Post on 03-Jul-2020
Access Equity in Prisons:
Towards a Joint Response in Africa
20 July
18:30 – 20:30
Session Room 2
HIV Prevention, Treatment and Care in Prison
Settings: Public Health and Human Rights
Approach
AIDS 2016 Conference
Durban, South Africa
20 July 2016
Ehab Salah,
Adviser, Prisons and HIV
UNODC Vienna
Addressing HIV in PrisonsGuiding Principals
Prison health is public health
Human rights based, evidence informed and gender sensitive approaches
The Right to Health
The right to enjoy facilities, services and conditions at the highest attainable standards of health
- Availability
- Accessibility
- Acceptability
- Quality
The Principle of Equivalence
Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status.
Health policy in prisons should be integrated into and compatible with National Health Policy.
A MULTI FACTORAL ISSUE REQUIRING A MULTIDISCIPLINARY RESPONSE
Public Health
Occupational health
Criminal Justice
Gender policies
Human Rights
Prison management
Upholding the Rights of People
Living in Prisons
• The revised UN Standard Minimum Rules for the treatment
of Prisoners (Nelson Mandela Rules)
• Political Declaration on HIV and AIDS: Intensifying our
Efforts to Eliminate HIV and AIDS
• The Rules for the Treatment of Women Prisoners and Non-
custodial Measures for Women Offenders (the Bangkok
Rules)
• The UNAIDS Strategy acknowledges existing gaps in
health services in prisons and closed settings.
Sustainable Development Goals
To end AIDS,
TB and
combat
hepatitis and
other
communicabl
e diseases
To reduce
inequalities,
eliminate
discriminatory
laws and
policies
To promote the
rule of law to
ensure equal
access to
justice for all,
To empower all
women and
girls
Including those
in prisons and
other closed
settings
HIV in prisons - Gaps • Health care in prison settings is
typically limited and not equivalent to
those provided in the community
• Lack of continuity of care
• Health care in prisons is often
provided by the ministry responsible
for prison
• Lack of SRH and PMTCT
• Mandatory HIV testing and lack of
confidentiality
UNODC’s Support to Countries• Develop normative guidance on HIV in
prisons
• Promote -human rights based, age-gender
responsive and evidence-informed
approaches
• Support to review, adapt, develop and
implement effective legislation, policies and
strategies including on alternatives to
imprisonment
• Build capacities of government agencies,
CSOs and other national partners
Way ForwardEvidence-informed,
rights-based, age and gender-responsive HIV prevention treatment
and care
Improved quality and coverage of
comprehensive HIV services
Criminal justice reform programmes
including alternatives to incarceration
Prison reform initiatives including
improving the working and living
conditions
Strategic information to guide policies, strategies and
actions
To end the
AIDS
epidemic
by 2030
Thank you
@UNODC_HIV
Access Equity in Prisons in Africa? Epidemiology, Programmes and Practice in Africa
PK ChatoCommissioner General – Zambia Prisons Service
Chairperson - AHPPN
Advocacy & Sensitization
( 1,2,3,6,9,13)
Strategic Information
(Monitoring, Evaluation &
Research)
(4,5,7,14,)
Capacity Building
(8)
Enabling Environments
(Policy & legislation, Coordination, networking
& partnerships
(11, 12, 16)
Service Delivery
(10, 15)
AHPPN DECLARATION OF COMMITMENT
Advocacy & Sensitization
( 1,2,3,6,9,13)
5
Advocacy and Sensitization
0
10
20
30
40
50
60
70
50
70
0
27 26
0 0 0 0
5
51
5
40
52
22
4 45
3 3 4
15
4 4 3
Nr.
of p
eopl
e re
ache
d
Member States
High level Meetingstargeting Judiciary, MPs, Ministers & Corrections Chiefs
2010 2012 2014
7
African HIV in Prisons Partnership Network (AHPPN)
Advocacy & Sensitization
( 1,2,3,6,9,13)
Strategic Information
(Monitoring, Evaluation &
Research)
(4,5,7,14,)
9
HIV Sero-prevalence and Behavioural Studies in Prisons
0
5
10
15
20
25
30
35
ETHIOPIA LESOTHO MALAWI MOZAMBIQUE NAMIBIA* SWAZILAND TANZANIA ZAMBIA ZIMBABWE
1.3
23.6
11 11.313.8
25.9
5.3
13.5 13.7
4.2
31.4
27.5
24.5
13.2
34.9
9.96
27.4 28
Pre
vala
nce
rate
-%
Countries
HIV Prevalence in Community vs Prisons in Selected Sub-Saharan African Countries
HIV Prevalence in % Community HIV Prevalence in % Prisons
Other Strategic Information
Selected Sub-Saharan African Countries were supported to
undertake other activities aimed at collecting evidence to
support interventions in prisons.
