AIDS Blamed for Mounting Death Toll in South African Prisons

South Africa's prisons have become a breeding ground for HIV, and prisoners now represent one of the hardest-hit segments of a country plagued by the disease. South African prisoners, crammed into cells, share mattresses, tattoo needles and dirty razors. Diseases associated with AIDS -- tuberculosis, for instance -- flourish in the packed and poorly vented cells. Other STDs, which feed the spread of HIV, are rampant. With weaker immune systems, prisoners are more contagious and less resistant to the virus. Those already infected fall ill and die more quickly once in prison.

Between 1995 and 2001, deaths surged more than 500 percent in prisons, and AIDS is widely held responsible, according to Johannes Fagan, a judge in charge of monitoring prison conditions in South Africa. More than 1,000 of the country's 179,000 inmates died in prison last year. That number could soar to 45,000 a year by 2011 unless drastic steps are taken to improve conditions, health care and AIDS education, Fagan said.

Roughly 41 percent of all inmates have HIV, far above the 20 percent adult infection rate nationwide, said K.C. Goyer, who researched prisons for the South African Institute for Security Studies. A more precise figure is not obtainable, because the government does not force prisoners to take AIDS tests. Although free testing is available, most prisoners -- fearing the stigma attached to the disease -- remain unwilling to get tested.

Thousands of prisoners are raped amid the lowered security from overcrowding -- more than 60 inmates commonly share a cell designed for 12. And consensual sex is often unprotected because prisoners rarely have immediate and private access to condoms. Prisoners, like all other South Africans, do not have access to AIDS medications through the public health system. Goyer called the government's handling of prisons a lost opportunity to reach a vulnerable population and combat the disease's spread nationwide. "Prison health is public health," he said. "Inmates should leave prison cured of [STDs], with a handful of tuberculosis pills in one hand and a pack of condoms in the other. Imagine the impact it would have on public health."

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