Prison conditions

Unsafe sex and drug use in India’s prisons is leading to high HIV rates

But prison officials are in denial, say coordinators of the National AIDS Control Organisation’s prison intervention programme.

The National AIDS Control Organisation’s recently launched prisons intervention programme has found that a large number of prison inmates contract HIV because of unsafe sex and the sharing of needles within prisons. Preliminary data from the programme shows that 2.5% of more than 35,000 prisoners tested are HIV positive. The rate of HIV infection among the general adult population is much lower at 0.28%.

The data was gathered with the consent of prisoners in 15 prisons where the programme is being implemented. The majority of HIV positive cases were from Mizoram, with 60 of 455 inmates testing positive – an infection rate of 13%.

“A significantly high number of HIV positive people were intravenous drug users,” said Dr Kanudeep Kaur from Emmanuel Hospital Association, which coordinates the prison intervention programme with the Punjab State Aids Control Society.

Prisoners are also falling ill with hepatitis C and tuberculosis. More than 21,000 inmates at nine prisons in Punjab were tested for hepatitis C and 22% were found to have the disease. About 21% of almost 600 prisoners had tuberculosis. In prisons in the North East, 16% of inmates tested were positive for hepatitis C and about 3% had tuberculosis.

Range of health services

NACO first held a consultations on guidelines to prevent HIV in prison in 2014. In July 2016, NACO launched the programme in 15 prisons across Punjab, Assam, Manipur, Mizoram, Nagaland and Meghalaya.

Although some prisons in India like Tihar Jail in Delhi and Arthur Road Jail in Mumbai have had harm reduction programmes to prevent drug use, sharing of needles and other behaviour considered risky, this is the first concerted effort to prevent HIV transmission among prison inmates.

“It is most important to look at the most marginalised population,” said Sanjeeva Kumar, director general of NACO. “This is a section of society whose health concerns do not matter to many people.”

There are more than four lakh prisoners in India’s 1,401 prisons. NACO has decided to focus the HIV intervention on prisons in areas with high HIV prevalence and large numbers of intravenous drug users, such as Punjab and states in the North East.

Abraham Lincoln, who coordinates NACO’s prison intervention programme, said that the organisation plans to expand the programme to 90 prisons including in Bihar, Uttar Pradesh, Uttarakhand and Rajasthan.

The HIV programme in prisons includes services like providing information on HIV, testing and counselling, and connecting HIV positive inmates to antiretroviral therapy centres. The programme also provides testing and treatment for other sexually transmitted diseases. NACO is also concerned that HIV positive inmates can eventually transmit the disease outside prison, especially to members of their families. Many prisoners are undertrials who might be acquitted and leave prison. Others might get out on bail or after serving a short sentence. The programme also seeks to prevent this spread. Programme officers visit families of prisoners who might be released. “We try to improve adherence to treatment by going to their families (with the inmate’s consent) and counsel them about the disease,” said Kailash Ditya, deputy team leader of NACO’s North East technical support unit.

High risk of contracting disease

India has very little data on HIV prevalence and high risk behaviors in prison but some studies like the National Integrated Biological and Behavioral Surveillance 2014-’15 among high risk groups report drug injecting practices in prisons in every state. A study at Arthur Road jail in 2006 showed that men often have unprotected sex with other men, which might be consensual or coercive. Nalinikanta Rajkumar, president of the Community Network for Empowerment, who conducted hepatitis C screening activities inside Sajiwa Jail in Imphal has observed inmates sharing razors which increases the risk of contracting the disease.

Then, there is the environment conducive to tuberculosis. “If you look at inmates who stay for long periods of time in prison, they come from poor socio-economic strata,” said Vijay Raghavan, dean of the social protection office at the Tata Institute of Social Sciences. “Their nutrition levels prior to prison was already low. In prison, the conditions are such that there is increased vulnerability to diseases such as tuberculosis.”

Raghavan also pointed out that one of the major problems in prisons is a lack of medical facilities and a shortage of doctors and paramedics.

Resistance from police, prison staff

Implementing the programme has already thrown up some challenges at the prisons, which are already short-staffed.

In Uttar Pradesh, where testing for HIV and TB has started in four jails, some jail superintendents expressed apprehension to initiate HIV screening, said Umesh Mishra from the Uttar Pradesh State Aids Control Society. “They say that screening can be a security issue,” he said. NACO officials said that prison authorities are wary of letting people from outside the prison establishment interact with prisoners.

A programme coordinator who works with Guwahati Central Jail authorities said that during a talk to prisoners on the routes of HIV transmission which includes the unprotected sex, prison officials told them not to talk about “obscene subjects”.

No harm reduction programme

The World Health Organisation’s representative to India Henk Bekedam said during the consultation that inmates’ HIV risk can be minimised by giving drug users clean needles and syringes and by providing them opioid substitution therapy.

The needle and syringe programme is one of the 15-key interventions advocated for HIV prevention, treatment and care in prisons by the United Nations Office on Drugs and Crime and by WHO. However, most countries have not instituted this intervention citing security concerns.

Opioid substitution therapy involves giving a drug user a long-acting opioid like buprenorphine under medical supervision and along with psychosocial interventions, which helps reduce drug withdrawals and cravings and reduces the likelihood of the patient resorting to illegal means to get drugs.

All inmates can also be given condoms, said Bekedam.

Of the prisons in the programme, Shillong District Jail provides opioid substitution therapy to drug users. Punjab prisons only allow drug detoxification programmes to be carried out, which helps manage withdrawal symptoms. Kaur said that the Punjab government too wants to start opioid replacement therapy in prisons. But Lincoln said that the jail manual does not allow them to start either a clean needles and syringes programme or distribute condoms.

“The prison officials are in denial mode,” said an activist working with the prison intervention programme. “They say sex is not taking place in prison. They also say there are no drugs in prison. If we accept that both drugs and needles are smuggled inside prisons, then it poses a big question mark on the security at prisons.”

Meanwhile, one area where the HIV prisons intervention programme seems to be helping is to lend inmates a ear. “Prisoners are often relieved to have a friendly face and a ready ear to listen in prison,” said a programme coordinator in Guwahati. “Incarceration has a physical and a mental effect on people’s lives. They often cry just by talking to us.”

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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.