These include:
• Reviews and Inventory of HIV programmes implemented
in prisons
• TB Prevalence Studies
• Modes of Transmission assessment in prisons
• Impact of Condom programmes in prisons
• Assessment of drug use in prisons
Advocacy & Sensitization
( 1,2,3,6,9,13)
Strategic Information
(Monitoring, Evaluation &
Research)
(4,5,7,14,) Enabling Environments
(Policy & legislation, Coordination, networking
& partnerships
(11, 12, 16)
13
Development of a Model Policy and Strategic Framework
• Supported countries in Sub-
Saharan Africa to develop prison
specific HIV, TB & Other
communicable infections policies
and strategies
• A model policy to assist
development of prison specific HIV
policies is currently being finalised.
It is aimed at providing step-by
step guidance and template for
development of HIV policies in
prisons.
These Reviews were
expected to lead to
reforms to establish
enabling legal and
policy environments.
16
Advocacy & Sensitization
( 1,2,3,6,9,13)
Strategic Information
(Monitoring, Evaluation &
Research)
(4,5,7,14,)
Capacity Building
(8)
Enabling Environments
(Policy & legislation, Coordination, networking
& partnerships
(11, 12, 16)
18
0
50
100
150
200
250
4 4 4 4 4 4 4 4 6
130
60 5945
60
9478
30
201
Nr.
Of p
eopl
e tr
aine
d
Member States
People Trained as Trainers on an integrated Approach to HIV in Prisons
Regional Master Trainers NationalTotal
19
Advocacy & Sensitization
( 1,2,3,6,9,13)
Strategic Information
(Monitoring, Evaluation &
Research)
(4,5,7,14,)
Capacity Building
(8)
Enabling Environments
(Policy & legislation, Coordination, networking
& partnerships
(11, 12, 16)
Service Delivery
(10, 15)
Before After
23
Challenges
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
25
Challenges
Resistance due to cultural barriers
Lack of adequate data for evidence;
Widening the reach to include everyone within prison settings (e.g. children residing with their parents)
Lack of coordination at national and regional level;
Transitional mechanisms seems to be a challenge with changing governments
26
THANK YOU!
Access Equity in Prisons in Africa? Epidemiology, Programmes and Practice in Africa
Nthabeleng Motsomi-MoshoeshoeUNODC -Southern Afria
28
In 2009, the HIV in Prisons Situationand Needs Assessment Toolkit wasdeveloped.
Using this toolkit, HIV sero-prevalence and behavioural studieswere conducted for the first time inprisons in Sub-Saharan Africa
29
HIV Sero-prevalence and Behavioural Studies in Prisons
0
5
10
15
20
25
30
35
ETHIOPIA LESOTHO MALAWI MOZAMBIQUE NAMIBIA* SWAZILAND TANZANIA ZAMBIA ZIMBABWE
1.3
23.6
11 11.313.8
25.9
5.3
13.5 13.7
4.2
31.4
27.5
24.5
13.2
34.9
9.96
27.4 28
Pre
vala
nce
rate
-%
Countries
HIV Prevalence in Community vs Prisons in Selected Sub-Saharan African Countries
(2009 – 2014)
HIV Prevalence in % Community HIV Prevalence in % Prisons
Access to and provision of health care services in prisons is uniquely
characterised by`:
• the security and risk environments,
• prison culture,
• often limited resources and restricted range of options for health
service provision.
• General guiding documents exist for HIV service provision, however;
these are not responsive to the prison environment
• The provision of services therefore has to be tailored to the unique
characteristics of this environment, provide solutions for prison specific
barriers and challenges to ensure access to health service that is
equivalent to that available in the community.
Improving Provision of HIV & TB Services in Prison Settings in Sub-Saharan Africa
United National Office on Drugs and Crime (UNODC)
therefore commissioned a set of toolkits as part of its
Regional Programme on HIV and AIDS Prevention,
Treatment, Care and Support in Prison Settings in Sub-
Saharan Africa.
