Promoting sexual health and accessible HIV Prevention, Treatment, Care and Support services for women prisoners in Zimbabwe and Malawi.

The Sub Saharan African region remains at the epicentre of the HIV epidemic, with a continuing disproportionate level of HIV infected women and girls, and concentration of HIV among inmates in prisons. HIV prevalence among women prisoners is higher due to sub-standards in hygiene, limited access to sexual and reproductive (SRH) services, and interruption of the necessary services during incarceration. Adequate health services in prisons are mandated under the Sustainable Development Goals (SDG 3, 5, and 16), as well as under the United Nations Standard Minimum Rules for the Treatment of Prisoners (Nelson Mandela Rules), the Bangkok Rules for Female Prisoners and in the SSA region, where the partnership will take place, the Southern African Development Community Minimum Standards for HIV in Prisons. The rationale for this new partnership is grounded in the recent United Nations evaluation, which reported that current provisions for women in Zimbabwean and Malawian prison systems currently fall far short of mandated equivalence care standards.

This unique partnership will challenge and address the SRH inequalities of women prisoners, who are a vulnerable HIV/AIDS population in Zimbabwe and Malawi. Both countries are compromised by a lack of robust gender sensitive monitoring systems for HIV/AIDs in prisons, and little strategic information available around women prisoner's experiences and needs. It will set the scene for a strong international collaborative effort to monitor, investigate, understand and promote women prisoner's human rights and SRH needs in Zimbabwe and Malawi. The issue of HIV/AIDS in prisons is both a human rights and public health issue, which requires a strategic approach to prevent HIV transmission and improve health for all, whilst at the same time ensuring the respect of human rights and dignity of those infected and requiring treatment.

The partnership is interdisciplinary and inter sectoral, and brings together key partners from development, law, gender and human rights, and the performing arts, in conjunction with public health and clinical disciplines. Its research, communication and policy reform activities sit within the global aim of leveraging the end of AIDS through working and collaborating in an interdisciplinary and multi-sectoral partnership (sustainable development goal, SDG 17). Understanding prison environmental cultures which shape prison staff and wardens' understanding and responsiveness to female prisoners' SRH needs in both countries is vital to inform policy change and improved standards for women prisoners and their children.

In partnership with CSOs, the project activities will support expert and local knowledge sharing and build national and international collaboration to generate research interest, research capacity and expertise, and develop participatory theatre programmes used to disseminated HIV/AIDS and SRH messages. Local cultures are central to design and piloting in prisons. Participatory HIV communication using forum and image theatre have never been applied to women in the prison setting. Using theatre, women prisoners are both creators and spectators. This is central to communication of HIV and SRH messages to prisoners and staff, both within the public health and human rights domains. The partnership through its activities will foster health citizenship and a sense of belonging to a community of people whose citizenship has been devalued at two levels, namely that of gender, and that of incarceration.

The partnership represents a form of international sustainable development work which will create a first step in both countries towards addressing female prisoner SRH disparity, and ensure that their views are utilized to contribute to reframing of gender sensitive and human rights based prison responses and prison health policies, and enhance their access to high-quality and stigma-free SRH and HIV prison services when needed.

The partnership and its activities will advance international and national scientific understanding and policy dialogue around SRH needs and minimum standards of SRH service provision for women incarcerated in Zimbabwean and Malawian prisons. Prior to the partnership, research and surveillance activity on women prisoners SRH needs are scant, a trend which is visible in the SSA region itself. It is intended that partner countries will start to implement enhanced monitoring and surveillance of HIV rates among women prisoners and their children, develop gender sensitive and human rights based SRH services, and implement culturally appropriate and participatory HIV/AIDS educational programmes using performing arts in prisons.
Benefits of the partnership centre on conceptual impact in raising higher level, professional level, prisoner and community level HIV awareness and contribution to knowledge; instrumental impact in stimulating policy and practice reform around the SRH rights of women in prison based on the evidence synthesis and policy dialogue in each country; capacity building impact in building strategic research capacity to strengthen research uptake and evidence based strategic monitoring in prisons, and networks and connectivity impact in establishing this new cross cutting and interdisciplinary partnership which connects the supply of evidence with demand for change.

Long term impact centres on the new collaboration focusing on women prisoners SRH in the Zimbabwe and Malawi, with potential to expand across the SSA region, and a new focus on cross disciplinary research and education, evidence based programming and gender sensitive prison health policies in both countries and potentially the SSA region, in line with needs identified through the pilot study and international minimum standards requirements. This new research and HIV awareness raising focus using gender sensitive interventions in prisons should benefit the wider community, with long term community outcomes centring on reduced incidence of HIV in children, reduced complications and medical costs, and improved long term care of mothers with HIV, both when incarcerated and on release to their communities.

Capacity building across sectors is central to the lasting success of the partnership. The blended approach spanning arts, humanities and health, to strategic capacity building for information gathering, research activity, and participatory theatre related to HIV/AIDS education in prisons is supported by the full participation of CSOs. These CSOS have multiple functions in the general sustainable development agenda, and are active in the wider community in tackling the HIV/AIDS epidemic in Zimbabwe and Malawi. The collaboration between universities and CSOs in working together on the issue of women prisoners SRH will heighten impact, will support continued and SSA region research interest and capacity, and encourage development of interdisciplinary courses on public health in prisons. It will also underpin future collaborations in performing arts work both in prisons and in communities.

UNODC has pledged strategic oversight of this new partnership, and technical assistance for future expansion of similar capacity building work across other countries in the SSA region. Dissemination of findings to a wide variety of target audiences and through a variety of mediums is envisaged. All established and innovative channels for dissemination will be utilised and in appropriate local languages. Additional future plans to sustain the partnership and its collaborative activities include funding applications and the situating of this partnership as a special interest research group within the African HIV in Prisons Partnership Network.