HIV and AIDS in closed settings Issues and Challenges

1. 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

2. 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?

3. HIV prevalence in prison higher than in the community

4. HIV prevalence in women prison almost always higher than in men prisons.

5. 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

6. 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

7. A multi factorial issue requiring a multidisciplinary response

8. 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

9. Don’t do • Mandatory HIV testing • Segregation of PLWH • Send people to prisons for so called treatment

10. 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

11. 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

12. 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!

13. THANK YOUWWW.UNODC.ORG/AIDS