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By Aaron Goodman
Bangkok
30 December 2008

Prisoners living with HIV and AIDS at three Bangkok area prisons are able to receive proper medical care, thanks to a program begun by Doctors Without Borders. Starting in 2009, the Thai government will assume responsibility for all HIV/AIDS programs in prisons.

Thailand has been praised for its fight against HIV and AIDS, which includes universal access to antiretroviral (ARV) therapy. Yet prison inmates infected with HIV, which causes AIDS, were excluded from treatment. As a result, many died in prison, although lifesaving drugs were widely available outside.

Medecins Sans Frontieres' HIV/AIDS clinic in Minburi Prison, Bangkok, Thailand
Medecins Sans Frontieres' HIV/AIDS clinic in Minburi Prison, Bangkok, Thailand
In 2003, at the invitation of Thailand's Department of Corrections, Doctors Without Borders, known as MSF, began to help treat prisoners with HIV in Minburi Prison in Bangkok. Since then, the project has been extended to two other prisons near Bangkok.

Verapun Ngammee, who runs MSF's HIV prison program, says he was motivated to begin the work after he saw how urgently HIV-positive prisoners needed health care. He adds that once prisoners with HIV started to respond to treatment, prison officials and guards began to view them more positively and supported the project.

"From the beginning, when they got HIV, they got sick and they die. But when they have the project the patient who got sick and they come and they treat, after ARV, they improve, they can have some activity. That made another prisoner and prison guard surprised also because in the past their experience if you have HIV, you have to die," he said.

MSF works with the Department of Corrections to provide ARV therapy and distribute condoms to inmates. The charity also trains health workers to diagnose the disease and to prevent its spread.

It also established a peer-support system in which inmates volunteer as health workers. These men and women spread information about HIV prevention and encourage fellow prisoners to get tested.

Minburi Prison houses 2,100 men and 400 women. It was the first in Thailand to provide free ARV to prisoners. Today, three women inmates and thirteen men are being treated.

Before MSF began the program at Minburi Prison, inmates with HIV had virtually no health care to combat the disease. Prison officials and guards lacked knowledge about the illness and forced HIV-positive prisoners to sleep in the same quarters away from other inmates. MSF staff say guards also frowned on condoms being circulated behind bars, because they thought it would increase sexual activity.

MSF responded by running information sessions with prison staff that helped to integrate HIV-positive inmates with mainstream prison populations and led to improved medical care.

Petchara Petkon is serving the last year of a three-and-a-half-year sentence in Minburi Prison. She contracted HIV after sharing needles while injecting illegal drugs.

She says she has seen many women prisoners die from AIDS because they were unable to get treatment. Once she was transferred to Minburi Prison, she says she was able to get care.

She says after she came to the prison, her lymph nodes became swollen. Nurses at the prison clinic told her that her CD4 (T-cell) levels were very low and they gave her ARV therapy very quickly.

Nurses also taught her how to take the ARV drugs properly and stick to the correct treatment schedule.

Nui is a prisoner who volunteers as an HIV/AIDS health worker in the Minburi prison. He says by being a peer support health worker he can learn about HIV/AIDS and learn how to take care of himself. He also is able to share important information and help other inmates. He adds that health care workers in the prison now know how to treat prisoners.

MSF will end its HIV prison program in a few days. The group has developed a training curriculum and says it hopes its program will be implemented in other prisons across the country.

Thailand's Ministry of Health and the Department of Corrections will have the final say, because they will assume responsibility for HIV treatment programs in prisons.

Nipa Ngamtrairai, who heads the HIV/AIDS program in the Department of Corrections, says MSF filled a gap, because previously there were not any HIV/AIDS treatment programs for prisoners in Thailand. Now that prisoners are included in the universal ARV policy, she says she is pushing for treatment to be provided to as many prisoners as possible. She adds that prisoners have the same rights to health care as people outside of prisons.
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