Stone walls do not a prison make

Overview

Through Boresha (2010–2013), part‑funded by the European Union (EU), Mildmay worked with prisons in Kenya and Tanzania to reduce stigma, strengthen basic healthcare, and empower prisoners and officers living with HIV to know their rights, support one another, and access care. “Boresha” means “to make better” in Swahili.

Kibos Prison, near Kisumu, Kenya

Prison Officer Corporal George Agwanda coordinated HIV awareness and care improvements. “Since the Mildmay programme started, we greatly benefitted,” he said. “Inmates were trained in home‑based care (HBC) and were coping better, accessing care, and supporting each other. We didn’t have any inmates admitted with HIV in the ward, and the death rate reduced greatly.”

Prisoner testimony highlighted the impact of peer support and adherence counselling. Joe Wabuti, diagnosed HIV‑positive after severe illness, said: “The support group assisted me greatlyl adherence, nutrition. If there were no carers and no support group, I wouldn’t have been in this healthy state.”

Support group member John Mbuya described programme achievements: education and seminars with the Ministry of Health and Kenya Prisons Service; trainer‑of‑trainers in HBC, antiretroviral therapy (ART) adherence, opportunistic infections and public speaking; and promotion of nutrition, hygiene, recreational activities and psychosocial support. “We could declare that the monster HIV was under check and arrest at Kibos,” he said, noting ongoing work on defaults, denial, and risky behaviour.

Prison officers living with HIV

Disclosure among officers had historically been difficult. Officer Andrew Ogendo shared his journey through loss, diagnosis, and eventual engagement with the Kibos Prison Officers Living with HIV Support Group (established November 2010 and supported by Mildmay). “It was because of Mildmay, and their support of this group, that I was alive,” he said. Mildmay field officer and trainer Mary Wakenga (“Mother Mary”) oversaw training for hundreds of prisoners and officers since 2007, and observed, “We were progressing, not regressing.”

The Kibos Officers group

The group began with two officers trained in HBC by Mildmay and grew to 15 members, including widows and widowers. Weekly meetings offered psychosocial support, mentorship and adherence support, and activities included:

• Encouraging status disclosure among officers

• Health education to transform HIV care

• Prevention work with officers living positively

• Reducing stigma in the workplace

• Advocacy with prison leadership for officers’ rights

Leaders met Mildmay monthly for ongoing support and reporting. Chair Isaiah Otieno Odera said: “Our mantra was to train, treat and retain,” noting outreach to staff, families and young people connected to the prison.

Kodiaga Prison, near Kisumu, Kenya

With a community of around 3,000 (c. 2,000 prisoners; 500 officers), several HIV support groups were established under Boresha, building on Mildmay’s USAID‑backed HBC programme. Mixed officer‑prisoner groups (Kompesu, Kodiaga Men Prison Support Group), a lifers’ group (Gates of Hope), and a separate officers’ group operated alongside clinic‑based volunteer carers trained by Mildmay in wound care, bed baths, feeding and ART adherence.

Volunteer carers Peter and David said the work was satisfying and built friendships. Senior Sergeant Francis Odongo reported, “There used to be two patients per bed when we started; now the beds were empty.” Assistant Commissioner of Prisons, Francis Kemei, said: “The work of Mildmay was very important. Stigma reduced a great deal. Lives improved.”

Kamiti Prison, Nairobi, Kenya

At Kenya’s largest men’s prison, a support group with around 60 members was active, with 20 trained as community health workers (CHWs). Chief Medical Officer Dr David Odongo said: “The level of disclosure dramatically increased. Because of Mildmay, these prisoners were able to speak out. They had been told there was really nothing to fear.” Prisoner‑CHWs were confident delivering basic care between medical visits.

Prisoner leader Patrick M. Wandikra, six years into a 25‑year sentence, explained that 20 members were trained in August 2010 in community health needs, nutrition, adherence, opportunistic infections, and were “well‑versed” in supporting peers.

Langata Women’s Prison, Nairobi, Kenya

At Langata, the AIDS Control Unit oversaw voluntary counselling and testing, training and prevention. The Boresha‑supported group, established in 2010, had 63 members. Corporal Margaret Kiarie said: “Great friendships developed. They were encouraged and didn’t feel alone. They learnt how to live positively.”

Officer Edith, trained in HBC, described frontline care: “We had no more bedridden patients with HIV. Prisoners trained as CHWs knew how to clean and care for colleagues and advise on drugs.” By that time, 26 prisoners and six officers had trained as CHWs over 11 days. Prisoner‑CHW Carolyne said: “It was good to do what you could for the sick, and show them love. I hoped I made a difference.”

Impact

Across these prisons, the Boresha programme built peer support, disclosure and adherence, strengthened clinic‑community links, and trained prisoners and officers as CHWs and carers. Deaths and inpatient admissions associated with HIV decreased, stigma reduced, and networks of care were established that continued to shape practice in the years that followed.