Much has been written about prison conditions in South Africa. Overcrowding, violence, poor sanitation and inadequate access to health care are the order of the day in most prisons. These conditions provide the ideal setting for the spread of disease. In the words of Anton van Niekerk: 'Viral diseases, as we know, do not all become epidemics. To become an epidemic, a niche or social context is required'.
Although the exact prevalence in South African prisons of communicable diseases, such as the Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), is unknown, we may draw inferences from regional epidemiological studies. According to one study, HIV prevalence in sub-Saharan African prisons is two to 50 times greater than that of the general population. The high prevalence rates of HIV exacerbate the TB infection rates among inmates, as TB is the most common opportunistic infection among people living with HIV in Africa. TB incidence in prisons worldwide has been estimated at more than 20 times higher than in the general population. Consequently, it is not surprising that, according to the Department of Correctional Services' Annual Report for the years 2011 to 2012, the most common causes of natural deaths among inmates were TB, pneumonia and AIDS.