Problems
with condom access and drugs mean UK prisons face an HIV time bomb. And, as
our survivors’ stories show, positive life behind bars is one of fear
and isolation
Words Chris O’Connor
Main image Brand X Pictures
HIV factories’: a shocking label attached to many prisons around the
world. Writing in The Sunday Times this summer, Andrew Sullivan commented:
“What bath houses were in the 80s, prisons are in the new century.”
He was referring to the US, where HIV rates in some prisons can be as high
as 20 per cent. The UK is not in that league: figures for prisoners living
with HIV are comparatively low, although definitely underestimated. Concerns
that UK prisons are sitting on a time bomb of HIV and hepatitis C infections
should shock the UK authorities out of any complacency.
The condition of HIV positive prisoners globally has recently led to a clash
between the US government (anti-condom, anti-clean needles) and UNAIDS (pro-condom,
pro-needle exchange programmes). In the meantime, as our case studies later
in this story show, positive prisoners are
fighting isolation, ignorance and hostility.
The scale of the war
The UK Home Office claims 0.3 per cent of the UK prison population are infected
with HIV and around eight per cent with hepatitis B or C. “The tip of
the iceberg,” claims Glen Fielding, a gay ex-prisoner. He told The Guardian
that while in Littlehey Prison, 32 prisoners were sharing one set of ‘works’
made from a biro and diabetes needle. “Of those 32,” he said,
“four were HIV positive. By the time I left that nick, all 32, the whole
shooting match, had contracted the virus.” Fielding claims that, in
12 months, in two jails, he met “at least two dozen” HIV positive
prisoners who had not disclosed their status to prison staff.
One thing is clear; the Home Office numbers don’t stack up. With around
73,000 prisoners in the UK, 0.3 per cent works out at just over 200 people
with HIV and eight per cent means 6,000 hep B/C prisoners in England and Wales.
The numbers must be higher given a quarter of people living with HIV in the
UK do not know their positive status. Additionally, inside prison stigma and
discrimination are a daily fear, giving prisoners a huge incentive to a) not
be tested or b) choose not to disclose their status.
A 1999 study into hepatitis C in prisons concluded that: “Good research
informs. The British drugs policy in prisons needs academic credibility, not
credulousness or political spin.” In Scotland, the sheer weight of numbers
of blood-borne transmissions has forced prison authorities to react with pragmatic
programmes of prevention. In England and Wales, the most accurate estimate
has to be a platform for prisoner protection. The Northern Ireland Prison
Service claims to have ‘no incidence of HIV’ in its prisons.
The battlefield: equivalency of care
Whether there are one or 1,000 HIV cases in British prisons, one principle
has to apply. In a nutshell, a policy of ‘equivalency’ must apply
to standards of care and treatment within prison equivalent to those accessible
in the wider community. The Prison Service and the Department of Health both
agree with the principle, but in practice there are significant shortfalls.
Namely clean needle exchanges and universal access to condoms.
This year sees the completion of a rolling handover of responsibility of prisoners’
health care from the Home Office to local NHS services. Ironically, while
some observers feel this helps the ‘equivalency of care’ argument,
there are serious doubts about where prisons will fit in with primary care
trust (PCT) funding and priorities. It would be naïve not to acknowledge
that condoms and needles for prisoners are a politically thorny issue. But
it is a thorn that has to be grasped, according to human rights lawyer, Sean
Humber. “For far too long there has been insufficient attention paid
to the standard of care and treatment of prisoners. It’s very much a
forgotten issue of low political priority.”
The National Aids Trust (NAT), working with the Prison Reform Trust, is pushing
the agenda. Their new joint study, HIV and Hep C in UK Prisons: addressing
prisoners’ healthcare needs, out in September,
concludes that current policy and practice fails to meet the needs of prisoners
and to protect them from transmission.The Prison Service’s priorities
are reflected in the response to 156 surveys on positive prisoners’
needs sent out by NAT to prisons across the UK; just 75 were returned.
