In Zambia, a university project is working to prevent the spread of Aids in jails, while in India students are benefiting from an awareness programme.

Prisoners are imprisoned "to be reformed, not to become HIV-positive", says Oscar Simooya, chief medical officer of the Copperbelt University in Zambia and head of an outreach programme serving eight of the country's jails, writes Karen MacGregor.

But the reality is that when men are jailed anywhere in sub-Saharan Africa they face a high risk of infection - primarily through unprotected sex, sharing razors, tattooing, intravenous drug use and lack of HIV/Aids education and materials.

While sexual activity between males is common in prisons, homosexuality is illegal in Zambia and so, therefore, is the distribution of condoms that could help cut down the rapid spread of the killer virus.

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Simooya's project, "In But Free: HIV-Aids Prevention in Prisons", is one of two intervention programmes run by the university's health service. The project, initiated in 1995, is aimed at promoting HIV/Aids prevention in jails, using both prison inmates and officers as key players. There are some 13,000 prisoners and 2,000 officers in Zambian prisons.

The programme's work includes training inmates as peer educators and officers as counsellors: so far, 623 inmates and 126 prison officers have been trained. It also produces and distributes education materials, promotes hygiene and recreational activities and provides shaving appliances, nutritional support and monthly medical consultations.

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There is comprehensive evaluation - an annual prison conference, monthly project meetings, in-depth interviews with peer educators and group discussions with inmates and staff.

Lack of resources, however, and the illegal status of homosexuality have impeded progress in combating infection. Initially, In But Free called for the issuing of condoms in prisons - but it ran into opposition in and outside the facilities.

Despite much progress, researchers have found that there is still risky behaviour in Zambian prisons, along with high levels of sexually transmitted disease and tuberculosis. Lack of drugs in prison clinics limits treatment, while poor hygiene, overcrowding and insufficient food exacerbate the poor health of infected inmates.