Creating healthier prisons

Zambian prisons can be very unhealthy places. Problems include massive overcrowding, insufficient food and poor hygiene conditions. Diseases such as TB and malaria are common. Some 27 per cent of prisoners are living with HIV, which is more than double the figure for the general population.

At Prison Fellowship Zambia (PFZ) we believe that health education can empower those in prison to live healthier lives. We run a range of interactive health education sessions with prisoners to discuss issues that are affecting their well-being. 

Mobile medical clinics 

Working in collaboration with the government, we provide mobile clinics that go into prisons. These are staffed by volunteer health workers. If prisoners need more complicated treatment, we arrange a referral to one of the bigger health facilities. 

We encourage prisoners to get tested for HIV, and deliver counselling before and after their test. For those who are diagnosed as HIV-positive, we provide help with accessing treatment. We also give them nutritional supplements and regular check-ups to see how they are doing. 

Getting the message across

PFZ runs health education sessions to teach prisoners about issues such as hygiene, nutrition and HIV. We give the prisoners information leaflets on the topic in question, and make sure these are translated into local languages. However, many prisoners are illiterate, so we also use drama. We hire a drama group to present health messages in prisons using singing, drums, acting and picture demonstrations.

I remember seeing a good example of a drama on the importance of following your HIV treatment plan. One actor played the part of a prisoner with HIV who had just been prescribed HIV treatment. The actor expressed thoughts such as, ‘I am in prison and I will never see my family again – it is best to die here and now, so I will not take my medication.' Then another actor came alongside the first actor to support him, explaining all the reasons for taking the treatment. Dramas like this help people understand and engage with health messages. 

Supporting one another

As workers with PFZ, our time in prisons is limited to certain hours each day. We therefore train prisoners as peer educators so they can spread health messages among their fellow inmates. These peer educators run individual and group discussions on subjects such as HIV prevention. In peer groups, prisoners are better able to express their concerns openly and feel that everyone identifies with them. Many peer educators are HIV-positive themselves. When the prisoners see them working with PFZ in responsible roles, this helps to reduce the stigma of living with HIV.

We also train certain prisoners to be something we call ‘treatment supporters'. As shown in the drama above, when prisoners are first diagnosed with HIV they often feel a sense of despair and cannot see the point of taking their medication. The treatment supporters offer encouragement to these inmates. They help them realise they will have a future outside prison one day, so it is worth taking the medication.

Discussion question

• How could you help improve the health care in your local prison?