The condom conundrum
In 1999, Glen Fielding’s long campaign to make condoms available to
jailed men having sex with other men ended in victory at the High Court. Although
a judge ruled that Home Office policy on the distribution of condoms to prisoners
was not “irrational”, he decided that a particular decision not
to supply them to Fielding was wrong. Fielding went on hunger strike to highlight
his campaign and spent time at 27 different prisons during his eight-year
term. In essence, condoms are to be available on prescription and for ‘genuine’
gay men. Many human rights observers are of the view that the current policy
on condom provision interferes with fundamental human rights. The NAT/PRT
study quotes ‘Dan’: “I was rationed to one condom a day.
I was told that if I took the used condom back, to prove it had been used,
they would give me more. But even taking used condoms back didn’t mean
fresh supplies.” Other prisoners report using latex gloves as condoms.
In general, provision of condoms in prisons is patchy, slow and confidentiality
is farcical. Each governor runs their prison as a personal operation and can
make their own interpretation of guidelines. Asked if prison rules on condoms
were under review, a Home Office spokesperson, Debbie Kirby, told us that
guidelines on condoms were being made clearer and more uniformly applied.
“We are on the horns of a dilemma with condoms,” she says. “The
Human Rights Act says it may make us liable, but we are told it is still illegal
to have sex in prison. Obviously, some people will find succour in same-sex
relations. Some governors hand condoms out like Smarties; others are much
more prescriptive.”
In response to a Commons question in July, the Department of Health stated
that they were about to publish guidance on how condoms are dispensed in prisons.
The Terrence Higgins Trust is currently running a lobbying campaign of MPs
to ensure condoms are universally and anonymously available in prisons (see
www.tht.org.uk).
Aside from any consensual sex, coercive sex in prisons may be a significant
source of HIV transmission. In 2004, a survey by The Howard Journal of Criminal
Justice reported that a survey of ex-prisoners found one per cent, around
2,000 men, had experienced forced sex attacks out of the 200,000 who pass
through prison annually. One interviewee in the NAT/PRT study, ‘Tony’,
said: “The first night I was there I was raped by my cell mate; I was
bleeding and in agony. Nobody spoke about rape inside. It wasn’t until
I got out and moved in with my girlfriend that I thought about things. Months
down the line I went for a HIV test. It was positive.”Condoms may not
be the prime barrier to transmission in these cases. Instead, NAT would like
to see the separation of vulnerable inmates from potential aggressors through
cell-matching, increased staffing and supervision (especially at night) and
the protection of inmates who report rape.
A need for needle exchanges
The UK approach to controlling HIV infection among intravenous (IV) drug users
is a success story. The rates compared to many other European countries are
comparatively low. This is largely due to a harm reduction policy which includes
the introduction of needle exchange programmes (NEPs). In fact, HIV infection
rates in this group have actually fallen. The equivalency gap means that in
prisons in England and Wales, NEPs are currently not an option. By contrast,
the Scottish Prison Service is rethinking its approach.The issue of exchanging
old needles for new ones is not an easy option. On the one hand it can appear
to condone and even support drug use. On the other, NEPs work. Study after
study has shown they offer protection against blood-borne viruses. In Spain,
as of 2004, needle exchanges were operating in more than 30 prisons. NEPs
have also been operating in Germany, Moldova and Belarus while Italy, Portugal
and Greece are said to be investigating NEPs. According to the Canadian HIV/Aids
Legal Network, the existing NEPs have been highly effective.But as human rights
lawyer Sean Humber told us: “The Home Office refuses to consider even
a trial of an in-prison NEP.” This policy was recently challenged by
a prisoner, John Shelley, represented by Humber. Shelley claims that the refusal
of the Prison Service represents a real and immediate risk to his life. At
a judicial review in April 2005, a judge refused permission for the case to
continue. The judge cited security concerns and concerns about condoning drug
use. “These are the discussions society had about a decade ago,”
says Humber. “In a sense, the Prison Service weighing in with these
issues is not really relevant. Society generally agreed that NEPs should be
implemented. We don’t really think it’s for the Home Office to
argue the point and come to a different conclusion.” Currently John
Shelley’s solicitors want to go to the Court of Appeal and are seeking
funding from the Legal Services Commission.
Bowing to increased concerns about hep C and HIV, the Prison Service is making
disinfecting tablets available. They are recognising the health benefits of
cleaning injecting equipment and tattoo needles. But the efficacy of these
tablets, particularly in clearing HIV completely from contaminated syringes
is questionable, according to the Journal of Aids (15 Dec, 2001).
