HIV, hepatitis C and TB at Cebu City Jail

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MARIT STINUS-CABUGON

A REPORT that 136 of the Cebu City Jail’s estimated 4,200 inmates recently tested positive for HIV alarmed Cebu City Councilor Dave Tumulak, who chairs the city government’s health committee, that he asked the city health department to screen all inmates for HIV and tuberculosis.

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In 2014, the Department of Health randomly tested 250 of the jail’s then approximately 2,400 inmates. The results came back with 13 percent positive overall (Sun Star Cebu, November 2015)). If the prevalence rate is the same today, this would mean more than 500 HIV-positive inmates in the Cebu City Jail.

HIV prevalence in the Philippines remains less than 0.1 percent. However, the rate of new HIV cases has gone from one new case a day in 2007 to 29 at present, making the Philippines one of the few countries in the world with increasing number of new infections. According to the National Youth Commission, the 15 to 24 year old population account for 62 percent of all new HIV infections.

Transmission of HIV is usually associated with sexual contact but in Cebu City, the most common mode of transmission is and has been sharing of needles. Cebu City, however, also has a high infection rate among men having sex with men. The DOH in 2015 reported that HIV prevalence in this group was 7.7 percent, the highest in the country.

Infection rate among Cebu City’s injecting drug users (officially around 2,500 but probably much higher) jumped from one percent to 53 percent in the period 2009-2010. From the mid-1990s until 2009, an NGO and the Cebu City health department distributed syringes to injecting drug users, while subjecting them to blood tests and counseling. The program was stopped in 2009 (The Atlantic, 2016) when an amendment to the Dangerous Drugs Act made it illegal to possess and distribute drug paraphernalia like syringes.

Losing access to free needles, many drug users resorted to sharing. Implemented in connection with a DOH research program, the free distribution of syringes resumed in 2010 to arrest the sharp rise in HIV cases. However, the program was stopped for good in 2014.

The sharing of needles is blamed for the high prevalence of HIV and hepatitis C among Cebu City Jail inmates—the 2014 DOH study found almost 50 percent of the inmates to have hepatitis C. There are simply so many injecting drug users behind bars, and many of these are HIV positive. In its study, the DOH found 93 percent of HIV positive male inmates to be injecting drugs. Needle sharing continues inside prison resulting in more HIV and hepatitis C infections. HIV- positive inmates are being offered antiretroviral therapy. This suppresses the virus and reduces the risk of infecting but it is not a cure. Hepatitis C medication, on the other hand, is too costly for the government to offer. Infected inmates will have to live with the disease.

Tuberculosis spreads through the air. While in the past, tuberculosis screening of prison inmates was offered only during special occasions such as World TB Day (Philippine Information Agency, March 2016), starting this month, chest x-ray, as part of the general physical examination, has become compulsory for all prisoners who are committed to the Cebu City Jail. The Philippines is on the World Health Organization’s list of 30 high-burden countries (out of 196 WHO member countries) not only as far as tuberculosis is concerned, but also multi-drug-resistant tuberculosis (WHO Global Tuberculosis Report 2016).|

Why should we care if some miserable drug users, sick with HIV, hepatitis C and tuberculosis, end up in jail
infecting other miserable criminals? Should we be spending scarce government resources on treating them? First of all, as a humane, civilized society we recognize the right of every person, including prisoners, to dignity and basic safety. Secondly, not all the inmates of the Cebu City Jail are guilty of committing crimes. They are still awaiting trial. Most are poor and can afford neither a lawyer nor bail. Some inmates spend more time in jail waiting to be tried than the penalty of the crime for which they are accused. Eventually, they will all be released – some, because they are acquitted, others because they have served their terms, while some will be committed to the New Bilibid Prisons or the Abuyog Penal Colony to serve longer sentences. There is no tracking system, no way to monitor if those afflicted with HIV and tuberculosis continue their treatment once released from the Cebu City Jail.

Eventually, majority of inmates will rejoin the community. The probability of their infecting their partners with HIV and hepatitis C, their children and others with tuberculosis, is high. A health problem that until 2009 appeared to have been manageable, affecting a relatively small segment of the population of Cebu—HIV-infected injecting drug users—has turned into a serious public health problem.

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