HIV/AIDS in Prison Settings Dr. Monica Beg HIV/AIDS Unit, United Nations Office on Drugs and Crime, Krakow, Poland September 27, 2004

Outline of presentation … Global HIV/AIDS situation HIV/AIDS in Eastern Europe Global injecting drug use (IDU) HIV among IDUs in Eastern Europe HIV/AIDS in prison settings WHO/UNAIDS guidelines relative to HIV/AIDS in prisons UN resolution specific to HIV/AIDS in prison settings Addressing HIV/AIDS in overall prison context

13,158,345 IDUs Worldwide 10,292,220 of them (78%) in developing countries 130 countries and territories Estimates on the size of the IDU populations available in 130 countries and territories (1998/2003) Countries with estimates on the size of IDU S. & S-E Asia: 3.3m E. Europe & C. Asia: 3.2m E. Asia & Pacific 2.3m MENA:0.4m S. Saharan- Africa 0.009m L. America: 1m Caribbean: 0.02m N. America 1.4m W. Europe: 1.2m Australia & N. Zealand: 0.2m

In some states of Eastern Europe and Central Asia – in particular Russia, Ukraine, Lithuania, Latvia and Estonia, reports indicate that the rates of HIV- infection among prison inmates are higher than in the general population. Why? Prisons - a breeding ground for HIV …

General prison conditions... Overcrowding Violence, self harm Higher prevalence of drug use, HIV, hepatitis B and C, TB, mental illnesses than in society outside Vulnerable groups/behaviour: - Hierarchical homosexual relations - Other forms of sexual violence e.g. gang rape - Tattooing - Drug use, including injecting drug use (IDU)

Overcrowding … Prisons are overcrowded in 111 countries Prisons in 39 countries housing 1.5 to 3 times capacity High turnover … 30 million prisoners in and out of prison per year worldwide 10 million people imprisoned at any given time

Source: Dr. Stoever, 2004

In 1993 WHO issued guidelines on HIV infection and AIDS in prisons… “All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community without discrimination, in particular with respect to their legal status or nationality. The general principles adopted by national AIDS programmes should apply equally to prisoners and to the community.”

In 1997 UNAIDS recommended intervention components to prevent HIV/AIDS in prisons: - Provision of syringes - Ensurance of availability of bleach - Demand reduction for drug users including substitution treatment - Provision of discreet and anonymous access to condoms - Education on HIV transmission risks - Introduction of peer education

In 2004, the UN Economic and Social Council adopted a resolution specific to HIV/AIDS in prison settings, recognizing that … Effective HIV/AIDS prevention, care and treatment strategies require behavioural changes and increased availability of, and non-discriminatory access to, HIV/AIDS prevention, care and treatment services; Prisoners have the right to adequate health care; Access to qualified medical personnel should be ensured for prisoners.,

Summary … Prison settings – high risk environments for HIV/AIDS There are proven, effective interventions for prevention Issue is governmental denial, not lack of evidence

HIV/AIDS in prison settings … warrants a comprehensive approach Advocacy to mitigate problem of governmental denial & to create favourable legal / policy environment HIV/AIDS prevention, care and treatment in prison settings equivalent to outside community Improvement of general prison conditions by - Minimizing overcrowding (e.g. use of alternative measures and diversion programs) - Operating secure, safe and orderly prisons - Reducing violence