New developments in Scotland
Scotland’s approach to blood-borne virus and drugs in prison is undergoing
a transformation. To a certain extent the Scottish Prison Service’s
(SPS) hand was forced by the scale of the drug problem in Scotland; an estimated
80 per cent of offenders are drug users when they enter prison compared to
40 per cent in England and Wales. Fundamentally, the spectre of another Glenochil
outbreak haunts the SPS (see Stephen Kelly interview, opposite). At the end
of 2004, Scottish jails proposed to give heroin injection kits to prisoners.
Inmates would be given clean syringes and swabs on a no-questions-asked basis.
Dr Andrew Fraser, Head of Healthcare for the Scottish Prison Service said
he feared an epidemic of blood-borne viruses would sweep through jails unless
urgent safety measures were taken. Bleaching tablets have been available in
Scotland since 1993.
This year Scottish prison chiefs went a step further and announced they were
to scrap Mandatory Random Drug Tests (MRDTs). “The Scottish Prison Service
did their best to implement what was a political decision,” said Sir
Clive Fairweather, the former Chief Inspector of Prisons. “The drug
problem is getting so huge, it would make more sense to test people to find
out who hadn’t taken drugs. The decision is expected to be formalised
later this year.
Although the decision has produced the ‘lost the war on drugs’
cry, one chief of police said: “We have got to try something new because
the systems that have been tried up to now aren’t working. Drug tests
have pushed drug users in jail to move from the long lasting cannabis to the
hard-to-detect smack.”
The SPS announced that Scotland’s prisoners are to be given free condoms
and dental dams. According to NAT this is one of the most radical changes
to Scottish prison life for decades and recognises the necessity to consider
prisoners’ lives after release.
Even the US wakes up
In the US, the situation appears out of control, to the extent that the highest
adult HIV rates are found in communities where the largest numbers of ex-offenders
live. NEPs and condoms are not available in prisons, based on a moral perspective
rather than a health dynamic. The US Government has even been leaning on UNAIDS
agencies to drop the condom and clean needle approach, threatening to drop
funding of Aids prevention projects that advise such protection. Now though,
California has to act to firefight the epidemic of HIV and hep C in its penitentiaries.
A ‘Condom Distribution Bill’ has just passed the California State
Assembly which will allow public health and non-profit groups to distribute
condoms to inmates. The Bill has yet to pass the State Senate.
In the meantime, people like Mike Kay from Teesside Positive Action and Maria
Hortelao from Positively Women (PW) are going in to prisons to offer support
and information. They continue to give day-to-day counselling to isolated,
scared and sick people despite regimes and policies which will result in additional
caseloads. Mike Kay recently had his funding for a self-help group at HMP
Frankland pulled by the local PCT.
Stephen
Kelly
Stephen Kelly is Scotland’s ‘HIV monster’. Not our words,
but those of the tabloid headlines. In 2001, he was the first person in the
UK to be convicted of ‘recklessly injuring’ his former partner,
Anne Craig, by transmission of HIV. Sentenced then to five years imprisonment,
Stephen Kelly had already had a life of prison and drugs. He was diagnosed
in 1993 as part of the infamous Glenochil outbreak, when at least 13 prisoners
who had shared the same works went on to become HIV positive. Stephen still
maintains his innocence and claims the conviction was “political”.
However, he also has much to say about conditions inside.In their home in
East Kilbride, Stephen sits on the edge of the settee. His wife, Jackie, is
making coffee. She was his nurse in Shotts High Security Prison where they
were married in 2003. Stephen pulls on his cigarette and clears his throat.
What he’s going to say clearly makes him uncomfortable.
Among the photos of the kids in school uniform, Stephen reaches for a folder
and out spill cuttings from the cream of Scotland’s tabloid press: ‘HIV
Monster To Wed Prison Nurse’, ‘Parents Shun HIV Rat’. “I’m
a monster by the way. Can’t you see the bolts in my neck?”
“I’ve been in a lot of prisons. I had some blood tests done at
Glenochil Prison. Then my partner Elizabeth and mother of our two kids died.
The day I buried Lizzie, I didn’t know I was HIV positive but the whole
jail knew before me. When they told me after the funeral, I was walking back
through the hall and they were all standing, laughing, saying, “one
dead and now another one”. They thought Lizzie had died of Aids although
she hadn’t. I just went crazy and started throwing chairs around. I
was 24.
