Peru: MSF publishes booklet on fighting HIV/AIDS in extremely overpopulated prison
with the publication of the booklet "Lessons Learned: a multidisciplinary work experience in STI and HIV/AIDS
After five years of work in Lima's Lurigancho prison, focusing on STI and HIV/AIDS, Mèdecins Sans Frontières (MSF) Peru has started handing over its project, in one of the most populated prisons of Latin America, to local authorities.
The National Penitentiary Authority now has the means and capacity to continue the work. MSF will still support health workers inside Lurigancho for the rest of 2006. A booklet that summarizes the experiences of the MSF team has been published in both English (Lessons Learned) and Spanish (Lecciones Apprendidas).
"Working in a prison has been an unique experience and a different challenge in preventing HIV/AIDS," said Piero Gandini, Head of Mission for MSF in Peru. "During these five years, the activities have been diverse, with many discussions and lots of examples of successes and set-backs. In the 'Lessons Learned' booklet, we have tried to summarize the most relevant information and anecdotes, the heart of the story of the project."
Today, Lurigancho houses more than 8,500 inmates in a space designed for 1,500. At the end of the nineties, MSF received authorization to visit the prison and perform a study into the incidence of tuberculosis (TB) and sexually transmitted infections (STIs), including HIV/AIDS. The results of the survey pushed MSF to start a STI and HIV/AIDS control program in Lurigancho.
The prison has become a large, self-organized community that works as a small city, complete with neighborhoods, its own particular culture, services and economy.
Inside the prison, the risk of contracting HIV is five to seven times higher than in the streets of Lima. During visitor days, an average of 4,000 people enter the facility. They include relatives, friends and salespeople who, through their contacts, help spread infectious diseases among the prison population.
Starting in 2000, MSF developed, together with the National Penitentiary Authority, a project inside Lurigancho prison. The multidisciplinary approach of the STI and HIV/AIDS control program has allowed the team to; improve the quality of medical care and treatment of people living with HIV/AIDS; train professionals from other disciplines (such as psychology, social work and education); give special support to the most vulnerable groups; and, in general, show that it is possible to offer timely and adequate care for STIs and key medical attention to people affected by HIV/AIDS in contexts as complex as prisons.
Lurigancho has a typical internal organization. The prison is destined for male inmates imprisoned for common crimes, such as aggravated robbery, murder, unlawful possession of a firearm, sexual crimes and drug trafficking. First-time prisoners are locked up together with repeat offenders.
The prison has become a large, self-organized community that works as a small city, complete with neighborhoods, its own particular culture, services and economy. The prison population has their own representatives, called delegates.
The health situation is critical. Risky behavior between inmates is very common and includes unprotected sexual practices, unsafe tattooing, drug abuse and sexual violence. In addition, discrimination and stigmatization make life very difficult for people living with HIV/AIDS.
"In the cell block they discriminate against you with their eyes. They look at you as if you were dead, as if you were insulting them. That discourages you," said an inmate with HIV.
"In the cell block they discriminate against you with their eyes. They look at you as if you were dead, as if you were insulting them. That discourages you," says an inmate with HIV. "They yell at you in front of everyone, 'Hey AIDS man, make a line to get your dish'. They humiliate you and that embarrasses you. Then the people with HIV will not leave their cells, or go to collect their food, as they are afraid. Sometimes they leave the cell block to live outside in the corridor or anywhere else. It is hard, but they believe it is better as they are not constantly reminded that they are sick."
The level of health care and follow-up for people affected by HIV/AIDS is still insufficient. In October 2005, there were 97 people living with HIV/AIDS being followed by the MSF team in Lurigancho prison. However, this is a fluctuating population because of the high turnover of admissions to and releases from the program. So far, 17 inmates have started anti-retroviral treatment. Efforts have to be made to increase this number and improve the quality of HIV/AIDS care received in the prison's clinic.
"We are presenting our 'Lessons Learned', with our mistakes and achievements, hoping that they will be useful to all professionals involved in health in prisons," said Gandini. "Today, while we are finishing a period of the project, we want to share our experience and contribute to the debate on how to fight HIV/AIDS and STI in complex situations."