A life-saving programme for prisoners with HIV

Indeed, it can be tricky for prisoners to just get their blood tested and see if they have the deadly virus. Given the inability of authorities to stop prisoners from having sex and taking intravenous drugs, there is obviously a high risk of those with HIV passing the virus on.

In 2003, Médecins Sans Frontières, or "Doctors Without Borders", started a pilot project in three jails in and around Bangkok to provide cheap anti-retroviral drugs (ARVs), and educate health workers, guards and the prisoners themselves about the disease.

The project was undertaken at the Bang Kwang, Min Buri and Pathum Thani prisons.

I visited the medium-security Min Buri prison late last year to review the MSF project, which has now come to an end. Judging by the feedback from prisoners, guards, health staff and the prison director, the project has been a godsend for the hundreds of inmates.

One prisoner, named Jeap, freely admitted that she would probably be dead if it were not for the MSF programme providing her with the ARV drugs. The petite 44-year-old with a self-deprecating sense of humour has had HIV for more than two decades.

Jeap said she worked as a maid in Bangkok. Her husband was a drug user and she too got hooked on heroin in her late 20s. She used to crave the drug and felt powerless to fight it. Now she realises that her survival was unusual. Most of her friends from that time are dead from overdoses or HIV.

"I'm the only one left," she said. "I came here [to Min Buri jail] four years ago from another prison where there was no counselling or information [about HIV]. I was unable to get a blood test. But here I have got treatment and training.

"We have a group activity for those with HIV. I have been on the [anti-retroviral] drugs for three years. They have really made an impact on my health. My weight has increased from 41 to 54 kilograms."

Health workers at the jail are very good, said Jeap, who is looking forward to being released in 11 months.

Talking to younger prisoners with HIV, one begins to realise that Thailand's education system and public awareness about the disease is not at the level it should be.

How many young Thais - particularly those from poor families - are ignorant of the intimate details about how the virus is spread and what needs to be done to avoid it? One can't help thinking they number in the millions. In an era of increasing promiscuity, knowledge about the transmission of HIV seems incredibly important. If there is one lesson children need to have drummed into them at school it is about HIV/Aids, simply because it would save lives. It is unsettling to find young people whose parents either don't recognise this a major threat to their child's future, or who don't have the knowledge to pass this information on to their children.

Meanwhile, MSF's HIV project coordinator, Verapun Ngammee, said the mindset of officials had changed dramatically since the programme was launched. "At the beginning, some guards had a bad attitude in regard to condoms being given out [to prisoners]. We had to sit down and discuss it. We said if they could guarantee there would be no sex we wouldn't need to give them out. Then they realised they could not stop prisoners having sex. So, now, it's better."

In Bang Kwang, where there are about 6,400 prisoners, the initial problem was prisoners' scepticism about why outsiders wanted to help people locked up. But, he said, there were now 89 prisoners involved in their programme, with 60 on ARV drugs.

"There is very good adherence at Bang Kwang," he said.

Min Buri jail director Kongkrit Pornkongtwatch said he was sad the MSF project had ended and feared HIV would continue spreading. "It has made a lot of improvements, as we can't even afford a full-time doctor here. If prisoners get infected, there is no way to protect other inmates.

"Staff in other jails need to be trained too. This is a good model for other prisons, but that is a policy decision for the Department of Corrections."

Kongkrit said Thais looked down on criminals, "but if we give them a chance, they can do many other things".

The big question is simple. Will the Department of Corrections adopt the curriculum developed by MSF on treatment for prisoners with HIV and replicate this highly effective project in all Thai prisons?

Let's hope common sense prevails.