“Inside, we used to go to work at 8.30am in the morning. I’d be
leaning off the bed with my neck hanging down with somebody giving us a hit
and a screw would stick his head in and say, ‘come on, hurry up, Stephen,
you’ve got to go to work’.
“After I was diagnosed I felt OK at first. Then people started to get
sick. One of my pals, he was sick and didn’t tell his family or any
prison staff. We begged him to go to the hospital and ended up talking him
into going. He was smoking a hell of a lot of smack, and when he took his
jumper off, God forgive me for saying this, he was like one of those starving
kids in Africa. He went to hospital on Thursday and died on the Saturday.
A screw came in first thing in the morning, singing, “another one bites
the dust.” There was almost a riot.
“I didn’t have any problems with other inmates. The only stick
I got for it [being HIV positive] was when I got the five years. I was taken
to Edinburgh and had a lot of trouble with that mob. They’d read it
all in the papers. Basically I had to show them I wasn’t going to go
hiding from anybody and I had to protect myself. Sometimes I used the virus
to my advantage. I would cut my hands, get them covered in blood; they’d
soon back off.
“I had to see the consultant handcuffed to a screw. There was nothing
between us; it was very, very cold. There’s no confidentiality whatsoever.
Anything you said would be all over the prison.
“The only visitors were a few guys from Body Positive Scotland. They
gave me money from the hardship fund for the kids.
“I just spent four months back in prison. I sat on a chair 23 hours
a day and that was it. People with the virus can’t afford to do that.
“There’s a real lack of understanding about HIV. Our next door
neighbours won’t let their kids play with our son. They think somehow
HIV is going to jump from me to our kids to their kids. It was in the papers
where we live; we’ve had tyres slashed and God knows how many pizzas
delivered. They wanted us to take our son out of the school because I’m
HIV positive.”
Grant Turnbull
Grant Turnbull has been inside for 25 years. He’s also been diagnosed
HIV positive for 25 years. He was one of the first people in Scotland to be
diagnosed and has been in many prisons in Scotland and, now, England. He is
opinionated, hardened and in HMP Frankland. Scottish newspapers have included
Grant in stories of gang culture in Edinburgh prisons.
“I was taken to hospital following an
accident playing football. Blood tests were done there on a swollen leg. They
eventually started to barrier nurse me.
“I didn’t know what was going on. Then the doctor told me I had
Aids. I remember laughing at him as I thought it only affected gay men. He
said that as I injected drugs this was how I had become infected.
“Most of the medical staff left me without help; when they did come
into the room they were wearing protective outfits. I asked about my wife
and daughter as my wife had only recently given birth. I was told it was a
‘grey area’ and then nothing more. I asked to use the phone but
was told I couldn’t as they only had one and it would have to be destroyed
if I used it.
“The doctor told me that with Aids I had between three to six months
to live. Bearing in mind I had years left on my prison sentence to serve,
I was not likely to get out alive. I was terrified of going back to prison;
Aids was used as a bullying term, now I had it. The governor of the prison
came to see me. He was a Christian and told me I needed to confess my sins
and trust in God and that he would apply to the Home Office for compassionate
parole. I didn’t get it.
“When I got back to prison, officers were in the yard holding a meeting.
The governor told me that the officers were refusing to work with me, so I
would have to be put in the prison’s segregation unit. I was assured
that it would only be for a short time. From that day I barely saw the face
of another human being. At meal times I was ordered to stand facing the rear
wall. I was told if I moved or turned around I would not get fed. I spent
months feeling nothing but anger because of the way I was treated.
“As more people were diagnosed with Aids, I was moved to a viral infection
unit in the prison where we were all kept together. The attitude from staff
was awful in the early years.
“I realised my health was important so applied for rehab and I was off
gear for nearly 13 years. I have had chest infections but nothing too serious.
My T-cell count dropped to 39 but it has improved: I’ve been on 3TC
and nevirapine and others but am now on efavirenz and Combivir. I’ve
got peripheral neuropathy and bad circulation so my legs are f***ed and mobility
is difficult. I also have hep B and C to contend with and although I started
on pegylated interferon, I was forced to stop because of the side effects.”
