The black flower of civilised society, a prison

I visited my first prison in Indonesia in late 2002: Kerobokan in Bali, We knew that the prison was home to many injecting drug users (IDUs), and a study by Made Setiawan et al from 1998 had told us that even then a quarter of the prisoners were still injecting - then as now, it's often easier to score in prison than outside on the street. More recently, surveillance in the prison had reported 36 IDUs with the virus out of 66 tested.

We sat down with a group of about a dozen inmates, together with Dr Hartawan, the prison doctor. We gave our standard pitch about HIV infection, and the risks of sharing needles. At this, one of the inmates grew quite angry. He told us that we were the nth group of visitors who'd come to tell them that it was quite probable that they were HIV-infected. But still there was no way for them to get tested, to put their minds at rest, one way or another. This, he said, was a violation of his rights. Reasonable.

Dr Hartawan told us that the authorities were very not yet willing to allow testing. If this was offered and the identities of infected inmates became known, other inmates might refuse to share cells with them, there might be violence, and discrimination would be inevitable.

However, not so long afterward, we heard that the authorities had allowed testing to start, initially just prior to discharge, but shortly thereafter for anyone who requested it. Thanks to a great extent to the efforts of Dr. Hartawan, but with support from a number of NGOs in Bali, there was no violence.

In mid-2004, I was asked to assist a group of activists in Bali who had carried out a needs assessment among HIV-infected injecting drug users (IDUs) in the island. During the discussion, I was told that 'stigma and discrimination has disappeared from the Kerobokan prison.' I could not believe my ears! I asked: among inmates, among staff and warders, or who? All, I was told.

The next day, by chance, I had arranged to visit one of my old friends who was in the prison, He's an HIV-positive activist who was there for drug-related offences. He had previously been very open about his status, so everyone in prison knew about it; it couldn't be hidden. When I arrived, he was taking part in a quiz about HIV involving several teams of inmates. This had been organized by Dr. Hartawan. I was amazed at how much they knew.

After the quiz, we went to the prison canteen for a coffee, I asked him about the report; was it true that he had no problems with discrimination? He told me that when he had started his sentence nine months before, it was terrible. But with support from Dr. Hartawan and NGO friends, and with his own efforts, there was no longer a problem. The canteen was quite busy, and no one took any notice of us. "Look at this," he said. "Nine months ago, if I came and sat down here, everyone else ran away!"

Conventional wisdom said that people with HIV would inevitably face stigma and discrimination in prison. Kerobokan, and Dr. Hartawan, proved this could be overcome. Since then, this has been replicated in many prisons around the country.

As with so many other aspects of this epidemic, Indonesia has again proved that conventional wisdom can be wrong.

Babé