Abuse and exploitation

Prisoners are five times more likely to be living with HIV than adults in the general community, with women facing the highest risk.

21 October 2019 | Local News

When participants, the majority of whom work in prisons, were asked to choose one word to describe female inmates at the start of a workshop last week in Windhoek, words like vulnerable, victims, special, problem, surprised, minority, neglected, daughters, poverty, attention-seekers and sadness were bandied around.

The issue of sub-par healthcare in prisons and the need for gender-specific services for women behind bars was the focus of a workshop for prison officials and other stakeholders from ten sub-Saharan countries.

Hosted by the United Nations Office on Drugs and Crime (UNODC), the three-day workshop to address HIV and sexual and reproductive health and rights (SRHR) in prison settings was geared to equip prison officials and policymakers with the knowledge and tools to improve the care and ensure the rights of women inmates.

Topics included the importance of integrated access to care and treatment, and minimum standards according to international guidelines, gender-based violence within a cultural and prison context, barriers to seeking help, rights and responsibilities of prison staff, pregnancy and postnatal care and a variety of other issues.

While Namibian prisons are populated by only a handful of women, 147, compared to roughly 4 000 male prisoners, women are particularly vulnerable to the risk of contracting HIV and other health challenges in prison.

“Women are highly susceptible to infection with HIV and other sexually transmitted infections in prison as they often come from socially marginalised groups and are vulnerable to sexual abuse and exploitation in the prison environment,” states a UNODC baseline assessment released this August on regional country HIV/AIDS and SRHR minimum standard compliance in prisons.

While HIV and TB are the main cause of death in prisons globally, and prisoners are five times more likely to be living with HIV than adults in the general community, women face the highest risk.

In Lesotho, HIV among men in prison stands at 31%, while for women the rate is close to 70%, showing the stark health challenges women in prison face.

One of the training facilitators, social scientist Heino Stöver, highlighted that for centuries, prison operations have been designed through the “eyes of men”.

He said the situation of females in prison has been “deeply” neglected, but “that is quite a mistake”.

As a result, the services designed for prisons did not take into account the special needs of women and were largely designed to cater for male needs, especially in regards to health rights, which differ substantially from those of women.

The UNODC study found that although progress has been made in several counties in the sub-Saharan region to improve health conditions in prisons, little has been done to specifically address the health needs and rights for women and juveniles behind bars.

The researchers say many prisons in the region “struggle to provide even the most basic healthcare services for people in prison”, and that few promote access to the “highest attainable standard” of physical and mental health and adhere to minimum standards of SRHR requirements as per international conventions and instruments.


Among the 10 countries surveyed for the study, Namibia was the only country with national policies and strategies for sexual reproductive health in place that include prison populations, and the only country where overcrowding was not an issue.

Moreover, only Namibia and South Africa have sexual reproductive health prison policies in place, while Namibia, Angola and South Africa are the only countries in which health facilities are adequate to provide basic medical care, as well as HIV and SRH services.

Namibia and Angola are the only countries that provide in-house maternal, newborn and child healthcare.

The study warns that where available, healthcare facilities in prisons are characterised by shortages of staff, medicines, equipment, poor health education and training, and poor linkage with public health care for services, monitoring and evaluation.

Namibian Correctional Service commissioner-general Raphael Hamunyela on Tuesday underlined that the issue of HIV and SRHR has become central to contemporary prison services and institutions.

He said the correctional services in Namibia focused on enhancing services for offenders, including women, living with HIV and are focusing on strengthening SRHR for offenders.

As part of this goal, programmes on these issues are being rolled out across the country.

“We must acknowledge that HIV and SRHR are issues that should be integrated into our policies, plans and operations, hence the importance of this training.”


Signe Rotberga, the regional UNODC HIV advisor, said a number of gaps in providing adequate SRHR and HIV health services to women have been identified and are addressed in the training.

Among the notable gaps are a lack of policy and legal frameworks, overcrowding in prisons, and insufficient human rights training and awareness of SRHR by prison officials.

One of the ways to address overcrowding, as well as the increased risks of inmates, apart from improving health services, is to review who is sent to prison and for how long.

Many prisoners, notably women, continue to serve sentences for petty or non-violent crimes, and advocates are pushing for alternatives to custodial sentences.

The study concluded that while prison services across the region have laws mandating human rights including equability of healthcare for inmates, in practice, substandard environmental conditions, sanitation, hygiene, supplies and healthcare prevent the realisation of the right of people in prison to the highest attainable standard of physical and mental health.


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