Unprotected sex and rampant drug use in Asia's overcrowded and run-down prisons are fueling the AIDS epidemic in the region, and governments have been slow to recognize the threat, activists say.
Prisons "are HIV factories," said Elizabeth Pisani of Family Health International, an AIDS prevention group in Jakarta. "We are introducing a population that we know to be infected with the virus into an environment where people shoot up drugs and have anal sex."
When HIV-positive prisoners are released, there is a high likelihood they will spread the infection, she said.
Rights activists have long called for better conditions in Asian jails, where they allege inmates are routinely beaten, and deadly diseases like tuberculosis and typhoid go unchecked. Medical care in many prisons is substandard or nonexistent and widespread corruption means just about anything _ from drugs to sex _ can be bought.
Few governments in Asia's developing economies keep officials figures on HIV infections among inmates. But private groups say they are rising at an alarming rate.
In Indonesia, prisons that had reported almost no HIV cases among inmates in 1999 had almost 25 percent of their populations infected in 2003, the National AIDS Commission said.
In Thailand, one quarter of inmates at Klong Prem Central Prison on the outskirts of Bangkok have tested positive for HIV, activists say. AIDS disease has also become a leading killer in Cambodian jails.
Rising HIV rates in Asian prisons reflect a global trend that has also hit Africa, South America and Russia, the United Nations says. South African prisons have seen death rates surge 500 percent in recent years, largely because of AIDS, while Russia is seeing its HIV rates in prison rise by 15 percent to 20 percent each year.
"It probably is much worse than what we expect because prisons represent the lowest common denominator of society," said Anindya Chatterjee, a senior adviser with UNAIDS in Geneva. "These inmates are the underclass and most vulnerable to HIV. We've seen this in Russia. We've seen this in China and we'll definitely see it in Indonesia."
Indonesian inmates describe a wild atmosphere in many jails, with cells are used as shooting galleries for heroin addicts and guards paid off to allow drugs inside. Sex is also widespread, with transvestites selling themselves for as little as a US$1 and the poorest and weakest inmates raped by gang members, inmates said.
"We just shot up in our cell and one needle usually went for about 100 inmates," said Henri Fonda, a former inmate who says he's HIV positive and has lost eight friends to the virus.
Some prisons in Indonesia have started distributing information to new inmates on the dangers of unprotected sex and intravenous drug use and plan to introduce methadone _ a heroin substitute prescribed to addicts _ in Jakarta and Bali prisons starting this month.
The tourist island of Bali has led the way, setting up an HIV clinic in one jail and handing donated antiviral drugs to AIDS prisoners.
But prison officials in Jakarta say the success stories are few and complain that most prisons have no money to test inmates for HIV, pay for costly treatments or send inmates out to hospitals.
Indonesia, the world's most populous Muslim nation, also has refused to follow the lead of European countries and offer free condoms or clean needles for injecting drug users. "If we start handing out condoms and needles, it's going to send mixed messages to inmates that we will start tolerating these things," says Tulus Wijaya, a warden at the Keroboken prison in Bali.
Thailand has begun to offer condoms in some prisons, but it is not providing inmates with clean needles.
"OK, so they can't hand out needles _ it's too extreme for them to accept," said Somchai Krachangsaeng of advocacy group the AIDS Access Foundation. "But maybe they can tell the prisoners the dangers of using drugs."