AIDS Awareness Campaign — Stories from Africa

Having AIDS in Cameroon's Largest Prison

At several million people, Douala is the largest and most dangerous city in Cameroon. Its central prison, built for 800 people, now contains 3,600, of whom perhaps 100 are female. The state is unwilling to provide anything beyond the most meager and basic diet, so clothing, medicine, and entertainment are only available to inmates lucky enough to have someone in the outside world who is willing to look after them. Unfortunately, it is far more common for families to completely reject members who become incarcerated since they are perceived to be sources of shame. Consequently, there is nothing like a prison uniform and inmates spend the day lounging in a remarkably crowded concrete courtyard with access to the health clinic and a Spartan room for peer education.

SunAIDS is responsible for the peer education room and are the providers of the only social program in the prison. SunAIDS was formed in 2000 by five Cameroonians who wished to devote their time to combating the spread of HIV/AIDS. It has grown to approximately 80 members, 95% of whom are HIV-positive. They scrape together funding from donors of every variety and design or coordinate diverse and original programs. With help from the World Bank and local cellular networks, they are currently modifying a portion of their simple offices into the center for a newly launched Helpline for information on HIV and Sexually Transmitted Infections. Volunteers of various backgrounds and from different organizations will be converging on this center to man the telephones that offer a free informational service to anyone in Cameroon with access to a telephone.

SunAIDS also provides the services typical of an association for HIV-positive persons: they offer counseling to anyone who visits their center, they offer access to numerous multimedia and print educational materials, they visit the homes of infected persons to assist patients and their families, and they host regular meetings of the HIV-positive community for group therapy and for the purposes of socializing. When the prison heard of their outreach and hard work, it contacted SunAIDS.

SunAIDS elected Suzanne Mbondi to be its representative to the prisoners because of its confidence in her skills as a counselor. Initially, Suzanne was apprehensive about the task; she had not nominated herself. She readily admits that "It is not easy to be there. Every time you are scared." But she has persisted with her work three days a week for the last ten months and has grown to enjoy it. Along with the coordinator of SunAIDS, Mr. Armand Totouom, who visits the prison with some frequency, she is hoping to expand the program until it can serve as a viable model to be followed in the dozens of other prisons scattered throughout Cameroon.

The German government's development branch, GTZ, helps to fund this program. They provided the funds for the creation of a small office space adjacent to the prison courtyard, they make it possible for fifty prisoners a week to be tested for HIV, and they help Ms. Mbondi with her food and transportation. Soon, the project will enter a new phase in which a permanent health aide will be provided to assist the overworked prison doctor and the unfortunate prisoners. This aide will be able to focus on issues of sexual health and the unique vulnerabilities of HIV patients.

An astounding number of prisoners submit to the HIV test. On average, the prison doctor, Dr. Amougou Ello Germain, tests fifty patients a week, using all of the available kits. He was quick to admit that "to some it is a diversion because there isn't much to do. Some prisoners wish to be tested every week." But he added that SunAIDS is doing very good work. He is the only doctor for all of Douala's six prisons and he spends much of his time at the central prison where SunAIDS is active. He noted that SunAIDS is the only organization that is trying to do anything for the prison population, explaining that aside from Suzanne and the occasional colleague it is only a handful of evangelists who are willing to brave the prison environment.

And it does take bravery. To reach the social offices of the prison, we were simply walked through the courtyard by a small woman in a military outfit who was carrying a chipped wooden stick that had been painted black. The courtyard was inhabited by at least one thousand prisoners who stood, sat, slept, followed us grasping at our hands and asking for things, or wished us welcome and merry Christmas, since it was that time of year. The offices were crowded with waiting inmates. Everyone else in uniform was manning the front doors or the courtyard gate; they were few in number. Suzanne marches through this milling swarm of convicted men to offer counseling and to train peer educators. As we cut our way through the courtyard, many voices murmured things about SIDA, confirming that they know why Suzanne appears, but nobody was disrespectful or threatening.

Suzanne introduced us to Daniel Babeneki Biyek, her most trusted peer educator. She and Mr. Totouom both joked with him about the necessity of his remaining incarcerated to help them with their work. He is a veteran of one year and will apparently be released soon. This constitutes one of the frustrations of social work within the prison. Suzanne has helped with the training of more than fifty peer educators. Of these, only seven currently remain in prison—the long-term prisoners typically avoid the transient population, the doctor, and everyone else.

The work of a peer educator is not easy. Daniel, for instance, spends much of his time going cell to cell or inmate to inmate, trying to encourage them to visit the small room where sexual health issues can be discussed with some privacy or to test themselves for HIV. He has taken to the work and expresses an interest in continuing with peer education after his release. However, for the time being he is asking for help. The center needs print materials in French that help to explain the nature of HIV/AIDS and sexually transmitted infections—it currently boasts three posters. It is a remarkably simple request, but SunAIDS does not have the funds to grant it. The doctor drew our attention to a more expensive concern: there is currently nothing that can be done for the prisoner who discovers that he or she has HIV/AIDS. The prison does not have a stock of anti-retroviral medications to distribute, nor does it have the machinery to test CD4 levels and determine the most effective drug regimen. This will obviously need to change.

HIV-positive prisoners can avail themselves of peer education, the opportunity to receive counseling from Suzanne and her colleagues, or they can join the fledgling Association of Prisoners Against AIDS, which is chaired by a warden and receives regular help from the doctor. For World AIDS Day, this association planned and successfully performed a series of sketches and musical numbers designed to enlighten the prison population at large. Their work was very well received and their membership continues to grow.

If all goes well, the project will be in full swing after another five or six months. At that point, Mr. Totouom and SunAIDS can start lobbying for the program to be replicated at other prisons. In all likelihood, this will entail finding foreign donors. Mr. Totouom's only bitter complaint was that the conservative trend in American politics has made it incredibly more difficult for a group that is vocal about condoms to receive the assistance and support that it deserves. The nodding heads of nearly a dozen SunAIDS members showed that his outrage with American policies that expect foreign cultures to behave like residents of the Bible Belt was shared by everyone in the room. He said, "I'm Christian—but we can't all be Methodists or Baptists or whatever."

For now, Mr. Totouom is helped by donors in Europe such as Médecins Sans Frontières, Solidarité SIDA, CARE, and GTZ. He and his organization will continue to work relentlessly on amassing more support and offering more comprehensive services.

To contact Mr. Totouom, please email: armand_totouom@yahoo.fr.

Unfortunately, as readers may have guessed, photography was not permitted within the prison walls.


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