PRESENTATION TO THE SELECT COMMITTEE ON SECURITY AND CONSTITUTIONAL AFFAIRS CURRENT INITIATIVES ON HIV AND AIDS AND AN OVERVIEW ON MEDICAL PAROLE

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PRESENTATION TO THE SELECT COMMITTEE ON SECURITY
AND CONSTITUTIONAL AFFAIRS CURRENT INITIATIVES
ON HIV AND AIDS AND AN OVERVIEW ON MEDICAL PAROLE

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PURPOSE

• TO BRIEF THE SELECT COMMITTEE ON SECURITY AND
  CONSTITUTIONAL AFFAIRS ON CURRENT INITIATIVES ON
  HIV AND AIDS AND AN OVERVIEW ON MEDICAL PAROLE

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CONTENTS

• Introduction
• Current projects / initiatives
• Mandates
• Comprehensive HIV and AIDS Program
• Partnerships
• - Prevalence Survey
• Medical Parole
• Challenges

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INTRODUCTION

• The core business of Correctional Services is the
  safe and secure custody of offenders in a humane
  environment that enhances rehabilitation
• DCS commitment to support government
  initiatives in the management of HIV and AIDS
  (putting more emphasis on prevention) is not
  without challenges
• Part of the fulfilment of the mandate DCS works
  in collaboration with external stakeholders to
  strengthen rehabilitation and to address the
  challenges

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CURRENT PROJECTS / INITIATIVES

• Mandates
• HIV and AIDS Policy for offenders available
• Post Exposure Prophylaxis Guidelines available
• Correctional Centre Based Care Policy approved

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CURRENT PROJECTS / INITIATIVES (Cont..2)

• Comprehensive HIV and AIDS Program
• Prevention
• Invited services providers to bid for the
  training of 320 professional personnel (Health
  Care workers, Social Workers, Psychologists and
  Spiritual Care) in Voluntary Counselling and
  Testing (VCT)
• Lay counsellors seconded from Dept. of Health to
  assist with VCT
• 120 Offenders to be trained as HIV and AIDS
  Master Peer Educators
• Commemoration of calendar events e.g. World AIDS
  Day 2006 in Eastern Cape Region
• Ongoing awareness and training sessions on
  healthy lifestyles and positive living

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CURRENT PROJECTS / INITIATIVES (Cont..3
Comprehensive HIV and AIDS Program)

• Care and Support
• Rendering of Correctional Centre Based Care by
  offenders to terminally ill offenders
• Ongoing therapeutic interventions
• Establishment of support groups
• 250 Health Care workers as Master Trainers in
  Correctional Centre Based Care
• Facilitation of the process of release on medical
  parole
• Encourage the buddy support system for
  offenders who are on antiretroviral and TB
  treatment (DOTS supporters)

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CURRENT PROJECTS / INITIATIVES (Cont..4
Comprehensive HIV and AIDS Program)

• Treatment
• Development of National Guidelines for DCS to
  facilitate access of offenders to antiretroviral
  treatment
• Assessment of identified Correctional Centres to
  be accredited as sites for the roll-out of the
  Comprehensive Plan (including antiretroviral
  treatment)
• 3 Correctional Centres already accredited as ARV
  sites (Grootvlei, Pietermaritzburg and
  Qalakabusha)
• Training of 250 nurses in the Comprehensive
  Management of HIV and AIDS related diseases
• Training of professional nurses in the management
  of Sexually Transmitted Infections and
  Tuberculosis (TB)
• Training of health care workers in the electronic
  TB register for record keeping in collaboration
  with Dept. of Health

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CURRENT PROJECTS / INITIATIVES (Cont..5)

• Partnerships
• Received donor funding from the US Government
  Presidential Emergency Plan for AIDS Relief
  (PEPFAR)
• Government departments e.g. Health, Home Affairs,
  Social Development, etc.
• Non-governmental, Community Based and Faith Based
  Organizations
• Private Sector

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CURRENT PROJECTS / INITIATIVES (Cont..6)

• Prevalence Survey
• Impact of HIV and AIDS epidemic felt globally
• Extent of infections in Department not known
• Department embarked on HIV and Syphilis
  Prevalence Survey in 2005
• Survey conducted scientifically to ensure
  validity and reliability
• - External Service provider to undertake survey
• - Voluntary participation

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CURRENT PROJECTS / INITIATIVES (Cont..7
Prevalence Survey)

• Purpose of the survey is to
• Assist Management to make informed decisions
• Mitigate the impact of HIV and AIDS epidemic
• Address speculations
• Obtain scientific data on HIV and Syphilis
  prevalence among staff and offenders

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CURRENT PROJECTS / INITIATIVES (Cont..8
Prevalence Survey)

• Approval granted by Minister and Commissioner
• Donor funds obtained from US Presidential
  Emergency Plan for AIDS Relief (PEPFAR)
• External service providers invited through bid
  processes
• Awarded bid to Limuvune Consulting
• Ethical approval obtained from HSRC
• Pilot project undertaken in Gauteng
• Completed pilot project on 24 May 2006
• Report presented to National Steering Committee

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CURRENT PROJECTS / INITIATIVES (Cont..9
Prevalence Survey)

• Methodology
• Scientifically 10 of the total
• Random sampling
• Anonymous and unlinked
• Coding system used to ensure confidentiality
• Briefing session to inform about the project
• Written consent sought before commencement

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CURRENT PROJECTS / INITIATIVES (Cont..10
Prevalence Survey)

• Findings
• Sample of 10 expected to participate in survey
  (768 staff and 2770 offenders)
• Participation rate 67 staff and 746 offenders
• Very disappointing participation rate

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CURRENT PROJECTS / INITIATIVES (Cont..11
Prevalence Survey)

