Come, let's away to prison

There IS some positive news, even if you have to dig a little for it. I've written before l about the way prisons in Indonesia are responding to HIV. Far from perfect, but at least quite enlightened. This was brought home to me by a report on Voice of America at the end of last year, headed Prisoners With HIV, AIDS in Thailand Now Receive Vital Treatment.

Seeing that headline, I assumed that as usual, Thailand was ahead of us, and that antiretroviral therapy (ART) had become universally accessible in Thai prisons. But it soon became clear that this was far from the truth. In fact, it appears that it applies only to three prisons in the Bangkok area, a result that represents work by MSF since 2003.

Efforts to provide appropriate health services for prisoners with HIV started in Indonesia around the same time. I've seen no reports about progress since then, but from my own experience, prisons from Jayapura in the east to Medan in the west are offering ART to inmates. In several of them, they are in some ways better off than those outside, and I'd personally prefer to be treated in the prison clinic in Bandung's Banceuy prison than in the main (referral) hospital. And besides ART, this prison also provides methadone substitution therapy for those addicts unable to break their habit.

I first visited Banceuy in about 2005. At that time, they were mulling over offering HIV testing to prisoners, but (as had occurred earlier in Bali), they were worried that it might lead to unrest. And they were also concerned over the cost of looking after people they assumed would be sick and need expensive treatment - at that time the health care budget per prisoner per year was Rp 700, maybe enough to buy a couple of aspirins. (I was told in Makassar last year that it had been increased to Rp 5 per inmate per day - sounded a whole load better until I worked it out!) But, we told them, if you can identify people with HIV early, before they fall sick, and put them onto ART that is available free-of-charge, you'll save all those costs, as well as the problems of escorting them to hospital and guarding them there. Don't know how much this influenced their decisions, but as I say, now they offer a model clinic.

Although there is clearly room for improvement, it is clear that in some ways Indonesia is leading the region in its response to HIV in the prisons - and hopefully that is also improving health care more generally for those incarcerated. In some ways it is sad that the country gets so little credit for this - the headlines always seem to go to Thailand, Malaysia or Vietnam. There's not much positive news coming from Indonesia; it's a pity we can't publicise the little there is!

Babé