The problem of HIV in Kenya's prisons - where prevalence is about twice the national average - will remain unsolved as long as homosexuality is illegal, and prevention efforts remain out of reach, experts have warned.
"We know homosexuality exists in the prisons, but our hands are tied because of the illegal nature of sodomy under our laws," Mary Chepkong'a, head of the Kenya Prisons Service AIDS Control Unit, told IRIN/PlusNews. "Because of the law, we cannot provide them with condoms to ensure they can protect themselves."
In Kenyan law, male-to-male sex is a criminal offence that carries a jail sentence of five to 14 years, although it is rarely used, but the legislation also excludes men who have sex with men (MSM) from the government's HIV programmes.
Chepkong'a said the reasons for male-to-male sex included consensual sex between inmates who were gay, forced sex, and sex between men who resorted to homosexual sex because their "basic sexual needs" were not being met.
"When a man is molested in prison, rather than getting the proper care he deserves, he is often taken back to court and given more jail time," she said. "We are not addressing the real issues."
The prisons service, which has collected data from 13 of the nation's more than 90 jails over a two-year period, found an HIV-infection level of almost 10 percent among inmates.
"There is no doubt about the high prevalence of HIV and TB [tuberculosis] infection in Kenya's penal institutions," Dr Zebedee Mwandi, coordinator of the US Centers for Disease Control programme that focuses on uniformed personnel, told IRIN/PlusNews. "The phenomenally high transmission rate can be attributed to homosexuality, sodomy, increasing injection drug use, and overcrowding."
The Oscar Foundation Free Legal Aid Clinic Kenya (OFFLACK), which promotes legal literacy and offers legal advice to the poor, said in a 2007 report that prisoners did not have "their basic right of conjugal contacts with their spouses", which, "coupled with the congested sleeping patterns where the old, middle and young sleep together", encouraged new infections.
Kenyan law prohibits sex in prison, so conjugal visits are also banned. "The inmates resort to sodomy and lesbianism, a situation that aggravates the spread of HIV/AIDS, and since none of them wants to admit that they practise the same openly it is hard to ask them to use condoms, as this will again encourage the practice considered a norm," OFFLACK commented.
However, it appears the government may be realising the need for programmes for MSM. "Intravenous drug users, MSM and prison inmates are a population in Kenya of epidemiologic importance," said the National AIDS Control Council (NACC).
In April the council admitted that "current policy and programming are not adequately targeting these populations for prevention and treatment of HIV/AIDS" in a report presented at a national prevention summit in the capital, Nairobi.
Turning the tide
The report blamed the slow response to high HIV/AIDS levels in prison on weak and outdated legislation, as well as religious and cultural inhibitions, but also reflected a changing attitude and greater willingness to tackle the problem.
"The creation of effective HIV prison prevention programmes are dependant on establishing the existence and understanding the nature and prevalence of 'prison sex', the construction of sex and power in the prison setting, the nature and prevalence of intravenous drug-use, and the use of cutting instruments," it commented.
Other signs of a change in thinking include intense debate among stakeholders and in the media over whether prisons should contain special rooms for conjugal visits.
While releasing data on trends in Kenya's HIV pandemic on 13 August, Prof Alloys Orago, director of NACC, said despite the fact that sodomy remained illegal, the NACC recognised the need to step up interventions targeting men who have sex with men.