Attitudes vastly improved “Some staff still have the attitude you found
in the 80s. In the past they’ve told inmates not to share towels with
me, take a draw from my cigarette, or share food, etc. Years ago I was told
not to tell other inmates I was positive as I would be killed. The officers
told me about a previous inmate with Aids whose life was made so miserable
by other inmates he had to be kept at the hospital for protection.“Now
there are very few problems from staff. Comments like ‘get the bargepole’
are hardly ever heard. Healthcare staff here [HMP Frankland] are great and
it makes all the difference. But sometimes it’s hard to access my consultant
and my meds have been missed on a few occasions, even changed. At one point
I even considered suicide but my consultant stood by me and sorted out my
meds.
“HIV and hep C are a bigger problem than you know. I know a lot of lads
with hep and they don’t take precautions as people might suspect them
of having something. Prisons run on fear and people don’t want to make
their lives more difficult.”
(Special thanks to Mike Kay of Teesside Positive Action for interviewing Grant)
Clare
One of the first things you notice about Clare is her voice. She’s softly
spoken, slightly hesitant but is dead straight in what she says. Sitting in
the coffee lounge at Positively Women, 30-year-old Clare looks composed, yet
there is a wariness of where her words might lead.
“I was remanded into Holloway on drugs-related charges in April 2003.
I had been an active drug user for a number of years before that. I had tried
to get clean a year before and had tested negative for HIV. I guess being
out of the chaos and madness of when I was using, after a month I thought,
‘I’ll go get a full health check-up’.
“I don’t remember much of the first six to eight weeks of detox.
The health adviser had counselled me before the tests, but to be honest I
don’t know how much I took in.
“Afterwards I went up to the remand wing, where I received the diagnosis.
The health adviser said: “We’ve had all your results back and
I am pleased to tell you that all the regular ones are negative… but
I’m afraid you are HIV positive.” I guess there is no easy way
of telling anyone, you can’t dress it up. It wasn’t done in a
harsh way, but I was absolutely smashed to bits.
“I remember going back up to my cell and sitting on the window sill,
thinking ‘Why me?’ ‘Why now?’ The first thing coming
into my mind was I’m not going to be able to have children. I now know
different.
“The support I got from the health adviser was brilliant, I saw her
the whole time I was in there, two to three times a week. I never needed treatment
then and I’m still not on any now. As painful as it was to be in prison,
if I had been outside it would have been just an excuse to go and use.
“Although there was literature available at the health centre, it was
about four months before I actually plucked up the courage to take anything
back to my cell, because they get searched. My big fear was that other people
would find out. I disclosed to one nurse, and she was very nice, but you hear
stories of even the nurses mistreating the inmates. There is a lot of self-harming
in prison, and if women are rumoured to be positive, they can be treated inhumanely.
“This is where Positively Women (PW) came in. Maria Hortelao, PW’s
drugs and prison case worker, visited me. PW come in and see women who are
either diagnosed in prison or are positive before they go in and give them
real support. For me it was an absolute life-line.
“I was remanded for six months in total and after court I was given
a drug treatment testing order and had to go into rehab.
I didn’t want to think or talk about it. I just kicked into complete
denial.”
Giving something back
“I came out of prison in 2003. I first went to PW when I got out and
Maria suggested I volunteer. I hadn’t a clue what I wanted to do, but
I guess part of me wanted to turn this whole experience around, for myself
and for other people. I’ve been at PW now for a year. I’d like
to go back into prisons and provide a service like the one that I was given.
“I haven’t worked for eight years and I now have a criminal record.
Being part of the traineeship at PW has really helped my self-esteem and helped
me to acknowledge my own needs and those of other positive women coming out
of prison. Some have never worked or had the chance to get the basic skills
for employment.
“We have launched our Equal Project (see page 28) as well as some creative
stuff; it could be photography or art. It basically involves three steps;
health, training and employment. For women with no skills it’s a chance
to turn things around. As part of our traineeship we’ve had Sarah Lang-Jones
from the UKC come in to talk about issues of self-esteem, CV writing and job
prospects. One of my worries was how am I going to cope with that eight year
gap. How do I approach future employers; what if they ask me about a criminal
record? I feel a lot less intimidated now.
“I’ve spent the last year at PW working towards something I feel
very strongly about. I’ve come a long way and want to help make that
difference to other people’s lives.”
