title: Imprisoned and imperiled: access to HIV and TB prevention and treatment, and denial of human rights, in Zambian prisons.
abstract: BACKGROUND
  Although HIV and tuberculosis (TB) prevalence are high in prisons throughout sub-Saharan Africa, little research has been conducted on factors related to prevention, testing and treatment services.
  
  
  METHODS
  To better understand the relationship between prison conditions, the criminal justice system, and HIV and TB in Zambian prisons, we conducted a mixed-method study, including: facility assessments and in-depth interviews with 246 prisoners and 30 prison officers at six Zambian prisons; a review of Zambian legislation and policy governing prisons and the criminal justice system; and 46 key informant interviews with government and non-governmental organization officials and representatives of international agencies and donors.
  
  
  RESULTS
  The facility assessments, in-depth interviews and key informant interviews found serious barriers to HIV and TB prevention and treatment, and extended pre-trial detention that contributed to overcrowded conditions. Disparities both between prisons and among different categories of prisoners within prisons were noted, with juveniles, women, pre-trial detainees and immigration detainees significantly less likely to access health services.
  
  
  CONCLUSIONS
  Current conditions and the lack of available medical care in Zambia's prisons violate human rights protections and threaten prisoners' health. In order to protect the health of prisoners, prison-based health services, linkages to community-based health care, general prison conditions and failures of the criminal justice system that exacerbate overcrowding must be immediately improved. International donors should work with the Zambian government to support prison and justice system reform and ensure that their provision of funding in such areas as health services respect human rights standards, including non-discrimination. Human rights protections against torture and cruel, inhuman or degrading treatment, and criminal justice system rights, are essential to curbing the spread of HIV and TB in Zambian prisons, and to achieving broader goals to reduce HIV and TB in Zambia.
authors.affiliation: Human Rights Watch, London, UK.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Todrys
authors.affiliation: Human Rights Watch, New York, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Amon
authors.affiliation: Prisons Care and Counselling Association, Lusaka, Zambia.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Malembeka
authors.affiliation: AIDS and Rights Alliance for Southern Africa, Windhoek, Namibia.
authors.forename: Michaela
authors.initials: M
authors.lastname: Clayton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006806:Human Rights; D006801:Humans; D008297:Male; D008875:Middle Aged; D011330:Prisons; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D015024:Zambia / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents