Building a caring correctional system that truly belongs to all PRESENTATION TO THE PORTFOLIO COMMITTEE ON CORRECTIONAL SERVICES: DEPARTMENT OF CORRECTIONAL SERVICES HIV and AIDS POLICY FOR OFFENDERS 06 SEPTEMBER 2005

Index  Purpose  Introduction  Mandates  Background  Policy Statement  Policy Objectives  Policy Principles

Index (Cont..2)  Implementation of HIV and AIDS Programmes and Services  Partnerships  Role of personnel in Correctional Centers  Achievements  Challenges to implement HIV and AIDS Programmes and Services  Conclusion

PURPOSE TO BRIEF THE PORTFOLIO COMMITTEE ON CORRECTIONAL SERVICES ON THE HIV AND AIDS POLICY FOR OFFENDERS

Introduction  The management of HIV and AIDS in Correctional Centres is aligned to the White Paper on Corrections and the Correctional Services Act, Act 111 of 1998  The development and implementation of HIV and AIDS Programmes was based on the National Department of Health’s guidelines, policies and protocols, i.e. Five Year Strategic Plan: for South Africa,.  South Africa is facing a number of challenges in managing HIV and AIDS in societies

Introduction (Cont..2)  Correctional Services is a microcosm of the society and inevitably shares some of the challenges in managing HIV and AIDS  The provision of effective health education, maintaining confidentiality and health standards in already overpopulated correctional facilities, carry their own particular difficulties.

Mandates   CONSTITUTION OF THE REPUBLIC OF SOUTH AFRICA. (ACT 108 OF 1996)   CORRECTIONAL SERVICES ACT (ACT 111 OF 1998) AS AMENDED.   WHITE PAPER ON CORRECTIONS.   WORLD HEALTH ORGANISATION’S GUIDELINES ON HIV INFECTION AND AIDS IN PRISONS   U.N. STANDARD MINIMUM RULES ON TREATMENT OF PRISONERS.   OTHER APPLICABLE NATIONAL AND INTERNATIONAL LEGISLATION REGULATING THE MANAGEMENT OF HIV AND AIDS IN CORRECTIONAL CENTRES

Background  In October 2002, the former Minister of Correctional Services, approved the Management Strategy (Policy) on HIV and AIDS in the Department of Correctional Services in the Department of Correctional Services  During the restructuring process in 2003/2004, the HIV and AIDS Program for employees and offenders were separated AIDS Program for employees and offenders were separated  In line with the developments within the Department, the approved Policy on the Management of HIV and AIDS was approved Policy on the Management of HIV and AIDS was also separated also separated

Background (Cont..2)  The Policy on the Management of HIV and AIDS for offenders was formatted to the new policy format and it has also been aligned to the White Paper on Corrections  The Policy is currently in the process of being reviewed, so as to ensure that fundamental changes in government’s approach to treatment, care and support is included

Policy Statement The Department commits itself to implement efficient and effective programmes and services in Correctional Centers directed at;  Prevention of new infections  Care and support to all infected and affected offenders  Holistic treatment of opportunistic infections as well as the provision of antiretroviral therapy to offenders who are eligible  Protecting the human rights of offenders who are either infected or affected by HIV and AIDS

Policy Objectives  Prevent the spread of HIV and other related infections amongst offenders  Provide care and support to offenders who are either infected or affected by HIV and AIDS  Provide treatment to offenders afflicted with any illness associated with HIV and AIDS  Conduct and / or facilitate research on HIV and AIDS issues

Policy Objectives (Cont..2)  Capacitate offenders to cope with the effects of the epidemic and disseminate knowledge or assistance to fellow offenders and communities  Capacitate personnel rendering services to offenders  Monitor trends of the epidemic relevant to Correctional Centers  Establish partnerships to implement

Policy Principles Policy Principles   Confidentiality, respect, sensitivity and kindness in dealing with HIV and AIDS related issues   Integration of HIV and AIDS related matters in all policies, strategies and activities of the Department   Commitment of the Department to create a non- discriminatory, non-stigmatized and supportive environment to all infected and affected offenders   No compulsory testing of offenders to determine their HIV status

Policy Principles (Cont..2)   The principles of universal precautionary measures to apply in all Correctional Centers at all times   Rights of offenders to be promoted and protected   Post exposure prophylaxis to be made available to all offenders who are at risk of HIV infection or in contact situations such as gang related violence or other injuries

Implementation of HIV and AIDS Programmes and Services  PREVENTION:  Awareness sessions conducted on a regular basis  Syndromic management of sexually transmitted infections, tuberculosis and HIV and AIDS related opportunistic infections tuberculosis and HIV and AIDS related opportunistic infections  Condom promotion on a continuous basis  Promotion of voluntary counseling and testing  Facilitation of access to prevention of mother to child  transmission (PMTCT) services  Participation in special commemoration days, i.e. World AIDS Day, Candle Light Memorial, etc. Candle Light Memorial, etc.  Procurement of educational videos and posters

