HIV Prevention in Prison – Sai, health leader in Minburi prison, Thailand

While sex in prison remains taboo, both prisoners and prison staff understand the importance of prevention. HIV prevalence in jail is believed to be higher than in the general population, especially since most of the prisoners are incarcerated for drug-related offences and injecting drug users are a high-risk population. In 2004, MSF was given permission to provide condoms to prisoners  in Minbury as part of its health promotion activities, which help drastically reduce HIV/AIDS transmission. MSF is also providing treatment to the prisoners suffering of HIV/Aids

27- year-old Sai, currently serving a six-year sentence for a drug-related crime, is one of the health leaders trained by MSF. In charge of 17 other Katoey (Transgender) and Men having Sex with Men (MSM), he is often the first person they contact when they have a health problem.
 
His role is to disseminate information about prevention, opportunistic infections, and safe sex practices and to make sure prisoners have access to condoms, counselling or treatment.  PHA (People living with HIV/AIDS) groups meet twice a month and Sai also provides psychological support to MSM.

Although sex is very controversial in the prison, it remains nonetheless the main mode of transmission. The bi-monthly meetings provide a space to answer questions freely and get support.

"Yes, sex in prison is forbidden, but it happens anyway, and that's why access to condoms and information about safe sex practice is crucial," explains Sai, who adds that he himself contracted HIV in prison.

"It happened before I was trained as a health leader. MSM often imagine they know about HIV transmission, but if a boy is good looking and clean we think he's not infected. HIV is just what happens to others," he says, "until you get a test and you realise you're positive."

Sai felt terrible when he found out he was infected but this was also a motivation to take an active role and become a health leader. "So many people needed information, I wanted to help. The situation now has greatly improved, with information, treatment and prevention available. Now MSM are no longer blamed for the spread of HIV in the prison" he stresses" and that's why I always make sure all MSM in my group  get tested regularly."

HIV/AIDS care in prison in Thailand

In June 2003, the Department of Corrections of Thailand asked Médecins Sans Frontières (MSF) to help treat prisoners suffering from HIV and AIDS in Minburi prison, in Bangkok. Although the country was lauded for its fight against the disease and for its universal access to antiretroviral (ARV) therapy, prisoners remained excluded from the scheme at the time. As a result those affected by HIV/AIDS suffered and died in prison, while life saving drugs were widely available outside. 

Five years of collaboration between MSF and the Department of Corrections have yielded great results in improving the care and treatment of prisoners. In 2005 and 2007, the project was extended to two other prisons in the Bangkok area: Bangkwang, Asia's highest security prison and Pathum Thani prison. Today, MSF is handing over its project and has finalised a curriculum to help develop this model in other prisons nationwide.