Stone walls do not a prison make

Imagine, for a moment, being an inmate in an East African jail. Imagine the crammed cells, the ever-present threat of violence, the poor sanitation, the smell, the toil, the sweat and the shame. Imagine on top of everything else living with HIV, facing daily discrimination and isolation, being sick, in pain, confined, in fear of death. Imagine enduring that for just one day. Then think about facing that for a ‘10-stretch’, or 15, or 20 years or even every day for the rest of your life.

Now, imagine a tiny seed of hope - how quickly you would run to grasp it, how dearly you would cling to it.

For hundreds of prisoners – men and women – living with HIV in Kenyan and Tanzanian jails, Mildmay International has been able to provide that hope. Through the Boresha project – funded by the European Union and launched in 2010 – Mildmay has worked closely with prisoners, prison officers, administrators and national prison services to set up and support initiatives which seek to break down stigma, reduce discrimination, improve basic healthcare, and empower people to know and defend their rights, take care of themselves and each other, and speak out for the vulnerable and marginalised.

Boresha is a Swahili word meaning ‘to make better’. Here are some stories and testimony which show that Mildmay is achieving that simple goal, and a whole lot more.

KIBOS PRISON

‘The death rate has greatly reduced’

At Kibos Prison, just out Kisumu, Kenya, prison officer Corporal George Agwanda is the coordinator of the work to raise awareness of HIV and the standards of care for those living positively. He is Mildmay’s contact on the inside.

George explains: “Since the Mildmay programme started we have greatly benefitted. Inmates have been trained in home-based care and they are now coping a lot better, are able to access better care and support each other.

“We don’t have any inmates admitted in the ward with HIV and the death rate has reduced greatly since the programme began. We still have a way to go – we need more training. Mildmay has worked beyond the call of duty.”

‘The support group assisted me greatly’

Joe Wabuti is a prisoner at Kibos.

“Before I found out my status, I was very sick. A month could not go by without me being admitted to the prison hospital or receiving outpatient treatment. Early last year, I fell seriously ill – I couldn’t look after myself as I had no strength. I had no appetite and I had developed oral thrush and serious diarrhea. Within a short time, I was in a coma and was rushed to the district hospital – that’s where I was diagnosed HIV-positive. Eventually, I was brought back to Kibos prison for nursing.

“When the support group members discovered I was HIV-positive and had been put on ARVs they chipped in and assisted me greatly. They advised me on drug adherence, they also advised me on the importance of good nutrition and made sure I accessed it despite being in prison.

“The home-based carers here at Kibos, trained by Mildmay International through the Boresha project, have improved my health. If there were no carers, no support group, I would not be in this healthy state and I ask Mildmay to continue supporting us – for any good you do on earth is counted as a blessing in heaven.”

‘The monster HIV is under check and arrest at Kibos.’

John Mbuya is another member of the support group.

“Through the Boresha project we are not afraid to say that we indeed stand tall in the fight against HIV.

“With the coming of the European Union in partnership with Mildmay through the Boresha project we have made so many outstanding achievements already:

-       Education and seminars on HIV in collaboration with the Ministry of Health and Kenya Prisons Service

-       Members are now trainer-of-trainers in HBC, ART adherence, opportunistic infections and public speaking

-       Invaluable expertise has been shared with this whole community and has been used to preach the gospel of good nutrition, proper hygiene, recreational activities and psychosocial support

“To an extent we can today declare that the monster HIV is under check and arrest at Kibos.

“Of course, we still have defaults [of treatment] and denials. Irresponsible sexual engagements, even to a smaller degree, are with us though we try to consistently advise against them.”

Three weddings, two funerals (and a happy ending)

Work with inmates is only one aspect of the prison element of the Boresha project. Great advances have also been made among officers, a group within which it has traditionally been very difficult to disclose a HIV-positive diagnosis.

Andrew Ogendo is an officer of the Kenya Prisons Service working at Kibos Main Prison not far from Kisumu. He is also HIV-positive. Today he is living openly and in good health. But it wasn’t always like that. Andrew’s life was filled with tragedy and turmoil until he joined the Kibos Prison Officers Living with HIV Support Group, a project supported by Mildmay as part of the EU-funded Boresha project.

