1. 1 Presentation: Portfolio Committee on Correctional Services: Prevalence Survey Date: 29 July 2008 Presenter: CDC Development and Care

2. 2 OUTLINE OF PRESENTATION 1.Purpose 2.Background 3.HIV Prevalence Results 4.Syphilis Prevalence Results 5.Recommendations of the survey 6.Interventions (staff) 7.Interventions (offenders) 8.Treatment and conditions of incarceration of terminally ill inmates 9.Medical parole 10.Challenges

3. 3 1.PURPOSE The purpose of this presentation is to provide:  The report on the HIV and Syphilis prevalence survey carried out among employees and offenders in the Department of Correctional Services,  Interventions,  Treatment and conditions of incarceration of terminally ill inmates,  Granting of medical parole, and  Challenges the department is experiencing in this regard.

4. 4 2.BACKGROUND  The Department commissioned LIM’UVUNE CONSULTING to undertake an unlinked-anonymous HIV and Syphilis prevalence survey among its staff and offenders.  The sample of both staff and offenders for the study was stratified according to the following demographics: Urban / rural Correctional Centers Gender Age groups Work rank levels (for personnel only) Regions according to the Department’s geographical divisions.  Pilot conducted in Gauteng in May/June 2006.  Roll out of survey in October 2006.  Survey launched in November 2006.

5. 5 3.HIV PREVALENCE RESULTS REGIONSTAFFOFFENDERS Head Office0%N/A Eastern Cape12.1%16.5% Free State / Northern Cape 4%19.5% Gauteng4.5%22.5%

6. 6 3.HIV PREVALENCE RESULTS (Continued) REGIONSTAFFOFFENDERS KwaZulu-Natal22.7%34.6% Lim/Mpu/N. West14.4%20.7% Western Cape2.6%6.3% National prevalence 9.9%19.8%

7. 7 4.SYPHILIS PREVALENCE RESULTS REGIONSTAFFOFFENDERS Head Office3.0%N/A Eastern Cape3.8%5.3% Free State / Northern Cape 2.3%6.1% Gauteng4.5%9.5%

8. 8 4.SYPHILIS PREVALENCE RESULTS (Continued) REGIONSTAFFOFFENDERS KwaZulu-Natal1.7%4.3% Lim/Mpu/N. West3.2%3.9% Western Cape3.1%5.3% National prevalence 2.9%5.6%

9. 9 5.RECOMMENDATIONS OF SURVEY  Momentum with offenders be increased with necessary programs of comprehensive HIV & AIDS management initiatives.  Based on limited interest in participation displayed by staff, an organizational survey be conducted to determine contributory factors.  Periodic prevalence survey to measure correlation between training and all interventions.  Intensify ownership of HIV programs and initiatives.  Attention in terms of resources to be given to areas where the HIV prevalence is higher, e.g. Gauteng and KZN.  Department to determine impact of drugs on the prevalence of HIV and syphilis.

10. 10 6.INTERVENTIONS (Staff)  Implementation plan for the recommendations or results of the HIV and Syphilis prevalence survey was developed.  The HIV & AIDS Base line Audit on services/ programmes was conducted nationally (March to May 2007).  Information on Post Exposure Prophylaxis was disseminated nationally to inform employees of precautionary measures when exposed to infectious bodily fluids  World AIDS Day commemorated at Pretoria Head Office in partnership with the SANDF.  A Draft DCS Employee Health and Wellness Strategy was aligned to the DPSA model.

11. 11 6.INTERVENTIONS (Staff- continued)  3 Regional Coordinators (2 year contract) posts were advertised, funded by Presidential Emergency Plan For AIDS Relief (PEPFAR) to address the capacity issues in the 3 regions with the highest HIV prevalence rate.  Quarterly HIV reporting framework was developed and implemented nationally to evaluate HIV and AIDS programmes nationally.  The concept of HIV and AIDS mainstreaming was finalised and is in the process of dissemination.  Feedback on the results of the HIV and Syphilis Prevalence Survey is in the process of dissemination to all regions.

12. 12 6.INTERVENTIONS (Staff- continued)  HIV and AIDS issues must be integrated into Employee Health and Wellness Strategy, policy and procedures.  Human resource capacity issues to be addressed in revised structure.  Benchmarking exercise on HIV and AIDS programmes carried out against SAPS and Education.  National audit of HIV and Aids services for employees completed  HIV and AIDS placed on DCS risk management strategy  Baselines for HIV and AIDS for employees developed and presented to Risk Management Committee.

13. 13 7.INTERVENTIONS (Offenders)  An HIV and AIDS framework has been developed to operationalize the NSP.  Intensified training in the following: Nurses and offenders as peer educators. Nurses as master trainers in Correctional Centre Based Care. Professional staff trained on Voluntary Counselling and Testing. The Correctional Centre Based Care policy procedures has been approved and implemented. In total, 16 Wellness Centres have been accredited to improve access to ARV treatment.

14. 14 7.INTERVENTIONS (Offenders- continued)  The reporting system has been improved in order to obtain more reliable statistical information with regard to HIV, AIDS and tuberculosis.  Intensified Prevention, Care and Support Programs (e.g. condom distribution, commemoration of health calendar days, voluntary counseling and testing).  HIV and AIDS placed on DCS risk management strategy  Baselines for HIV and AIDS for offenders developed and presented to risk management Committee

15. 15 8.TREATMENT AND CONDITIONS OF INCARCERATION OF TERMINALLY ILL INMATES  Palliative care is based on the condition of the inmates  Offenders are receiving psychological and spiritual support  Offenders are receiving clinical monitoring and management of opportunistic infections including TB and other HIV and AIDS related complications  Appropriate end-of-life care  Social and material support, such as nutritional support, legal aid, and other support based on needs.

16. 16 9.MEDICAL PAROLE  Health care professionals make recommendations for consideration of medical parole  There is no fixed period an offender must serve prior to being released on medical parole  The medical parole of offenders is approved by the Correctional Supervision and Parole Board Chairperson.

17. 17 9.MEDICAL PAROLE (Continued)  Statistics on medical parole placements for the period 1 July 2007 to 30 June 2008:  RC Eastern Cape4  RC Gauteng12  RC KwaZulu/Natal1  RC Northern Cape & Free State 3  RC Limpopo, Mpumalanga & N W24  RC Western Cape9

18. 18 9.MEDICAL PAROLE (Continued) Correctional Services Act 111 of 1998: Section 79 Correctional supervision or parole on medical grounds “Any person serving any sentence in a prison and who, based on the written evidence of the medical practitioner treating that person, is diagnosed as being in the final phase of any terminal disease or condition may be considered for placement under correctional supervision or on parole, by the Commissioner, Correctional Supervision and Parole Board or the court, as the case may be, to die a consolatory and dignified death”.

19. 19 10.CHALLENGES Balancing the protection of the community with the medical condition and expectancy of the offender. Risk of recommitting of crimes especially sexual and aggressive. Prevalence of HIV/ AIDS and uncertain life expectancy. Lack of sufficient after care by families – poverty and lack of resources e.g. distance to medical facilities, transport, proper nutrition, etc. Lack of sufficient community structures and hospices to provide after care. Reluctance by hospices because of financial burden.

20. 20 10.CHALLENGES (Continued) Reports from medical practitioners are inconclusive with result that report from second medical practitioner must be requested – causes time delays. Second reports are sometimes also inconclusive and places Parole Boards in position that it cannot approve placement due to lack of information/ inconclusive reports.

21. 21 Business Unusual: all hands on deck to detain, rehabilitate and reintegrate offenders for a safer South Africa