1. Knowing your Epidemic: Designing Better Interventions in Prisons Deputy Commissioner Mary C. Chepkonga Kenya Prisons Service International AIDS Conference 2012, July 25 2012, Washington DC USA

2. About Kenya Prisons Service (KPS) Kenya Prisons Service established since 1911 Mandate of KPS: – To contain and keep offenders in humane safe custody – To rehabilitate and reform offenders, – To facilitate administration of justice and – To promote prisoner social reintegration Headed by Commissioner of Prisons 108 prisons countrywide 23,000 uniformed and civilian staff Directorate of Health Services manages prison health services AIDS Control Unit set up in 2004 for HIV workplace policy

3. Profile of Inmates Population (KPS 2010) Total Prison Population54,000 Annual cumulative 253,524 (2010) Incarceration rate (per 100,000 pop)667 Official Holding Capacity of Prisons26,757 Female prisoner population Annual cumulative 23,644 (9.3%, 2010) Child prisoner popn below 18 years (excludes children with mothers) Annual cumulative 771 (0.3%, 2010) Number of remand prisonersAnnual cumulative 164,893 (2010) % Pre-trial versus convicted prisoners65% (KPS, 2010)

4. Prisons Study Design Objective: To determine prevalence of HIV and risk behavior in prison settings. Study population: 783 inmates plus 247 prison staff Target location: 25 prisons countrywide Methods: – Individual questionnaires: - 783 inmates and 247 prison staff – Focus group discussions - 6 for inmates – Key informant interviews – 25 prison staff – Health facility assessment – 25 facilities Ethical clearance: Kenyatta National Hospital Ethics & Research Committee

5. Age and Sex Distribution of Inmate Respondents A total of 783 inmates were interviewed and tested for HIV

6. Profile of inmate respondents 84% of inmates were first time offenders 6

7. Risky Behaviour in Prison 38% of inmates reported ever sharing razor-blades 9% of inmates ever coerced into sex, particularly inmates <24 yrs 13% of inmates had consensual sex with other inmates Exchange of sex for money, goods or services is reportedly common A third of prison staff could recall work related events that may have exposed them to HIV infection, e.g. injury from needles for medical staff while warders cited injury from hidden needles when searching inmates.

8. HIV Testing History and Prevalence 77% inmates previously tested for HIV versus 23% for TB High HIV prevalence among prison inmates 8.2% versus 6.4% for adult population (KDHS 2008/09) HIV prevalence for female inmates thrice that of male inmates: 19% versus 6%. Inmates from Maximum Security prisons had highest HIV prevalence (16%), followed by Women's prison (13%)

9. Drug Use in Prison 13% of inmates have used cannabis, 3% amphetamines, 2% alcohol, 1% heroin and 0.4% cocaine. Illicit drugs trafficked into prison by inmates from court hearings or corrupt security officers who supply drugs or facilitate their entry.

10. HIV-Related Services Availability in Prison

11. Recommendations from Study Adapt the UNODC recommended comprehensive package for HIV interventions in prisons as per country context and national guidelines Promote a human rights approach and principle of equivalence for prison health as in the community Ensure enabling environment for smooth implementation of the comprehensive package of HIV prevention Develop a joint action plan with all concerned stakeholders for the pilot and roll out of the comprehensive package.

12. Progress to Date Prisons study report disseminated widely: all provincial KPS focal points, national HIV stakeholders and at ICASA 2011 Kenya Prisons Health Strategic Plan development is underway Comprehensive Package for HIV Prevention in Prison Settings launched in Nairobi and Mombasa Drug use in prisons being addressed in national harm reduction guidelines for IDUs

13. Acknowledgements MOHA KNH NHRL NCHPR UNODC UNAIDS NASCOP NACC Bon Sante KPS ACU & SUB-ACUs Study participants: – inmates, – prison staff, – health workers

14. THE END Q & A 14