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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; 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 prevalence in prison higher than in the community
HIV Prevalence rates in general population and in prisons in selected countries
45% 40% 35% 30% 25% 20% 15% 10% 5% 0%
i ex M s Ru co o ati er d Fe n tv La ia d lan er itz Sw F e nc ra d In ia es on in pa S
General adult population Up-to in prison population
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HIV prevalence in women prison almost always higher than in men prisons.
HIV prevalence rates in women / men prisons in selected countries
30% 25% 20% 15% 10% 5% 0%
A BR AZ IL MO LD O RW AN IST GA SP AI N (CT ) BO N VA IN AN DA DI PA K
HIV Prev Women in prison HIV prev Men in Prison
HIV and HIV/TB in prison: contributing factors
1. 2. Criminal Justice /Legal framework: over-representation of most vulnerable population groups for HIV All modes of transmission occurring in the community, occur in prison: ² sexual transmission (consensual, forced) ² blood transmission (injecting drugs, tattooing, and nosocomial infections (through health care), fights) ² vertical transmission: mother to child transmission Poor prison conditions: overcrowding, malnutrition, poor ventilation, hygiene Poor prison 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 5 Denial & lack of interest
3. 4. 5. 6. 7.
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
A multi factorial issue requiring a multidisciplinary response
Comprehensive HIV response (staff and prisoners)
Access to information (IEC), peers prevention Access to Voluntary Counselling & 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
Mandatory HIV testing Segregation of PLWH Send people to prisons for so called treatment
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
² Health, tuberculosis and HIV in prison poorly funded Poorly represented in national AIDS strategies Poorly (not) included in GF proposals
Some important Prison indicators
Prison population rate:
² Number of prisoners / 100 000 hab.
% pre-sentenced prisoners Occupancy rate Classification system:
² Women ² Children ² Pre-trial
Proportion of drug users (MSM, Sex workers) Prevalence HIV/TB/HCV/HBV Mortality rates HIV services available/coverage
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!
THANK YOU WWW.UNODC.ORG/AIDS