Through an interpreter, Andrew told his remarkable story.

“It was my wife who fell sick first. The doctors confirmed she had TB. She was advised to go for an HIV test – and she was positive. At that time I was also encouraged to go for a test, but I failed to attend because I was afraid of the results and what that would mean for my job as a prison officer. I left my wife and, because I am a polygamist, I got married again.

“I had sex with my second wife without a condom and she eventually fell pregnant. It was mandatory for her to be tested during pregnancy. She tested positive too, but I still wouldn’t go for that test.

“I finally got up the courage and went to be tested and, of course, I was infected. I began receiving care and then I was put on ARVs. The treatment was working and I was relieved. I had lost all of my energy and even my libido. Unfortunately, at this time my second wife ran away from me and went back to her home village. She had been on drugs, but I had realised she had stopped taking them. I heard that she had started going downhill. Then, I heard that she had died.

“But before that I had taken another wife. Even with this third wife I was having sex without a condom. Fortunately for her she was negative when she was tested. She had conceived and she was negative.

“Then I joined the Living with HIV Support Group here at Kibos. For the first time, there were others around me who were like me. I received a lot of information and advice about HIV. Now I’m okay. My third wife and I are living happily, and safely, as a discordant couple. I’m lucky I still have her.

“It is because of Mildmay, and their support of this group, that I was alive. If Mildmay had had no involvement most of us would have been dead by now.”

‘We are progressing, not regressing.’

Mary Wakenga is a Mildmay field officer and trainer working in several Kenyan prisons. In such high esteem is she held she is known as Mother Mary by prisoners and officers alike wherever she goes. She has overseen the training hundreds of prisoners and officers, and seen many support groups established, since Mildmay began working in jails in 2007.

She said: “Andrew Otengo’s story is in some ways hard to take – but it certainly shows that we are progressing, not regressing. His story will help other prison officers. He has learnt from his experiences and hopefully, with the support of this group, he will stay alive for a long time.”

“We have a good partnership with the prisoners and the officers at Kibos and at other prisons. They have seen improvement and they know and feel that we are with them. They know that there is someone who cares.”

A healthy community, less stigma and actively preventing the spread of HIV

The Kibos Prison Officers Living with HIV Support Group, is one of several groups set up and supported by Mildmay for prison staff in Kenya and Tanzania.

It was established in November 2010 by just two HIV-positive officers who received training in home-based care from a Mildmay International team. When they returned from this training they saw a need to start a support group for officers infected and affected by HIV and their family members. The group soon increased to five members, then nine and 11. Now there 15, many of whom are HIV widows or widowers.

The group holds weekly meetings for officers offering psychosocial support, mentorship, and HIV drug adherence support. It also:

-       Encourages disclosure of HIV status among officers

-       Works towards ensuring a healthy community

-       Provides health education to transform HIV and AIDS care within the prison

-       Carries out HIV prevention work with officers living positively

-       Aims to reduce HIV stigma in the workplace

-       Meets with prison bosses to talk through issues affecting HIV-positive officers

-       Advocates for the rights of officers living with HIV

The group’s leaders meet with Mildmay every month to received ongoing support and report progress.

Isaiah Otieno Odera, chair of the support group, said: “Our mantra is to train, treat and retain. We have many beneficiaries beyond the group itself too. We have managed to give confidence, information and education on HIV to staff at morning parade, to family members leaving church services, to young people at the prison playgrounds.”

KODIAGA PRISON

‘There were two patients to a bed when we started, now the beds are empty.’

Kodiaga prison, also near the lakeside city of Kisumu, Kenya, has a community of 3000 – including 2000 prisoners and 500 officers. 240 prisoners with HIV. The HIV prevalence is now around 12 per cent, having fallen from about 30 per cent (according to some reports) when Mildmay began working there.

There are several HIV support groups set up at Kodiaga through the Boresha project, and a culture of home-based care established under Mildmay’s USAID-backed home-based care programme and now supported by the EU-funded project.

