Sex between prison inmates is a reality at Manica Provincial Prison, in central Mozambique, but because same-sex relations are taboo, and conjugal visits are not allowed, many HIV-positive inmates say they were infected before they were sent to the largest prison in Manica Province.

The reality is often different. "Based on the analyses we carried out, we found that some inmates were indeed infected before being locked up, but the majority was infected inside the jail," said Elsa Thaibo, director of the health department in Chimoio, who is also responsible for providing medical assistance to the prison located in the city.

Carlos Alid, 38, who was jailed in 2005 for counterfeiting money and has four more years left to serve, told IRIN/PlusNews: "Because of the lack of other options, some men seek what they should be getting from their wives or from other women, in men."

He discovered he was HIV positive after a voluntary test in prison, and suspects he was infected after becoming an inmate. Alid said some of the younger prisoners have sex with older ones in exchange for food and protection, especially since many do not enjoy the support of their families. The sex does not always include condoms.

HIV behind bars

The prison, located near a mountain with the shape of man's head, known as "Cabeça de Velho" (old man's head in English), has an HIV prevalence rate of 4.5 percent among the approximately 1,000 inmates, according to official data.

"It's been very difficult to keep this [HIV] outside. You can't see it coming and it's impossible to see it being transmitted," said prison director Francisco Mate.
Between January and May of 2008, 43 of the 246 of the prisoners examined – both men and women – were diagnosed as HIV positive; of these, eight are taking antiretroviral (ARV) treatment.

UNAIDS has encouraged the authorities to acknowledge that sex between men occurs, and that preventative measures be adopted. Nevertheless, three years ago, several prisons in Mozambique rejected the proposal that condoms be distributed to inmates, arguing that there was no homosexual activity taking place in prisons.

This is slowly changing. "The government already understands that the distribution of condoms in jails does not promote homosexuality, but rather contributes toward HIV prevention. That's why it's begun to distribute them," said Thaibo.

Besides unprotected sexual relations, specialists point to needle sharing to inject drugs and unsterilised tattooing instruments as factors that could contribute to the spread of HIV in the nation's prisons.

"Prison authorities are unable to control the high-risk practices," said David Demo, 33, who has been in prison for two years for homicide.

Signs of change

But prevention means more than just condom distribution. In addition to giving out free condoms, the group Shinguirirai (support, in the Shona language) holds lectures and education sessions, provides psychological assistance and helps prisoners stick to their ARV treatment regimen.
Rui João, 27, in the prison's high-security wing for the murder of a neighbour in 2006, discovered he was HIV positive in September 2007 and began taking ARVs. He is now one of Shinguirirai's activists and gives other prisoners information about AIDS, and supports those on treatment.

Prison employees are also included in the awareness-raising campaigns, and with the support of the Provincial Nucleus for the Fight Against AIDS, Shinguirirai organised courses last year for both prison workers and inmates.

According to João, prison conditions are not ideal for HIV-positive individuals to live healthy lives, such as a nutritious diet and an adequate environment, which are fundamental to the success of ARV treatment.

Some NGOs and religious institutions have sought to make up for these shortcomings with balanced meals and medical assistance for HIV-positive inmates on two Saturdays a month, but the need persists.

Even so, prison director Mate believes there are signs of change. "There was a time when a considerable number of inmates died because of a lack of care, but this has gone down now because it's not easy for a prisoner to see a fellow inmate die. Little by little, we're managing to get somewhere."

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