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Needle and syringe programmes in prisons Dr Fabienne Hariga Senior Adviser UNODC HIV/AIDS Section.

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Presentation on theme: "Needle and syringe programmes in prisons Dr Fabienne Hariga Senior Adviser UNODC HIV/AIDS Section."— Presentation transcript:

1 Needle and syringe programmes in prisons Dr Fabienne Hariga Senior Adviser UNODC HIV/AIDS Section

2 HIV in prisons: a public health issue The facts 30 million people go through prisons each year People who inject drugs represent up-to 70% of prison population Number of PWID go 1-6 times through prisons during life HIV prevalence prisons up-to 50 times higher than general population HIV transmission via injection equipment does occur in prisons – Ex: Thailand: HIV incidence 4.18 per 100 person--years among all inmates - 11.10 injection inmates (Thaisri et al 2003) Hepatitis C xx? times more HIV and TB first causes of mortality in prisons in many countries

3 Injection in prisons: – Reduced – Initiation In the absence of NSP, people share syringe and needles and/ home made syringes Source: The Fix DRUG INJECTION IN PRISONS

4 1.Needle and syringe programs (NSPs) 2.Opioid substitution therapy (OST) and other evidence-based drug dependence treatment 3.HIV testing and counselling (HTC) 4.Antiretroviral therapy (ART) 5.Prevention and treatment of sexually transmitted infections (STIs) 6.Condom programmes for people who inject drugs and their sexual partners 7.Targeted information, education and communication (IEC) for people who inject drugs and their sexual partners 8.Prevention, vaccination, diagnosis and treatment of viral hepatitis 9.Prevention, diagnosis and treatment of tuberculosis (TB) (52 CND Political declaration ECOSOC resolution E/2009/L.23) WHO/UNODC/UNAIDS Comprehensive package for HIV and PWID

5 5 The evidences: Feasibility & Effectiveness of NSP in prison settings Drug consumption by participating stable or decreased No reported instances of initiation of injecting Sharp decline in reported sharing of needles and syringes - virtually non-existent No reported new HIV, hepatitis B or hepatitis C Facilitate the referral to drug treatment Reduce the occurrence of abscesses No reported use of needles or syringes as weapons No accidental puncture for prison officers

6 Harm reduction in prisons works

7 HIV in prisons: a human rights issue Global policies on access to health care/HIV in prisons Alternatives to imprisonment (GA A/RES/S-20/3) Declaration on the Guiding Principles of Drug Demand Reduction – (CND Res 55/12) Alternatives to imprisonment for certain offences as demand reduction strategies that promote public health and public safety and GA A/RES/45/110 (Tokyo rules) Article 12 of the Covenant on Economic, Social and Cultural Rights, “[t]he States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” RES AG 2200 A (XXI) (1966) …..the obligation of States to respect the right to health implies to refrain from ‘denying or limiting equal access for all persons, including prisoners or detainees (…) to preventive, curative and palliative health services 7 Basic Principles for the Treatment of Prisoners, Principle 9, that “Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.” GA RES 45/ (1990 )

8 Equivalence ? Needle and syringe programmes in community and in prisons (2013) Adapted from Global State of Harm Reduction, 2012 Afghanistan ( pilot) Germany (1)Iran Kyrgyzstan (all) (Luxembourg) Moldova (9) Portugal? Romania Spain (38) Tajikistan 1 (pilot) Switzerland (7) Australia? France? Canada ?

9 Country Total N. Prisons settings Start Year Implementation modality Nb. Prisons w/NSP 200620112013 Switzerland1141992 Disp. machines/Health services/NGOs 777 Germany1851996Dispensing machine111 Spain821997Prison Health service/NGO38 Moldova171999Peer based/health services799 Kyrgyzstan172002 Peer-based + health services /NGO 1116 Belarus322003 1 Pilot00 Armenia122004Health Service3 Pilot00 Iran2532005Health services1 pilot3 pilot0 Luxembourg22005Health services11review Portugal492007 0 1 Pilot 0 Romania452009Health services030 Tajikistan192010 0 1 Pilot 1 pilot Afghanistan20130 (1 pilot )

10 Prison Needle & Syringe Programmes Models of Distribution Photographs by Rick Lines Germany Photograph UNODC Moldova Romania

11 Observations Very limited number of pre-trial or penitentiary establishments with needle and syringe in prisons Low coverage Many programmes do not work very well: – Too strict control / lost of privileges – Lack of confidentiality and anonymity Peer based NSP seemed to be the most effective and the most sustainable

12 By-law 3/2007 and Order 22 144/2007 Ministry of Health and Justice authorized a pilot PNSP in Lisbon and Paços de Ferreira in 2008–2009. The participant, after giving specific information on his pattern of use, received a kit with two syringes, filters, disinfecting towel, clean cup, citric acid, bi-distilled water and a condom. The rules were that the kit should be kept inside its box; if the cell were inspected, the inmate should state that he is in possession of the kit; and the kit should only be taken outside the cell to be exchanged by the health-care unit. After 12 months no syringes were exchanged in either of the prisons CASE STUDY: PORTUGAL

13 Conclusions Mixed system seems the best measure (Peer based /dispensing machines/health service) No exceeding control measures Training Quality control and M&E Part of comprehensive package of interventions including overdoses prevention & management

14 Part I :Background Evidences Legal framework Part II: Elements of PNSP Models advantage/disadvantages Guides of an effective programme Materiel Part III: Advocacy for PNSP Part IV: Planning and implementation Preparation Programme framework Budget Implementation Part V: Quality assurance Monitoring Evaluation Trainin g Annexes

15 General Principles A commitment to public-health objectives & to the rights to health. Clear policy direction and oversight of the programme Consistent guidelines and protocols + flexibility to take into account variations in population profile and security levels. Participation of prisoners and staff in the planning and operational process Training to raise understanding, allay fears of staff and prisoners and encourage prisoner participation.

16 Part of a comprehensive approach 1.Information, education, communication 2.Condom programmes 3.Prevention of sexual violence 4.Drug dependence treatment including OST 5.Needle and syringe programmes 6.Prevention of transmission through medical services 7.Prevention through tattooing, piercing and other skin penetration 8.Post exposure prophylaxis 9.HIV testing & counselling 10.HIV Treatment, care and support 11.Prevention, diagnosis and treatment of TB 12.PMTC 13.Prevention of STIs 14.Vaccination, diagnosis & treatment of hepatitis 15.Protecting staff from occupational hazards

17 Acknowledgements Heino Stöver Participants in different consultations

18 Thank You UNODC HIV Website LINK

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