Transcript HIV AIDS Section Comprehensive package of interventions for HIV in prison settings Fabienne Hariga Senior Adviser UNODC HIV AIDS section, Vienna AIDS 2012 Washington, 27 July 2012

HIV AIDS Section
Comprehensive package
of interventions for HIV
in prison settings
Fabienne Hariga
Senior Adviser
UNODC HIV AIDS section, Vienna
AIDS 2012
Washington, 27 July 2012
30 million people incarcerated each year
Joao da Silva
50-80% of deaths in prisons reported
to be due to TB (HIV)
The proportion of injecting drug
users/ drug dependent people among
the prison population can be very
high up to 50%
High risk work environment for staff
especially for TB and also for HIV
High HIV prevalence rates in prisons
4
HIV prevalence in prisons higher than in the
community
HIV prevalence rates in general population and in
prisons
HIV Gen. Pop.
HIV Prison
A
rm
en
A ia
us
A tral
ze ia
rb
ai
Bu jan
lg
In ari
do a
ne
A sia
rg
en
tin
Es a
Sw ton
az ia
ila
nd
35%
30%
25%
20%
15%
10%
5%
0%
Women represent less than 10%
of the population
HIV prevalence in women prison
almost always higher than in men
prisons.
80%
70%
HIV men
60%
HIV women
50%
Total HIV
40%
30%
20%
10%
0%
Canada Argentina Uganda Ukraine Zambia Swaziland
HIV and HIV/TB in prison: contributing factors
Criminal Justice /Legal framework: overuse of imprisonment, overrepresentation of most vulnerable population groups for HIV and level of
efficiency of criminal justice system
All modes of transmission occurring in the community, occur in prison:
(sexual, blood, vertical)
Poor prison conditions: overcrowding, malnutrition, poor ventilation, hygiene
Poor prison management: violence, gangs, corruption, classification
Low access to health care (preventive, curative, reproductive and palliative)
and weak or absence of 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 for people living
and working in prisons, for their families
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and for the community
A multi factorial issue requiring a multidisciplinary
response
The Comprehensive Package: General Principles
Prison health is public health
– Linkages with public health and community programmes
Human rights based and gender sensitive
– Principle of equivalence
– Medical ethics
– No segregation of PLWH;
Criminal justice reforms to reduce the prison population
– Alternatives to imprisonment
– Reduce pre-trial incarceration
– End compulsory detention of drug users and sex workers for “rehabilitation”
Prison reforms
– Ensure safe prison conditions
– Prevent violence
– Proper classification
– Conjugal visiting rooms
The Comprehensive Package: 15 Key interventions
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Information, education and communication
HIV testing and counselling
Treatment, care and support
Prevention, diagnosis and treatment of tuberculosis
Prevention of mother-to-child transmission of HIV
Condoms programmes
Prevention and treatment of sexually transmitted infections
Prevention of sexual violence
Drug dependence treatment including Opioid Substitution Therapy
Needle and syringe programmes
Vaccination, diagnosis and treatment of viral hepatitis
Post-exposure prophylaxis
Prevention of transmission through medical or dental services
Prevention of transmission through tattooing, piercing and other
forms of skin penetration
15. Protecting staff from occupational hazards
Acknowledgements
• Ralf Jürgens
• Contributors through the
electronic consultation and
participants at the expert group
meeting
• UN Partners: ILO, UNAIDS,
UNDP, WHO
Prisoners shall have access to
the health services available in
the country without
discrimination on the grounds of
their legal situation. Basic Principles
for the Treatment of Prisoners (9)
THANK YOU!
www.unodc.org/aids