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HIV and AIDS in closed settings Issues and Challenges . Journalist Global Media Training National Press Foundation’s Journalist Vienna, 14 July 2010. Dr Fabienne Hariga Global focal point for HIV in prisons. 30 million people incarcerated each year in prisons only;

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hiv and aids in closed settings issues and challenges

HIV and AIDS in closed settingsIssues and Challenges

Journalist Global Media Training

National Press Foundation’s Journalist

Vienna, 14 July 2010

Dr Fabienne Hariga

Global focal point for HIV in prisons

slide2
30 million people incarcerated each year in prisons only;

HIV prevalence in prison can be very up- to 65%;

50-80% of deaths in prisons reported to be due to TB (WHO)

Proportion of IDUs, can be very high (80%)

Number of drug users detained in CDTC?

hiv and hiv tb in prison contributing factors
HIV and HIV/TB in prison: contributing factors
  • Criminal Justice /Legal framework: over-representation of most vulnerable population groups for HIV
  • All modes of transmission occurring in the community, occur in prison:
    • sexual transmission (consensual, forced)
    • bloodtransmission (injecting drugs, tattooing, and nosocomial infections (through health care), fights)
    • vertical transmission: mother to child transmission
  • Poor prison conditions: overcrowding, malnutrition, poor ventilation, hygiene
  • Poorprison management: violence, gangs, corruption
  • Low access to health care (preventive, curative, reproductive and palliative) and weak or nonexistent linkages with public health sector and NGOs
  • Stigma and discrimination for PLWH, for detainees; for drug users , MSM
  • Denial & lack of interest

Prisons are a breeding ground for HIV and TB epidemics

key elements to be addressed
Key elements to be addressed
  • Introducing comprehensive HIV prevention, treatment & care
  • Providing equivalent health care services to those in the community
  • Improving prison conditions and undertaking prison reforms
  • Reducing prison population and undertaking criminal justice reforms
comprehensive hiv response staff and prisoners
Comprehensive HIV response (staff and prisoners)
  • Access to information (IEC), peers prevention
  • Access to VoluntaryCounselling & Testing (VCT)
  • Prevention, treatment of STIs and condoms programming
  • Access to safe injection equipment, tattooing eq.,
  • Access to evidence-based drug dependence treatments including opioid substitution
  • Access to ARV (Treatment, PEP, PMTC)
  • Access to protective equipment (staff)
  • Prevention of sexual violence, conjugal visiting rooms
  • Universal precaution
  • Prevention and treatment of TB and HIV/TB collaborative
don t do
Don’t do
  • Mandatory HIV testing
  • Segregation of PLWH
  • Send people to prisons for so called treatment
slide10

Challenges

  • Overuse of imprisonment and underuse of alternatives
  • Legal contexts
  • Prison authorities are often isolated from other national health authorities such as M.o.H, drug control agencies, national AIDS councils, or CCM;
  • Denial that HIV in prison is a problem, that transmission occur in prison
  • Many authorities are concerned but lack of politic and public interest
    • Health, tuberculosis and HIV in prison
      • poorly funded
      • Poorly represented in national AIDS strategies
      • Poorly (not) included in GF proposals
some important prison indicators
Some important Prison indicators
  • Prison population rate:
    • Number of prisoners / 100 000 hab.
  • % pre-sentenced prisoners
  • Occupancy rate
  • Classification system:
    • Women
    • Children
    • Pre-trial
  • Proportion of drug users (MSM, Sex workers)
  • Prevalence HIV/TB/HCV/HBV
  • Mortality rates
  • HIV services available/coverage
remember
Remember !
  • HIV in prisons: all regions are concerned
  • UNODC programmes should address HIV/TB in prisons for all (and not only HIV and Drug users in prisons)
  • There are many issues, many challenges … but also opportunities!
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