"Here is the mess," the warder said when he shoved Michael Adams* into an overcrowded cell in Allandale Prison, near South Africa's Cape Town, 10 years ago. That first night, Adams was raped by two men, and he was repeatedly assaulted during much of his time behind bars.
"Two gangsters came over to me and made me stand naked in front of the gang," he said recently, now out of prison and working at a hospital. "They did things to me."
After his ordeal, a nurse told him, simply, "This is what happens in prison." When he complained, the warder laughed at him.
Adams says he contracted HIV from those assaults. But because he was still awaiting trial, he had to wait two months to see a psychologist, and, despite begging for an HIV test, it would be two years before he was diagnosed. He was not given access to antiretrovirals, and only started taking them after his release.
"In prison, everyone knew I had AIDS because they changed my meal plan," he told IRIN/PlusNews. "There was no discretion."
He still has recurring nightmares. At age 37, he lives with his mother, who refuses to wash his clothes because he is HIV-positive.
He is now taking the Department of Correctional Services (DCS) to court to claim damages for his suffering. "I am angry," Adams said. "I have no friends and no love life, and nobody in the department even cares."
Sexual violence widespread in prisons
Sexual violence and the subsequent spread of HIV is "regrettably common" in South Africa's prisons, said Lukas Muntingh, coordinator of the Civil Society Prison Reform Initiative, run by the University of the Western Cape Law Clinic.
The severe rate of overcrowding - over 200 percent in some prisons - exacerbates the situation by worsening health conditions and overwhelming personnel.
In 2006, DCS conducted a national HIV and syphilis prevalence survey among its prisoners and staff, and found prevalence levels ranging from 19 to 60 percent in some prisons.
Sexual violence is widely accepted by both inmates and prison authorities as part of the prison experience in South Africa, said Sasha Gear, programme director of Just Detention International (JDI), an international organization that aims to end sexual violence in prisons. Warders receive no training on preventing or responding to sexual violence; reports from prisoners show that warders are aware of the extent of sexual violence, and sometimes even encourage it.
Vulnerable inmates, such as those who are young, gay, new to prison, of small build, mentally disabled and non-aggressive are often forced to provide sex to other inmates - usually for the duration of their incarcerations
A culture of violence
According to Gear, the culture in men's prison facilities are dominated by hypermasculine, homophobic attitudes among both inmates and staff, which encourage sexual predators to target men perceived as not "manly" enough.
"Vulnerable inmates, such as those who are young, gay, new to prison, of small build, mentally disabled and non-aggressive are often forced to provide sex to other inmates - usually for the duration of their incarcerations," Gear said.
There are currently no policies in place to ensure that sexual assault laws are implemented in prisons.
In 2010, the Framework to Address Sexual Abuse of Inmates in DCS Facilities was developed by JDI, the Centre for the Study of Violence and Reconciliation, and DCS officials to address the policy gap in DCS's handling of sexual violence, said Emily Keehn, manager of the prisons programme at Sonke Gender Justice Network, which is advocating for the implementation of the framework.
The document was handed over to DCS for consideration and, hopefully, implementation. Two years later, the authors have no idea what happened to it.
But this year, thanks in large part to civil society initiatives, statistics on prison assaults will be disaggregated into different categories, including sexual violence, for the first time in the annual report by the Judicial Inspectorate of Correctional Services, the government-appointed oversight body. This will enable better understanding of the scale of sexual violence in the detention system.
Spilling into the community
Inmates who have been sexually victimized often take the scars of abuse home with them, said Welcome Witbooi, who completed a 13-year sentence three months ago. He is now working at Sonke Gender Justice Network.
"Offenders who have been sexually abused take it out on children and women. They want to reclaim their masculinity," he said. "An offender who has been raped doesn't see a child. He sees an object that he can abuse."
The trauma and HIV acquired during prison sexual violence then bleed into families and communities.
"If unaddressed, these health implications, amongst many others, are similarly fed back into broader society when inmates are released," he said.
Support for HIV-positive inmates
Although a ruling in 2006 guaranteed access to antiretroviral treatment for prisoners, the quality of HIV-related health services varies from prison to prison.
Access to antiretrovirals is often unreliable, with inmates waiting months before receiving their medication. "With a disease where adherence to a medication programme is vital, these gaps are very dangerous to inmates' health," Keehn told IRIN/PlusNews.
DCS also provides condoms to inmates, but it does not provide lubricant to prevent the condoms from breaking during anal sex. "Access to [HIV] testing is uneven and depends on many factors, like the specific prison and whether there is a motivated HIV coordinator on staff," she added.
In addition, inmates living with HIV often face discrimination by their peers and DCS staff. Shortages in medical and counselling staff, and a lack of understanding about HIV by inmates and staff, make life very difficult and lonely for HIV-positive inmates.
[This report does not necessarily reflect the views of the United Nations.]