Download HIV/AIDS in prison settings

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
Global estimates for adults and children
end 2003

People living with HIV/AIDS
40 million [34 – 46 million]

New HIV infections in 2003
5 million [4.2 – 5.8 million]

Deaths due to HIV/AIDS in 2003
3 million [2.5 – 3.5 million]
00002-E-1 – 1 December 2003
Adults and children estimated to be living
with HIV/AIDS as of end 2003
Western Europe
Eastern Europe
& Central Asia
520 000 – 680 000 1.2 – 1.8 million
East Asia & Pacific
790 000 – 1.2 million
700 000 – 1.3 million
North Africa & Middle East
Caribbean
South
350 000 – 590 000 470 000 – 730 000 & South-East Asia
Sub-Saharan Africa 4.6 – 8.2 million
Latin America
25.0 – 28.2 million
Australia
1.3 – 1.9 million
& New Zealand
12 000 – 18 000
North America
Total: 34 – 46 million
00002-E-3 – 1 December 2003
AIDS cases per million population
in selected countries, 1988-2002, eastern Europe
Cases per
million
Ukraine
25
Latvia
20
15
Georgia
Update at 30 June 2003
10
5
0
1988
Lithuania
Belarus
1990
1992
1994
1996
1998
2000
2002
Year of diagnosis
EuroHIV
Data adjusted for reporting delays
AIDS cases by transmission group
1988-2002, eastern Europe
Cases
1200
Injecting drug users
1000
800
600
Persons infected
heterosexually
Update at 30 June 2003
400
200
0
1988
Homo/bisexual men
1990
1992
1994
1996
Year of diagnosis
1998
2000
2002
EuroHIV
Data adjusted for reporting delays
Estimates on the size of the IDU populations available in 130
countries and territories (1998/2003)
N. America
1.4m
W. Europe:
1.2m
E. Europe &
C. Asia: 3.2m
S. & S-E
Asia: 3.3m
Caribbean:
0.02m
L. America:
1m
MENA:0.4m
S. SaharanAfrica
0.009m
E. Asia &
Pacific
2.3m
Australia &
N. Zealand:
0.2m
Countries with estimates on the size of IDU
13,158,345 IDUs Worldwide
10,292,220 of them (78%) in developing countries
Global HIV prevalence (%) among IDUs
(1998/2003)
North America
0.4 – 42.0
Caribbean
0.0 – 55.2
Western
Europe
0.0 – 66.5
E-Europe & Central Asia
0.0 – 73.7
E. Asia & Pacific
0.0 – 84.0
South & S-E.
Asia
North Africa & Middle
0.0 – 90.1
East
0.0 – 59.4
Sub-Saharan
Africa
0.0 – 2.0
Latin America
0.0 – 80.0
Australia &
N. Zealand
0.3 – 1.23
To ease comprehension, both absolute
nos. and %s have been rounded up
Prisons - a breeding ground for HIV …
In some states of Eastern Europe and Central Asia –
in particular Russia, Ukraine, Lithuania, Latvia and
Estonia, reports indicate that the rates of HIVinfection among prison inmates are higher than in the
general population.
Why?
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
Prevalence of Infectious
Diseases in European Prisons
• Prevalence of Hepatitis C among
injecting drug users is 50-90%
• Prevalence of HIV varies from 0-17% of
the total prison population (average 5%)
Source: Dr. Stoever, 2004
Newly reported HIV cases in Lithuania,
1988-mid 2002
400
350
300
Alytus prison
outbreak May
2002 (284 HIV
cases)
250
200
150
100
HIV
50
00002-E-8 – 1 December 2003
Au 01
g02
20
00
20
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
19
89
19
19
88
0
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