HIV AIDS Section Fabienne Hariga Senior Adviser UNODC HIV AIDS section, Vienna Comprehensive package of interventions for HIV in prison settings 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

4 High HIV prevalence rates in prisons

HIV prevalence in prisons higher than in the community

Women represent less than 10% of the population HIV prevalence in women prison almost always higher than in men prisons.

8 HIV and HIV/TB in prison: contributing factors Criminal Justice /Legal framework : overuse of imprisonment, over- representation 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 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.Information, education and communication 2.HIV testing and counselling 3.Treatment, care and support 4.Prevention, diagnosis and treatment of tuberculosis 5.Prevention of mother-to-child transmission of HIV 6.Condoms programmes 7.Prevention and treatment of sexually transmitted infections 8.Prevention of sexual violence 9.Drug dependence treatment including Opioid Substitution Therapy 10.Needle and syringe programmes 11.Vaccination, diagnosis and treatment of viral hepatitis 12.Post-exposure prophylaxis 13.Prevention of transmission through medical or dental services 14.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

THANK YOU! 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)