‘In But Free’-an HIV/AIDS intervention in an African prison

Unprotected male to male sex, sharing of razor blades, tattooing and injecting drug use have been recognized as risk factors for HIV transmission at Kamfinsa Prison in Zambia. Beginning July 1995, an intervention called 'In But Free' and led by inmates trained as peer educators (PEs) has been implemented at the prison. Activities include face-to-face information giving, provision of HIV/AIDS educational materials, distribution of scissors, voluntary HIV counselling and testing and the promotion of better standards of hygiene. No condoms have been distributed. The project has been well received by inmates and staff. A total of 119 PEs have been trained and hold regular meetings with other inmates. Sixty pairs of scissors have been made available. Reports from inmates and staff indicate a reduction in tattooing and injecting drug use but male-to-male sex and the sharing of razor blades continues. HIV testing shows prevalence rates of 75% compared to the national average of 19% in adults. These findings suggest that the risk of HIV transmission at the prison is still high and measures to address this situation are urgently needed. Condom distribution in prisons must now be considered as well as steps to improve the poor living conditions in most Zambian prisons. © 2001 Taylor and Francis Group, LLC.