With their overcrowded cells, filthy environment, and rampant multi-partner sex, Haiti’s prisons are ideal settings for the spread of tuberculosis (TB) and HIV/AIDS. Neither the penitentiary administration nor the Haitian Ministry of Health have statistics on how many inmates are infected with HIV/AIDS and/or TB. Inmates are not screened upon admission in the prisons and their condition is discovered only when they become very ill.
In the second half of 2008, among the 71 prisoners from the National Prison in Port-au-Prince screened for pulmonary problems at the largest TB center in the country, 13 were hospitalized due to the seriousness of their case. In 2001, the Haitian Red Cross reported that, among the deaths registered in the detention centers in Haiti, 19 percent were related to some kind of pulmonary diseases.
In Haiti, 30 percent of TB cases are related to HIV. Reports indicate that Haiti has the highest rate of HIV/AIDS among the Caribbean countries. According to Dr. Gabriel Timothee, Haiti General Director of the Ministry of Health, in 2006 Haiti had a rate of 2.2 percent HIV/AIDS in a population of 9.5 million. However, as reported by Dr. Joelle Daes, Coordinator of Fight Against TB and HIV/AIDS, there is “no program in place to care for the prisoners who are living with HIV/AIDS.” But recently, efforts are being undertaken by stakeholders like 'Gheskio', 'Health Through Wall' and 'Minustha' to bring some reliefs to the inmates.
The few prisons with a dispensary are ill-equipped and understaffed. For example, in December 2008, the National Prison in Port-au-Prince had 22 beds for 34 patients. That same prison has two doctors and two nurses for more than 2,000 inmates.
The National Prison in Port-au-Prince is filled to almost nine times capacity with 3,600 prisoners. An inmate in Haiti lives in an average space of eight sq feet in comparison to the international norm of 48 sq feet. Prisoners also have prolonged exposure to an environment where illegal drug use and sexual activities, although forbidden, are common. Although sex is not discussed by either inmates or penitential authorities, some admit the existence of sex between men, voluntary or forced. There is needle sharing and condoms are unavailable. According to Dr. Jean Pierre Elie, Assistant Medical Director, ‘’homosexuality is present in Haiti’s prisons, although it is ignored by the authorities and despite penitentiary rules against sexual relations. There has been no policy in place for distribution of preventive devices’’.
A former inmate confirms: “It happened before my own eyes… I saw men doing pernicious acts. The authorities know about it, but they do nothing to prevent it’’.
Eighty to ninety percent of inmates are illiterate, poorly educated and/or socio-economically disadvantaged. They, therefore, bring with them into prison an increased risk of ill health, including a high risk of tuberculosis infection and disease.
Inside the prison is an atmosphere of violence and fear where the stronger inmates constantly threaten and often abuse the others. The inmates who are suspected of being HIV/AIDS and/or TB infected are accused of infecting the others and tend to receive harsher treatment both from other inmates and the personnel. The period of detention is unpredictable, as prolonged detention is usually the norm, but those who are released may be going back to their community while carrying illnesses such as TB and/or HIV.
