Prevention of Sexual Transmission of HIV in Zambia Prisons : An ethical Perspective on the Provision of Condoms

Abstract

There are high HIV prevalence rates among prisoners around the world and, in most cases, the levels of HIV infections among prisoners tend to be higher than in the general populations. In Zambian prisons, HIV prevalence is estimated to stand at 27% against a national HIV prevalence rate of 14%. This situation is described as being "grave". It is grave because of other compounding factors such as poor environmental and prison conditions. A major risky behaviour associated with sexual transmission of HIV in Zambian male prisons is male-to-male sex (MMS). MMS is anal sex that is usually performed under coercive circumstances. The risk of sexual transmission of HIV is high because prisoners, in most cases, do not take precautionary measures when engaging in MMS. There is an urgent need to put in place workable preventive interventions that can reduce the high HIV prevalence rates in Zambian male prisons.This study, Prevention of Sexual Transmission of HIV in Zambian Prisons: An Ethical Perspective on the Provision of Condoms, has two main objectives: First, to inquire into the main preventive interventions that are currently in place to prevent sexual transmission of HIV and second, to critically assess from an ethical point of view arguments for and against condom provision in Zambian prisons. It is divided in two parts: an empirical part and a philosophical part. The empirical part discussed current practices in prisons that are aimed at preventing sexual transmission of HIV. Data was collected through secondary sources and informal interviews. Secondary sources involved reading documents while informal interviews were done through a questionnaire and personal interviews with prison authorities. The philosophical part consisted of an ethical analysis of the arguments for and against the provision of condoms among prisoners. The Principle of the Lesser of Two Evils (PLE), which is an ethical principle that is widely used in literature on the prevention of sexually transmitted HIV, was employed.It has been discovered that while there are a number of preventive interventions that have been put in place to reduce HIV infections through MMS, much more needs to be done in order to adapt these measures to a male prison environment. Prison environment is a peculiar environment that requires specifically tailored preventive measures suitable to that environment.One such effective, though controversial, preventive intervention that should be introduced in Zambian prisons is the provision of male latex condoms. Using the PLE, it has been shown that the policy of condom provision can be seen as a lesser evil because the disadvantages of not providing condoms outweigh the disadvantages of condom provision.