1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Working together for the implementation of prevention, medical care and harm reduction in prisons: a practical experience! Catherine Ritter Heino Stöver

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Aknowledgements Nicolas Ritter Sydney West, International AIDS Society (IAS) Fondation Sidaide, Switzerland Jörg Pont, Vienna/Austria

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Plan Introduction Exercice Discussion Prevention, harm reduction and treatment in prisons: Available tools and documents Conclusions

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org Introduction Aim of this workshop: explore prevention and harm reduction issues in prisons on an institutional level Participants - multiple professionals - will practice actively in an interdisciplinary way the steps of questioning around the implementation of prevention and harm reduction concerning HIV and hepatitis in prisons. Method: role play based on a concrete situation

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Drug use and Needle & syringe program (NSP) in prisons Drug use and dependence: 10-48% in male, 30-60% in female prisoners Prevalence and frequency of drug use decrease during imprisonment Sharing of equipment is a reality Use of non sterile equipment in prison is the most important independent determinant factor of HIV infection 50 NSP programs over the world 12 countries: West and East Europe and central Asia (Jürgens 2009)

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Exercice Case study: working in groups to resolve a situation, by playing - representing the various figures involved in prisons: health staff, prison staff and administrators, NGO’s, social staff Extracts of guidelines “Standards in prevention, testing and care of addictions and infections in prison” issued in the frame of a national project “Controlling infectious diseases in prisons (BIG) 2008–2011”, developed by the Federal Office of Public Health (FOPH) in partnership with the Federal Office of Justice (FOJ) and the Conference of Cantonal Justice and Police Directors (KKJPD) in Switzerland.

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Steps - Running Read the case available Make groups according to professional identity: if possible, chose another profession than your own! Prepare the meeting (10 minutes) Define 1-2 actors in each group and observers Play the meeting (10-15 minutes) Discussion

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Discussion What were the general feelings of the actors, for example if playing the part that is not your own profession? Should something be conducted differently in such interdisciplinary meetings? What decision was taken during the meeting?

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Discussion What were the main resistance factors towards change? What were the main factors helping/promoting the change that you could rely on?

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org Overcome resistance…how Show the evidence: it works! Talk together! Regular interdisciplinary meetings among all the actors: prison staff, administrators, health staff, harm reduction partners in the general community Staff training in harm reduction: health staff, prison staff and administrators Evaluation of harm reduction measures Advocate harm reduction and be in line with national policies Communicate, inform, teach….all the time!

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Evidence of NSP’s: No HIV/HCV seroconversion No increase in drug use or iv drug use Reduced needle sharing No reports of agression with syringe used as weapon

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Prevention, harm reduction and medical care in closed settings: available tools and documents Heino Stöver, Germany

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Guiding Principles in Prison Health Care 1 Continuity of care as people pass through, in and out of the prison system is the critical issue. Access to drug treatment and health and social care provision equivalent to those provided in the community and appropriate to a prison environment. Drug users released from prison should be offered on-going rehabilitation and support on their return to the community and be encouraged to maintain their contact with community substance misuse services, as appropriate. Range of services provided should be appropriate, supported by best available evidence and ensure equivalence of national standards of care across the country. Needs of particular groups, must be considered. Vital that the service users ‘voice’ is heard and their experiences are taken into account. 1 THE PATEL REPORT (2010): PRISON DRUG TREATMENT STRATEGY REVIEW GROUP)

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org UNODC/IL (2012) www.UNODC.org/AIDS

15. Washington D.C., USA, 22-27 July 2012www.aids2012.org http://www.euro.who.int/__data/assets/pdf_file/0009/99018/E 90174.pdf

16. Washington D.C., USA, 22-27 July 2012www.aids2012.org Health in prison project WHO http://www.euro.who.int/en/what- we-do/health-topics/health- determinants/prisons-and-health

17. Washington D.C., USA, 22-27 July 2012www.aids2012.org Training documents Public Health Programme of the European Commission 2010

18. Washington D.C., USA, 22-27 July 2012www.aids2012.org Key documents Lines & Jürgens Réseau juridique canadien VIH/Sida 2006, 2009 http://www.aidslaw.ca/ FR/themes/prisons.htm

19. Washington D.C., USA, 22-27 July 2012www.aids2012.org

20. Washington D.C., USA, 22-27 July 2012www.aids2012.org To get started… Prison adaption: under construction (2012) WHO, 2007

21. Washington D.C., USA, 22-27 July 2012www.aids2012.org Systematic review of prison OST (Hedrich et al. 2012; Addiction) Review of 21 studies (incl. 6 RCTs) shows that OST is effective among the prison population: ++reduced heroin use, injecting and syringe-sharing in prison, if doses adequate; ++increases in treatment entry and retention after release; ++post-release reductions in heroin use; +pre-release OST reduces post-release deaths; +/-evidence regarding crime and re-incarceration equivocal; ? lack of studies addressing effects on incidence HIV/HCV; Disruption of continuity of treatment, especially due to brief periods of imprisonment, associated with very sigificant increases in HCV incidence.

22. Washington D.C., USA, 22-27 July 2012www.aids2012.org Time gaps in the official introduction of OST in prisons: ~7-8y (Source: EMCDDA; D. Hedrich et al. 2012,)

23. Washington D.C., USA, 22-27 July 2012www.aids2012.org

24. Washington D.C., USA, 22-27 July 2012www.aids2012.org Websites UNODC/UNAIDS/WHO publications http://www.unodc.org/unodc/en/hiv- aids/publications.html WHO Harm reduction package http://www.who.int/hiv/topics/idu/harm_reduction/en/# Needles, syringes, and paraphernalia for harm reduction http://www.exchangesupplies.org/

25. Washington D.C., USA, 22-27 July 2012www.aids2012.org Thank you for the active participation! Catherine Ritter: info@catherineritter.ch Heino Stöver: heino.stoever@fb4.fh-frankfurt.de

26. Washington D.C., USA, 22-27 July 2012www.aids2012.org IAS/NIDA Research Fellowship Programme Encouraging HIV and Drug Use Research The IAS/NIDA Research Fellowship Programme is announcing a new round of research fellowships focusing on the linkages between HIV and drug use. Stipend of US$ 75,000 in two categories:  junior scientist for an 18-month post-doctoral training  well-established HIV or drug use researcher for eight month of professional development training More information at www.iasociety.org/iasnida.aspx