <strong>in</strong> other countries, although similar studies have not<br />

yet taken place <strong>in</strong> South Africa.<br />

Because all but a very small percentage of <strong>prison</strong>ers will return to the community upon<br />

completion of their sentences, many <strong>issues</strong> related to <strong>prison</strong>er health become <strong>issues</strong> of public<br />

health when they are released. Due to poor medical treatment of contagious diseases which<br />

thrive <strong>in</strong> the <strong>prison</strong> environment, <strong>prison</strong>ers return to the community sicker than they left <strong>and</strong> take<br />

their sicknesses with them. The cost of miss<strong>in</strong>g out on this <strong>in</strong>tervention opportunity, to reduce<br />

the <strong>in</strong>cidence of disease both <strong>in</strong>side <strong>and</strong> outside the <strong>prison</strong>, is great. The illnesses that are<br />

particularly prevalent <strong>in</strong> <strong>prison</strong>s <strong>in</strong>clude hepatitis B <strong>and</strong> C, syphilis, tuberculosis, <strong>and</strong> HIV/AIDS.37<br />

HIV<br />

While reliable statistics are not available on the number of HIV positive <strong>prison</strong>ers, the<br />

characteristics of the typical <strong>prison</strong>er are those of a demographic at high risk for HIV <strong>in</strong>fection.<br />

As a result, many <strong>prison</strong>ers will already be HIV positive upon enter<strong>in</strong>g the <strong>prison</strong>. Given that a<br />

typical South African <strong>prison</strong>er is a young black man, it is reasonable to expect that the <strong>in</strong>fection<br />

rate <strong>in</strong>side <strong>prison</strong> is at least as high as it is for this demographic outside of <strong>prison</strong>. Table 1 shows<br />

the actual <strong>and</strong> projected <strong>in</strong>fection rate for black men aged 20 to 34 <strong>in</strong> South Africa. Us<strong>in</strong>g this<br />

data, it can be estimated that the current HIV <strong>in</strong>fection rate <strong>in</strong> South African <strong>prison</strong>s is at least<br />

30%.<br />

Table 1: Actual <strong>and</strong> projected HIV/AIDS <strong>in</strong>fection rate among black men aged 20-34 years<br />

<strong>in</strong> South Africa<br />

Year HIV AIDS Deaths Total population<br />

1990 12850 72 91 3255922<br />

1991 30211 199 230 3339520<br />

1992 61496 485 515 3423389<br />

1993 111993 1040 1038 3507257<br />

1994 186732 2023 1929 3590827<br />

1995 287594 3647 3347 3673561<br />

1996 409965 6150 5455 3753681<br />

1997 550438 9749 8436 3830120<br />

1998 703113 14719 12474 3903094

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