HIV and HCV in prisons: From evidence to action. Firenze, ICAR 2011, 27 March 2011 Ralf Jürgens, Canada. Acknowledgements. Annette Verster & Andrew Ball (WHO) Peer reviewers UNODC, UNAIDS. Background.
Firenze, ICAR 2011, 27 March 2011
Ralf Jürgens, Canada
Sources: WHO, UNODC, UNAIDS, 2007; Jürgens, Ball, Verster, 2009; Pontali , Ferrari, 2008; Dolan et al., 2007, Macalino et al., 2004, Dolan & Wodak, 1999; MacDonald, 2005; Bobrik et al., 2005; Taylor et al., 1995
Difficult to obtain reliable data
Methodological and ethical challenges
Sex violates prison regulations
Feelings of shame and homophobia: prisoners decline to participate in studies
Admitting to having been raped in prison goes against prisoner code
Nevertheless, evidence is clear: consensual and non-consensual sex do occur
Africa: (Nigeria, Zambia, Mozambique): 4-5.5%
South America: 10% (Brazil)
Asia: 20% (Thailand)
Central & Eastern Europe:
Russia (9.7-12%; much higher among long-term prisoners)
Slovakia: 19% of female, 5.6% of adult male, 8.3% of juveniles
Armenia: 2.9% penetrative (36% against their will)
Western Europe, Canada, Australia: 1-12% among males, up to 37% among females
Source: WHO, UNODC, UNAIDS, 2007
Drugs can and do enter into prisons
Many prisoners are in prison because of offences related to drugs, and find a way to use inside
Some discontinue using drugs in prisons
Other prisoners start using (and/or injecting) drugs in prison
No country has been able to stop drug use in prisons
Extensive HIV transmission can occur in prisons, significantly contributing to the spread of HIV among the general population.
Thailand: HIV prevalence rate among injectors rose from a negligible percentage to over 40% between Jan & Sept 2008, fuelled by transmission of HIV in prisons.
Six studies among people who inject drugs in Thailand found that imprisonment was associated significantly with HIV infection.
Outbreaks of HIV in prisons have been documented in a number of countries, incl Scotland, Australia, Lithuania, and Russia.
In Lithuania, in May 2002 the number of new HIV-positive test results among prisoners found in a two-week period equalled all the cases of HIV identified in the entire country during all of the previous years combined.
284 prisoners (15% of the prison population) were diagnosed HIV-positive between May and August 2002.
Lack of work and meaningful activities
Decaying physical infrastructure
Lack of adequate medical care
Lack of nutritious food & clean water
Abuse & corruption
Health of prisoners = issue of public health concern
All people in Italy would benefit from enhancing the health of prisoners and reducing the incidence of communicable diseases
prisoners and their families
the families outside prison
3. Communicable diseases transmitted in prison do not remain there.
Source: WHO, UNODC, UNAIDS, 2007; Correctional Service Canada, 1999; Dolan, Lowe & Shearer, 2004; May and Williams, 2002; Yap et al., 2007)
Today, NSPs are operating in a growing number of countries, in all types of prisons and prison systems:
In well funded prison systems (eg, Spain, Switzerland, Germany) and severely under-funded prison systems (eg Moldova, Iran)
In institutions with drastically different physical arrangements for the housing of prisoners, from single cell to barracks
In prisons of all security classifications and sizes
In men’s and women’s institutions
(Stöver & Nelles, 2003; Stark et al., 2005; Rutter et al., 2001)
PNEPs utilize various methods for distributing injecting equipment
Very little – see Moldova example
Cost effective – every euro spent on prison NSP saves many euros that would otherwise have to be spent on treatment of infectious diseases
NSPs are important component of efforts to reduce risk of HIV through injecting
But alone they are not enough to eliminate the risk
Effective, evidence-based drug dependence treatment is also needed, in particular methadone maintenance treatment (MMT)
46% of prisoners had a history of injecting drug use
Other measures would not be as effective
Drug interdiction efforts are very costly
They only reduce, but do not completely eliminate drug use in prisons
“Governments may … wish to review their penal admission policies, particularly where drug abusers are concerned, in the light of the AIDS epidemic and its impact on prisons.” (WHO, 1987)
All prisoners have the right to receive … preventive measures equivalent to [those] available in the community” (WHO, 1993)