Inside a KZN prison: Breaking the shackles on sex education in fighting HIV


Eshowe, a town in KwaZulu-Natal, is implementing new education strategies in the local prison to reduce HIV mortality rates. Health24 takes a closer look.

Doctors Beyond Borders (MSF), together with the Department of Health in KwaZulu-Natal (KZN), have been working since 2011 to provide health education to correctional services in their continuous fight to bend the curves of human immunodeficiency virus (HIV), tuberculosis (TB) and the mortality rate in rural KZN.

Counselling and testing

Because of the vulnerability and risky behaviour of prisoners, Eshowe is one of the high-risk areas. MSF saw the opportunity to educate the inmates to lower HIV transmission.

According to MSF, one in four people in Eshowe, aged between 15 and 59, are HIV positive.

Health promoters and counsellors have allocated days when they go to the prison to provide inmates with among other things screening and treatment for STIs, HIV testing services, TB screening and treatment.

Besides HIV and TB counselling and testing, condoms and lubricants are also distributed to the prisoners.

Before prison education, some inmates came to prison already knowing their HIV or TB status and were on treatment, while others knew very little about the risks. With the guidance of the programme, however, everyone is getting the opportunity to know their status and how to manage it. 

A lot of misconceptions

Health24 spoke to Showngishilo Dladla a female MSF counsellor. “I had to go through the process of explaining and educating them about the risks of HIV and how to prevent it. I also found that there were a lot of misconceptions around the topic,” she explained.

Being a woman in a male facility, Dladla finds herself in trying situations where she has to remain professional and focused despite being terrified.

Since HIV counselling is subject to a confidentiality policy, she has to face inmates alone without the presence of wardens.

“I'm left alone with the inmates to provide counselling but it is difficult because they often drift from the topic and see the session as an opportunity to ask non-related questions,” she said.

The HIV prevalence in the prison is so high that those who are HIV negative tend to be quite surprised. 

“When I try to understand their reaction, they just say ‘You know the life in prison’, refraining to give clear answers about sexual activities.”

The role of circumcision

Medical male circumcision (MMC) reduces the chance of HIV infections by up to 60%, according to MSF. This approach is promoted to reduce the high HIV rates in the community.

Partnering community NGOs work together with MSF in Eshowe to help recruit and educate people and promote the health benefits of MMC in prisons, clinics and schools.

HIV,AIDS,sex education,MMC

Like with any new change, implementing MMC was not easy, but since the implementation in 2013 there has been an increase in circumcision rates.

“About 400–500 prisoners are circumcised each year,” says MSF’s Head Health promoter Bhekinkosi Xulu .

“One way to reach men is by adapting HIV services to their needs.”

But why the focus on prisons?

“Inmates are part of the broader community and should not be excluded from community interventions. By providing service to prison inmates, the rate of transmission and new infections is reduced,” explains Musa Ndlovu, MSF’s Deputy Field Co-ordinator.

MMC awareness

Since MMC was introduced to the community, the level of awareness among adults and even children has increased rapidly.

"People are well informed. The response to MMC in communities is very interesting. My son came home from school with an indemnity form, asking me to sign it because he wants to be circumcised. The level of awareness is very high," says Ndlovu.

WATCH: MSF on Medical Male Circumcision

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