Implementation of HIV and AIDS Programmes and Services (Cont..2)  CARE AND SUPPORT : -Provision of on-going therapeutic counseling and support services -Encouraging the establishment of support groups for both infected and affected offenders -Recommendation for placement of terminally ill on medical parole -Provision of Correctional Centre Based Care -Referring terminally ill patients to hospices and care centers in community after release

Implementation of HIV and AIDS Programmes and Services (Cont..3) Implementation of HIV and AIDS Programmes and Services (Cont..3)  TREATMENT: - Symptomatic and prophylactic treatment of opportunistic infections -Ensure implementation of the Comprehensive Treatment, Care and Support Plan of Department of Health -Developed an action plan to ensure access to antiretroviral therapy -Distributed National Department of Health’s guidelines for antiretroviral therapy -Continuous monitoring of the implementation of the antiretroviral therapy roll-out to ensure that the Department is included in the implementation in provinces

Implementation of HIV and AIDS Programmes and Services (Cont..4) Implementation of HIV and AIDS Programmes and Services (Cont..4)  HIV PREVALENCE SURVEY: -Approval granted to conduct a prevalence survey among staff and offenders -Purpose is to determine the prevalence of HIV in the Correctional Centers -Survey to be finalize in the current financial year -Internal as well as external stakeholders are involved in the task team -Steering committee established to provide strategic guidance and to oversee the process -Service providers have been invited through tenders -Actual process of undertaking the survey will unfold towards October / November 2005

Implementation of HIV and AIDS Programmes and Services (Cont..5)  CAPACITY BUILDING: -Training of Master Peer Educators to sustain the current peer education program -Training of health care workers in the comprehensive management of HIV and AIDS related diseases as well as the comprehensive treatment plan for antiretroviral therapy -Training of health care workers in the rapid test kits, to enhance access to voluntary counseling and testing -Attendance of workshops, conferences and seminars presented by national and international organizations and other government departments -Capacity building work sessions in all Regions to strengthen policy implementation

PARTNERSHIPS  The Department has forged partnerships with a number of Community Based Organizations, Non-Governmental Organizations and Faith Based Organization for the following services: - Capacity building - Capacity building - Care and support - Care and support - Treatment - Treatment - Counseling - Counseling - Life skills - Life skills  The Department is in an ongoing process of endorsing programmes and services of all external service providers.  National, Regional and Management Area Quality Assurance Committees have been established to facilitate the endorsement of programmes and services

ROLE OF PERSONNEL IN CORRECTIONAL CENTERS  Serve as nodal points for information dissemination on HIV and AIDS  Participate in prevention and awareness activities, i.e. World AIDS Day, Candle Light memorial, etc.  Encourage offenders to refrain from behaviour that will put them at risk for HIV infection  Create a caring and supportive environment for those offenders who are HIV positive or terminally ill with AIDS  Advocate for a non-discriminatory and non-stigmatizing environment which will allow those infected and affected to live a qualitative life  Vigorously participate in educational programmes aimed at reducing the spread of HIV infection in the Department and promote compliance with the necessary legislation and procedures to ensure effective implementation of HIV and AIDS activities

Achievements   Establishment of the Directorate: HIV/AIDS at National level and coordinators at Regional level   Development and approval of a Compliance Framework, Monitoring and Evaluation Tool, Baseline survey Framework, Policy Implementation Plan Framework and Comprehensive HIV and AIDS Programme for offenders   Approval of the Post Exposure Prophylaxis Protocol/Guidelines   Approval of the Correctional Center Based Care Policy   Donor funding received from Presidential Emergency Plan for AIDS Relief (PEPFAR) to the amount of $ (R 3,6 million)

Challenges to implement HIV and AIDS Programmes and Services  Increasing number of known HIV and AIDS cases, HIV related opportunistic infections and co-infection of tuberculoses and HIV and AIDS  Increasing number of TB multi-drug resistance cases and difficulty in ensuring Directly Observed Treatment Short course (DOTS) due to overcrowding and a lack of staff  Provisioning of antiretroviral therapy to offenders who qualify to be on treatment  Ongoing adherence to treatment requirements after release

Challenges to implement HIV and AIDS Programmes and Services (Cont..2)  Impact of HIV and AIDS on resources within the Department e.g. Human and Financial resources, etc. - Increasing need for 24 hour in-patient facilities to - Increasing need for 24 hour in-patient facilities to render palliative care for the terminally ill offenders render palliative care for the terminally ill offenders - Facilities are designed for security purposes and the - Facilities are designed for security purposes and the undertaking of activities are sometimes difficult undertaking of activities are sometimes difficult - Increasing need for more funds - Increasing need for more funds - Increasing need for more personnel to render 24 - Increasing need for more personnel to render 24 hour health care. hour health care.

Challenges to implement HIV and AIDS Programmes and Services (cont..3)  Increased risk of exposure to staff and offenders due to gang related violence, use of contaminated instruments for skin piercing and sexual assaults  Accreditation of Correctional Centers to provide antiretroviral therapy  Overcome stigma and discrimination upon disclosure

CONCLUSION  The Department of Correctional Services is committed to ensure that HIV and AIDS is being prioritized  The Department will continue to rely to a greater extent on the already established partnerships in the fight against HIV and AIDS

Building a caring correctional system that trully belongs to all Thank you Together we can…