1 Health In Prison - HIV prevention for people with disability in prison Matthew Bowden Executive Director, Leadership Team People with Disability Australia

Sanibonani! Molweni (Xhosa) Lotsha (Ndebele) Dumelang (Northern Sotho) Lumela (Southern Sotho) Sanibonani (Swazi) Dumelang (Tswana) Avuxeni (Tsonga) Ndaa (Venda) Goeie dag (Afrikaans) Hello/ Good morning ! (English) 2

Introduction PWDA regards HIV/AIDS as a chronic health impairment that can lead to people experiencing disability – we address this through individual and systemic advocacy – our members include people living with HIV/AIDS PWDA works with people with disability who are in the most marginalised and segregated settings including people incarcerated in prisons, juvenile detention centres and immigration detention PWDA regards people with disability as being at specific risk of HIV infection and requiring adjustments in the way that HIV information, treatments and supports are provided 3

How are people with disability at increased risk to HIV infection? Lack of sexuality, sexual health and sexual rights information, education and training Inaccessible health promotion messages Segregated education or little/no schooling Homelessness and segregated housing - hard to access information and practice safer sex and safer drug use Marginalisation, inequality, disadvantage and poverty Higher rates of sexual assault Infantilisation and myths about the sexualities and drug use of people with disability Heterosexism, homophobia and assumptions only gay men are at risk of HIV 4

People with disability in prison and HIV We are locking up the most socially disadvantaged and vulnerable members of our community - rates are rising Disproportionate rates of incarceration both for children and adults with disability, rates increasing rapidly of people with psychosocial impairment in Australia Approximately 12% of adult prisoners have an intellectual disability (IQ below 70), 25% (borderline range IQ 70 to 79)– approximately 40% have an acquired brain injury. Rates higher for children (58% psychosocial, 33% ID) People with disability in prison vulnerable to sexual assault and more likely to not be able to practice safer sex and drug use Health promotion strategies mostly inaccessible 5

Health In Prison project Project conducted at Family Planning New South Wales (NSW) by Anthony Stralow and Matthew Bowden – HIV/AIDS and Intellectual Disability Project Funded by NSW Health, NSW Corrective Services and AIDS Trust of Australia Aim of the project to reduce the rate of HIV, sexually transmitted infections and blood borne virus transmission (hepatitis B & C) of inmates with cognitive impairment (ID, ABI, learning disability) by providing accessible information and education 6

Methodology Literature review Needs assessment of inmates with disability Interviews with inmates and prison staff – Corrections Health and Corrective Services Collaborative project between health promotion experts in disability and Merri Collier an artist with expertise in augmentative (pictorial) communication and plain English Focus groups in disability units of prisons in New South Wales (2), Victoria and Western Australia 7

Findings from research High rates of injecting drug use No access to new needles/syringes – high rates of sharing needles High rates of tattooing Homemade tattoo guns used High levels of physical violence causing cuts and blood spills Razors and toothbrushes often shared Stigma associated with disability Sexual activity between men taboo Poor knowledge on how to use condoms Low literacy rates Language specific to prison culture 8

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CRPD and HIV health promotion Article 25 (Health) obliges States Parties to ensure people with disability have the right to the highest attainable standard of health without discrimination on the basis of disability. States Parties are required to provide people with disability with access to sexual health programs and interventions with the aim of minimising and preventing further disability (i.e. HIV/AIDS, hepatitis B & C) 27

CRPD and HIV health promotion Article 21 (Freedom of expression and opinion, and access to information) requires States Parties to impart information to people with disability on an equal basis with others through all forms of communication in accessible formats including accessible language and augmentative communication systems Although Article 25 is a social right and can be realised progressively, Article 21 is a political right and must be given effect immediately 28

Conclusions People with disability have the right to: information about our bodies, our sexual rights and information about HIV transmission, safer sex and drug use be treated as adults with a full range of life experiences take risks and learn from our experiences and mistakes not be at the mercy of individual sexual attitudes of care givers not be sexually abused live in dignified and humane environments - Ann Craft,

The fight continues… To realise our rights we need to further combat: the overrepresentation of people with disability in our prisons and promote the rights of the most marginalised groups of people with disability the ongoing disability discrimination and stigma towards inmates with disability the poor response to sexual assault the lack of access to clean injecting equipment the lack of access to condoms and lubricant in some prisons realisation and implementation of CRPD Articles 25 and 21 30

Thank you 31