• Findings
• No correlation between Syphilis and HIV
• Prevalence of Syphilis not significantly
  associated with the presence of HIV
• Pilot project demonstrated HIV and Syphilis is
  prevalent
• Active Management participation and offender
  involvement led to better participation level

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CURRENT PROJECTS / INITIATIVES (Cont..12
Prevalence Survey)

• Obstacles
• Lack of cooperation and participation of
  Management in Management Areas
• Non-visibility of Management before and during
  pilot project
• Members and offenders not informed timeously
• Offenders only identified on the morning of
  survey

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CURRENT PROJECTS / INITIATIVES (Cont..13
Prevalence Survey)

• Obstacles continue
• Participation of offenders in other activities
  prioritised above survey
• High level of stigma and fear around HIV and AIDS
• Lack of vigorous communication and marketing
• Posters not displayed and pamphlets not handed
  out

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CURRENT PROJECTS / INITIATIVES (Cont..14
Prevalence Survey)

• Proposed Solutions
• Embark on vigorous communication and marketing
• Launch prevalence survey
• Encourage participation of Senior Management in
  Regions and Management Areas
• Create opportunities for open discussions

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CURRENT PROJECTS / INITIATIVES (Cont..15
Prevalence Survey)

• Proposed solutions continue
• Utilization of prominent external people and / or
  NGOs during information sessions
• Combine prevalence survey with other HIV and AIDS
  Awareness raising event, e.g. voluntary
  counselling and testing, etc
• Establish task teams in each Region to manage
  prevalence survey

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CURRENT PROJECTS / INITIATIVES (Cont..16
Prevalence Survey)

• Proposed Way Forward
• Survey to be rolled out nationally
• Proposed solutions to be considered and
  implemented upon approval of national roll out
• Embark on mass communication and marketing
  strategy

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CURRENT PROJECTS / INITIATIVES (Cont..17
Prevalence Survey)

• Action Plan for National Roll-out
• Finalize project plan for national roll-out by
  service provider
• Identification of Correctional Centres to draw
  sample
• Finalize Communication strategy
• Briefing / information sessions
• Distribute list of National Head Office teams led
  by Deputy Commissioners to support
• Regions Establish Regional teams
• Launch at Head Office on 02 October 2006

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MEDICAL PAROLE

• Mandates
• Constitution of the RSA Section, Act 108of 1996
• Section 35 (2) (e)
• Everyone who is detained, including every
  sentenced prisoner, has the right to conditions
  of detention that are consistent with human
  dignity, including at least exercise and the
  provision, at state expense, of adequate
  accommodation, nutrition, reading material and
  medical treatment .

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MEDICAL PAROLE (Cont..2)

• 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

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MEDICAL PAROLE (Cont..3)

• Process of identification
• - A registered nurse initiates the process by
  submitting a detailed report to the medical
  practitioner regarding the offenders medical
  condition. The medical practitioner can also
  initiate this process.
• - The medical practitioner will assess the
  offenders condition and complete a G 337 form
  (Medical Status Report of offender) and attach a
  specialists report together with any other
  medical reports (if any).
• - A medical practitioner must indicate if the
  illness is terminal and also whether the offender
  is in the final phase life expectancy

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MEDICAL PAROLE (Cont..4)

• Process of consideration
• - Once the medical practitioner has concluded
  his/her finding the medical report (G337) must be
  submitted to the Head of the Correctional Center
  for comments, recommendation to the Case
  Management Committee.
• - If the medical practitioner recommends
  medical parole proper after care must be arranged
  for the offender. This is normally the family
  but may also be a hospice or other suitable
  institution. A written undertaking must be
  provided by the after care responsibility.

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MEDICAL PAROLE (Cont..5)

• Consideration by Parole Board (1)
• - A parole profile report (G326) is generated
  by the Case Management Committee together with a
  recommendation where after it is forwarded to the
  Correctional Supervision and Parole Board. As no
  legislative minimum period has to be served
  regarding a submission for placement on medical
  parole, this is the first time the Board is aware
  of a submission for medical parole.
• - As the submission is urgent the Parole Board
  must schedule a sitting as soon as possible.
  Parole Boards even convene over weekends and
  after hours if necessary for this purpose.

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MEDICAL PAROLE (Cont..6)

• Consideration by Parole Board (2)
• If the medical report is not clear additional
  information may be requested from the medical
  practitioner on an urgent basis.
• Should medical parole be approved pertinent and
  clear conditions must be set by the Board which
  the offender must accept in writing.
• Whilst on medical parole the offender is subject
  to monitoring by officials from the Community
  Corrections Office in the Area where he/she is
  placed on medical parole.
• Should the offenders medical condition improve
  once released on medical parole he/she cannot be
  re-admitted to a Correctional Centre unless the
  conditions as referred to above are violated.

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CHALLENGES

• Balancing the protection of the community with
  the medical condition and life expectancy of the
  offender.
• Risk of recommitting of crimes especially sexual
  and aggressive.
• Prevalence of HIV and AIDS and uncertain life
  expectancy.
• In some instances the second opinion is not
  provided timeously

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CHALLENGES (Cont..2)

• Lack of sufficient after care by families
  poverty and lack of resources e.g. distance to
  health facilities, transport, proper nutrition,
  etc.
• Lack of sufficient community structures and
  hospices to provide after care.
• Increasing need for palliative care puts an extra
  burden on the limited resources of hospices.

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CHALLENGES (Cont..3)

• HIV is not a notifiable disease
• No compulsory testing for HIV and therefore no
  early detection for prevention, care and
  management of the disease
• DCS not a health competency
• Facilitation of access to external accredited
  sites vs. Security risks
• Inadequate resources, e.g. professional
  personnel, HIV and AIDS coordinators, finances,
  etc
• Stigma and discrimination

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Thank you