Officers and prisoners are in a support group together – Kompesu (Kodiaga Men Prison Support Group). There is a support group for lifers - Gates of Hope – made up of 60 inmates serving the longest sentences and also a separate group for officers.

Some inmates who are support group members have been trained by Mildmay in home-based care – wound dressing, bed baths, feeding, HIV drug adherence support - and work in the prison clinic as volunteers.

Peter and David are two of these volunteers. “We can wash them and provide them with food,” said Peter, taking time out from a shift on one of the wards. “It is very satisfying work and we develop many friendships.”

‘We work with the inmates as brothers and sisters’

Senior sergeant Francis Odongo, a prison officer and HIV supervisor at Kodiaga said:

“There used to be two patients per bed when we started, now the beds are empty.”

“As officers we work with the inmates as brothers and sisters. They need our support and we need theirs.”

View from the top

Assistant Commissioner Prisons, Francis Kemei, the officer in charge of Kodiaga’s prisons, said: “The work of Mildmay in the prison is very important and very valuable. Mildmay offers hope to those living with HIV. Mildmay is training the officers and the inmates themselves. Stigma has reduced a great deal. Their lives have improved.”

KAMITI PRISON

Kamiti is Kenya’s largest men’s prison and is located near the capital city Nairobi.

As part of the Boresha project there is a support group with 60 members. 20 of those members have been trained by Mildmay as community health workers (CHWs).

‘Nothing to fear’

Dr David Odongo is the chief medical officer at Kamiti.

“Our work with patients living with HIV is now much simpler. When we go home we are confident that these trained CHWs among the prisoners can carry out basic care.

“The level of disclosing has dramatically increased as a result of the work of Mildmay with the support group. Because of Mildmay these prisoners are now able to speak out. They have come out together. They have been told that there is really nothing to fear.”

Prisoners are well-versed with community health needs

Patrick. M. Wandikra is a prisoner at Kamiti six years into a 25 year sentence (“If I’m lucky, I might be let out in 18 with good behaviour.”). He is leading member of the prisoners support group.

“We are a group of 20 members well-versed with community health needs after the training we received from Mildmay international over two weeks in August 2010. We were trained how to handle members of our community and care for them especially on matters relating to nutrition, drug adherence, opportunistic infections.”

LANGATA PRISON

‘They do not feel alone’

Prison officer Corporal Margaret Kiarie is in charge of AIDS control unit at Langata, Kenya’s largest women’s prison, also near Nairobi. The unit oversees voluntary counselling and testing of prisoners and officers, HIV training and education and prevention with positives.

Lanata’s support group, established in 2010 through Mildmay’s Boresha project, has 63 members.

“They come and encourage one another,” said Margaret. “If one is feeling low they pick her up, they come and they share. Great friendships have developed in this support group. When they are supported by others who have gone through the same thing they are encouraged. They do not feel alone.

“They learn how to live positively. They care for each other because they are in the same situation. There used to be so much stigma, but since the support group started they have been encouraged.”

Front line carers

Edith is a prison officer at Langata who was trained in HBC by Mildmay in 2010 as part of Boresha. She works with Margaret within the AIDS control unit.

“We are the front line carers. I have got a lot of new skills and with these skills I’ve been able to do more and more. These skills have been a great help. I am now able to deliver the right care, in the right way. We as HBC trainees can then train prisoners and other officers as CHWs.

“We have no more bedridden patients with HIV. Prisoners trained as CHWs know how to clean and care for their colleagues when they are sick, and advise them on taking their drugs, and so people rarely get to that stage.”

Twenty-six prisoners and six officers have been trained as CHWs at Langata so far. The 11 days of training they all went through demonstrates the commitment they have.

‘You do what you can, you show them love.’

One of those CHWs is Carolyne, a young prisoner just completing her first year behind bars. She is currently facing a death sentence, which will be commuted to a full life-term on appeal (Kenya no longer implements the death penalty).

“It’s good to do what you can for the sick – and show them love. It makes me feel good. I’ve made friends with those that I have cared for, I’ve talked with them, encouraged them and I hope I’ve made a difference.”