Georgina Gutiérrez first confronted the horror of HIV when her husband was diagnosed with the virus in 1988, but it was only when he was sent to prison four years later that she became aware of the sub-human way in which infected prisoners are dealt with in Mexican penitentiaries. Since then she has been developing the first program in Latin America to combine treatment and rehabilitation for HIV patients who are incarcerated.
The New Idea
Based on her first-hand knowledge of the tribulations of inmates with HIV, Georgina Gutiérrez has designed a comprehensive intervention program that addresses the patients' core social, health care and rehabilitation needs. The first component involves the provision of information about the virus to prisoners who carry it, their family members, and to the security personnel with whom they most directly interact.
This information embraces the latest advances in drug therapy, and helps inmates frame demands for access to life-prolonging medication. The second component creates a network of support groups led by trained professionals that enable patients to discuss openly their questions and fears about the disease, as well as its influence on their self-esteem and plans for the future. The final component establishes vocational training and productive work opportunities for these prisoners, which improve their self-image by allowing them to earn some income while still in prison, as well as creating hope for gainful employment when their sentences are up.
While each dimension of Georgina's model involves the introduction of existing services to a heretofore abandoned population, what is most striking about her idea is the degree to which she has succeeded in integrating a "new" mix of "old" elements into the policy formulation of the Mexican federal bureaucracy charged with supervision of the prison system. She has convinced the highest officers of the General Directorate for Penitentiaries (DGR) that through the reallocation of existing human and fiscal resources, the services she advocates can be offered to inmates who carry HIV at very little additional cost. She has also negotiated partnerships with pharmaceutical companies who are her natural allies in the quest to provide the latest medicines to HIV patients in prison, at state expense. By successfully challenging the practice of neglect towards this population through judicious reference to human rights and budgetary realities, Georgina has opened the way for a national reform of treatment of prisoners with the virus, and is already drawing the attention of European and Latin American AIDS activists concerned with violations in their own penal systems.
There are no reliable statistics available to quantify the exact number of inmates with HIV in the Mexican prison system, or in any other Latin American country, because to this point no official authority has addressed the problem directly. The Mexican Foundation for the Struggle Against AIDS suspects that the percentage of persons infected is higher in prison than in the general population because of inmates’ complex sexual histories and their proportionally higher use of intravenous drugs. Prisoners who have been diagnosed as carriers of the virus are at least shunned and isolated, if not threatened and abused by fellow inmates and security personnel whose ignorance about modes of transmission of the disease leads them to resent any contact with infected persons.
This ignorance carries over to prison administrators who are unaware of recent developments in the fight against AIDS, whereby new medications promise to transform the viral infection from a certain death sentence to a chronic but manageable illness. Their attitude has been to ignore inmates with HIV because “they will die soon anyway,” which effectively becomes a self-fulfilling prophecy. One indication of this implicit policy “not to waste resources” on the moribund is that prison authorities systematically fail to provide HIV patients with access to vocational training or rehabilitative services, aggravating the boredom and depression of these inmates while they remain incarcerated, and perpetuating the cycle of recidivism once they leave.
Given the inherently closed nature of the penitentiary system, Georgina has been obliged to coordinate with the authorities of the DGR in order to gain access to the medical ward where her husband and 39 other inmates with the virus are isolated in the Santa Marta Acatitla prison in Mexico City. She spent several years working to gain the trust of the inmates and learning from them about the conditions they endured and their ideas on how their needs might best be served. In 1996 Georgina united the family members of these inmates, along with other bearers of the virus and their relatives, and founded the National Front for Persons Affected by HIV (FRENPAVIH), a national organization committed to lobbying for patients' access to medicine and appropriate public health policies for prevention and treatment of the disease. She convinced prison officials of the importance of providing accurate information to all inmates, and at the end of 1997 Georgina organized the first of a series of seminars in which experts explained in accessible language the nature, causes of and responses to the virus. This seminar in Santa Marta Acatitla sparked the interest and imagination of the inmates, and helped launch self-help groups in which infected prisoners shared for the first time their reactions to their predicament.
Georgina has demonstrated to the director of the DGR that the model established at Santa Marta Acatitla can be replicated in prisons throughout the Federal District of Mexico at very low cost. Prison personnel are already required to attend professional development courses at the Institute for Penitentiary Training (ICAPE), and she has incorporated classes on HIV/AIDS and sensitivity to bearers of the virus into the curriculum for medical staff, psychologists and vocational trainers. Georgina has already recruited a team of volunteers to facilitate the self-help groups. To this point she has been able to provide workshops on personal growth, emotional intelligence, and human rights aspects of HIV/AIDS to over 21,000 prisoners in Mexico City. She also gives informational talks and AIDS prevention workshops with the collaboration of other citizen organizations active in the fields of health, gender, and human rights. One concrete result of this work with the DGR has been the establishment of a policy which allows terminally ill inmates with AIDS to spend their final days at home.
She has mobilized the more than 3,000 members of FRENPAVIH around the country to press for similar services in their local prisons, while continuing to encourage the DGR to dedicate existing personnel and resources to patients with the virus. So far Georgina has established contacts for the replication of her project in the states of Tabasco, Puebla, Oaxaca, and M&eacute;xico. These contacts evolved from her efforts to organize training workshops on how to lobby local authorities for the introduction of her model into prisons around the country, with a focus on how to negotiate proposals with local authorities, clinical laboratories, and health institutions such as the Mexican Institute for Social Security (IMSS) and the Institute for the Social Security of State Employees (ISSSTE).
Georgina's work has already drawn international attention. A group working with AIDS patients in Germany came to meet with her, and is now sponsoring training for health and security personnel in prisons there. Doctors with FUNSALUD, a private Mexican foundation, have asked her to consult on the first survey of inmates with HIV in Latin America. Moreover, she has recently been invited to Peru to speak about HIV in the Mexican penal system at the Sixth Panamerican Conference on AIDS.
Georgina comes from a long line of social activists. Her father and grandfather founded a trade union for cinema projectionists, and she later joined them in organizing a residents' response to unilateral plans by the Social Security Administration to privatize their housing development. She has distinct memories from her school days of having twice taken a stand against teachers who were physically and psychologically abusing her fellow students, and in both cases the teachers were removed from the school. Yet none of this experience adequately prepared her for three blows that struck in quick succession - her father's death, her husband's diagnosis, and his subsequent incarceration. Georgina initially found herself reeling from these setbacks, before her fighting spirit recovered and inspired her to mobilize her energy and creativity to address the social ills to which she had been introduced.
Georgina's exposure to the plight of inmates with HIV has changed her life completely. She gave up reasonably lucrative work as a translator at the Shell Oil Company to work full-time as a volunteer at the Mexican Foundation for the Struggle Against AIDS, before eventually going on staff as their human rights coordinator. And after selling her house to help pay her husband's legal fees, she even sold her car so as to be able to dedicate herself completely to AIDS prevention and treatment activities. Even when her husband is eventually released, she will continue to push for the adoption of her model because, as she herself says, "I cannot do anything but this!"