Uganda prisons are exceptionally hard places, referred to as hotbeds for HIV, TB and other diseases according to a Human Rights Watch report (2011), where rates of HIV and tuberculosis infections are double those of the entire country. Prisoners are largely left out of treatment or prevention strategies, making palliative care even more necessary. Some of them, who are possibly infected with drug-resistant tuberculosis, live in confined spaces with other prisoners, further spreading the infection.
Overcrowding increases the spread of opportunistic infections as stress, malnutrition, and hard work weaken the immune system, making HIV-positive individuals more susceptible to getting ill. Prisoner wellbeing is often neglected and overlooked. HIV prevention programmes are rarely made available to inmates, and many prisoners with HIV are unable to access life-saving antiretroviral treatment.
Prisons have very limited funds for treatment. For example, less than 0.1% of U.S. funding to fight HIV in Uganda goes to programmes for prisoners. Furthermore, the UK Department for International Development (DFID) does not contribute to the prison health services. Nor has The Global Fund to Fight AIDS, Tuberculosis and Malaria been a significant contributor.
But the spread of HIV and TB within and from the prisons poses a serious risk. Every year, 50,000 people pass through Uganda’s prisons. If they can’t get prevention or treatment services in prison, they may be carrying infections with them when they come out.
The Worldwide Hospice Palliative Care Alliance (WHPCA) and the African Palliative Care Association (APCA) are working to support prison authorities to form prison based palliative care teams composed of health workers, prison staff and prisoners. Recruitment, training and support will be given to prisoners, to enable them to act as ‘Compassionate Cellmates’.
Central to this project is the recruitment and training of prisoners who will provide care, psychosocial support and friendship to other prisoners who are living with HIV, to enable them to have a better quality of life, stop the spread of HIV infection and battle stigma, isolation and apathy.
Compassion is a hallmark of palliative care, as important as capacity building, access to health services and medication. It is the caring heart that makes all things possible. It is the caring heart that makes palliative care a reality.