JAKARTA, Indonesia – Unprotected sex and rampant drug use in Asia's overcrowded and run-down prisons is fueling the AIDS epidemic (search) in the region, and governments have been slow to recognize the threat, activists say.
Prisons "are HIV factories," said Elizabeth Pisani of Family Health International (search), an AIDS prevention group in Jakarta. "We are introducing a population that we know to be infected with the virus into an environment where people shoot up drugs and have anal sex."
When HIV-positive prisoners are released, there is a high likelihood they will spread the infection, she said.
Rights activists have long called for better conditions in Asian jails, where they allege inmates are routinely beaten, and deadly diseases like tuberculosis and typhoid go unchecked. Medical care in many prisons is substandard or nonexistent and widespread corruption means just about anything — from drugs to sex — can be bought.
Few governments in Asia's developing economies keep officials figures on HIV infections among inmates. But private groups say they are rising at an alarming rate.
In Indonesia, prisons that had reported almost no HIV cases among inmates in 1999 had almost 25 percent of their populations infected in 2003, the National AIDS Commission said.
In Thailand, one quarter of inmates at Klong Prem Central Prison on the outskirts of Bangkok have tested positive for HIV, activists say. AIDS disease has also become a leading killer in Cambodian jails.
Rising HIV rates in Asian prisons reflect a global trend that has also hit Africa, South America and Russia, the United Nations says. South African prisons have seen death rates surge 500 percent in recent years largely because of AIDS.
"It probably is much worse than what we expect because prisons represent the lowest common denominator of society," said Anindya Chatterjee, a senior adviser with UNAIDS in Geneva. "These inmates are the underclass and most vulnerable to HIV. We've seen this in Russia. We've seen this in China and we'll definitely see it in Indonesia."
Some prisons in Indonesia have started distributing information to new inmates on the dangers of unprotected sex and intravenous drug use and plan to introduce methadone — a heroin substitute prescribed to addicts — in Jakarta and Bali prisons starting this month.
But prison officials say they have no money to test inmates for HIV or pay for treatments.
"We know this is a big problem but we've got no money," said Wahid Hussein, an official at the Cipinang Narcotics Prison. "When we see an inmate sick with AIDS, we can't do anything for them."
Indonesia, the world's most populous Muslim nation, has refused to follow the lead of European countries and offer free condoms or clean needles for injecting drug users. Officials say doing so would promote gay sex and drug taking.
Thailand has begun to offer condoms in some prisons, but it is not providing inmates with clean needles.
"OK, so they can't hand out needles — it's too extreme for them to accept," said Somchai Krachangsaeng of advocacy group the AIDS Access Foundation. "But maybe they can tell the prisoners the dangers of using drugs."