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Skills Building Workshop – Conducting Situation and
Needs Assessments in Prison Settings
HIV and AIDS in Prisons
Overview of Issues and Challenges
Brian Tkachuk – UNODC
Regional Advisor HIV and AIDS in Prisons -Africa
Why talk about HIV and other
infectious diseases in
prison settings?
•
In prisons, the levels of HIV infections tend to be much higher than in the general
population.
•
Prisoners are more vulnerable to TB, Hepatitis B and C, as well as sexually
transmitted infections.
•
HIV epidemic has struck prison settings around the world with particular severity.
•
HIV is a serious threat in prisons because of the nature of the prison population
(sex workers, drug users including IDU, gang members) as well as the extent and
nature of various risk behaviours that occur in prisons (Risk behaviours described
further in the presentation).
•
Prisons have grossly disproportionate rates of HIV infection and confirmed AIDS
cases.
• Ratio examples: Uganda: 2:1, USA: 6:1, Switzerland: 27:1, Mauritius: 50:1 (past)
Global Overview
(HIV in Prisons)
• On any given day there is about 9 million men, women, children and young
people living in prisons around the world. Prison populations are growing
rapidly.
• Worldwide, there are around 30 million people going through the prison
systems annually. This is a large turn-around implying that most prisoners do
return to their communities. This pattern clearly the demonstrates the principle
of “Good Prison Health is Good Public Health”.
• Overcrowding and poor physical conditions of prisons pose significant health
concerns, especially for HIV and TB prevention.
Global Overview (cont.)
• Prisons populations are predominantly male (including staff).
• Over a million women and girls are incarcerated worldwide and they are
especially vulnerable to sexual abuse. (We also know that very little health
and social services in prisons are tailored to women’s need - including those of
their children living with them).
• Men having sex with men are frequent occurrences in prison.
• Injecting drug use, which is one of the most efficient modes of HIV
transmission, occurs in prisons. If we take out the African continent (2/3 of all
infections), IDU accounts for the largest number of HIV infections. Drug use
does take place in prisons.
• Rape and other forms of sexual violence do take place in prisons. Victims at
are risk of contracting HIV (The behaviors do not only take place between
prisoners but may also involve staff).
Global Overview (cont.)
• Blood rituals, tattooing and skin piercing do occur in prisons and they do
pose a threat due to reuse and sharing of equipment.
• Health services for prisoners should be equitable to those offered to the
general community, but the reality is that accessibility and quality of
health services for prisoners are usually inferior.
• Opportunities for HIV and health awareness creation for both staff and
prisoners are scarce. This situation coupled with the lack of access to
prevention commodities impacts on overall infection rates. It increases
infection vulnerability as well as stigmatizing and discriminatory
behaviours in prison settings.
African Prisons and
its Population
•
There is approximately
918,000 prisoners in Africa.
•
Approximately 14,000 of them
are women and girls (African
imprisonment rate of women
are much lower than the rest
of the world)
•
668,000 of almost a million
are incarcerated in SaharanAfrica
African Prisons
and its Population (cont’d)
Although Southern
African countries
make up about
Central Africa
10% of the total
population of the
East Africa
continent, they
host one-third of
Southern Africa
the total prison
West Africa
population.
TOTAL
Prison
population
% of total
prison
population
Population
(millions)
% of total
population of
sub-Saharan
Africa
64 665
10
98 489 000
14
315 658
47
269 904 250
39
192 166
29
66 610 000
10
95 303
14
252 492 000
37
667 792
100
687 495 250
100
African Prison Populations Rates of Imprisonment
African Prison Populations Pre Trial Detention/Remand
African Prison Populations Pre Trial Detention/Remand
Cont’d
HIV in African Prisons
and HIV Prevalence
Evident that
prison
populations are
extremely
vulnerable and
programmes
need to be
developed for
the needs of
prisoners and
prison staff.
HIV in African Prisons
and HIV Prevalence
(recent findings)
Factors contributing to HIV
infections in Prisons in Africa
In addition to risk behaviours mentioned earlier:
•
Weakness of the criminal justice and judicial systems
•
Overcrowding
•
Lack of resources for maintenance of existing penal institutions
•
Inadequate nutritional considerations for sick prisoners
•
Poor or non-existent health and social services
•
Lack of prevention commodities
•
Lack of humanity - Social stigma/Institutional and society neglect
Way forward…
• National AIDS programmes & strategies and prison management policies need to be inclusive of HIV
and AIDS, along with TB, Hepatitis and STI’s.
• We need a holistic approach (measures to tackle inadequacies in prison conditions and health care).
• Access to prevention, treatment, care and support, services.
• Legal reforms need to be done to ensure that they are inline with more up-to-date national strategies
addressing HIV and need to include the development of alternatives to imprisonment.
• Raise (public) awareness on the higher risks of infectious diseases transmission in prison.
• Promote and support Information, Education and Communication initiatives.
• Networks (national and international) need to be created to engage all involved in the HIV in prison
settings responses (AHPPN).
• Develop Regional Guidelines to support the response to the issues of HIV and AIDS, along with TB,
Hepatitis and STI’s
Way forward cont’d…
To support all of these:
• We need evidence to develop tailored responses to address HIV and AIDS in
prison settings, nationally and regionally.
• HIV and AIDS Situation and Needs Assessments are critical to gather this
evidence.
Who should be involved in
the development of a
response
A comprehensive response demands consolidated efforts from all stakeholders
• Policy makers, politicians, parliamentarians
• Judiciary
• Prison authorities, prison managers, prison staff (including Health service providers in
prisons)
• Prisoners
• Civil Society Organisations
• National Programmes/Commissions (AIDS, Human Rights, TB)
• Line Ministries, such as Interior, Justice, Health
• Regional bodies and governments (e.g. SADC)
• International Organisations (Multi-Lateral, Bi-Laterals)
Thank You!
Email: [email protected]