The toolkits were developed in cooperative, consultative and
inclusive process with experts, professionals and
practitioners from relevant government institutions, prison
and correctional services, international organisations and
civil society organisations from the region.
During a high-level meeting on Improving HIV Service Provision in Prison Settings in
November 2014, Commissioner Generals of Correctional Services and experts agreed
on the need for these documents and in three consecutive thematic expert group
meetings the expertise, experience and inputs of these regional experts was sought to
ensure that the final documents are responsive to the local situation, while in line with
international standards.
The guidelines address the needs among people working in prison settings for
guidance and standard operating procedures, consistent with the legal framework of
the correctional services in each country, based on internationally agreed, effective and
efficient interventions and standards
Improving Service Delivery
This set of toolkits covers seven important areas
related to HIV & TB care in prison settings:
General Counselling for key populations in prison
settings
Psycho-social Counselling & Support for people
living with HIV in prison
Voluntary HIV Testing and Counselling (HTC) in
Prison settings
TB/HIV collaborative activities, management and
care in prison settings
Prevention of mother to child transmission
(PMTCT) in prison settings
Antiretroviral Treatment (ART) services provision
and care in prison settings
Provision of HIV Preventative Commodities in
Prison settings
34
THANK YOU!
Access Equity in Prisons in Africa
A CALL FOR ACTION
Commissioner General Dr. Johnson Byabashaija, Uganda Prison ServiceChairperson – African Correctional Services Association
Access Equity in Prisons: Towards a Joint Response in Africa
Towards A Joint Response
CALL FOR ACTION |
• Southern and Eastern African Consultation forum for the launch of the
African HIV in Prisons Partnership Network, held in Johannesburg, South
Africa, on 17-18 November 2009
• West and Central Africa Regional Consultation on HIV in Prisons and Among
Injecting Drug Users held in Grand Bassam Cote d’Ivoire on December 15-
18, 2009
African Declaration of Commitment for HIV and AIDS Prevention Care, Treatment and Support in Prisons
Access Equity in Prisons: Towards a Joint Response in Africa
A Call for Action
18 July 2016: Nelson Mandela International Day:
Pan-Africa Consultation on Health and HIV in
Prisons in Africa:
Recognize progress and efforts made
Concerned about gaps, challenges and
barriers to achieving access equity in prisons
CALL FOR ACTION |
Access Equity in Prisons: Towards a Joint Response in Africa
A Call for Action
We, the African Correctional Services Association
and the African HIV in Prison Partnership
Network, call upon all stakeholders, including
governments, parliamentarians, prison and
correctional services, international, regional and
national development partners, civil society,
including non-governmental and community-
based organisations, to:
CALL FOR ACTION |
Access Equity in Prisons: Towards a Joint Response in Africa
We call for action to:
1) Prioritise prison populations as part of national HIV & health strategies and responses, and ensure that people in prison settings have access to the same standards of human rights-based, evidence-informed and gender-responsive health care services and support that are available in the community;
2) Ensure that each prison has in place quality health-care services providing a comprehensive package of interventions for HIV and TB prevention, treatment, care and support, which are integrated within public health systems to ensure continuity of care on admission, during transfer between penal institutions and upon release;
Call for Action |
Access Equity in Prisons: Towards a Joint Response in Africa
We call for action to:
3) Develop, revise, reform, adopt and implement national legislation and regulatory frameworks that ensure the equitable access of prison populations to health and HIV services in line with international standards and principles, such as the Nelson Mandela Rules.
4) Ensure that sufficient financial, technical and human resources are made available to enable the effective implementation of the comprehensive package of HIV services for prison populations.
5) Improve prison infrastructure in line with international standards to protect the human dignity of prisoners and to allow for effective quality provision of HIV & health services.
Call for Action |
Access Equity in Prisons: Towards a Joint Response in Africa
We call for action to:6) Improve cooperation and coordination among and between national
criminal justice and health institutions, including implementation of national measures such as alternatives to imprisonment and reducing overcrowding in prison.
7) Develop and improve HIV and health monitoring and evaluation mechanisms to address the disparities related to the collection, availability and dissemination of data and strategic information on health and HIV in Prisons in African countries
8) Call on the United Nations Office on Drugs and Crime to develop in coordination with AHPPN and ACSA a strategic Pan-African Programmeon HIV and AIDS in Prison Settings to provide technical support to Member States to improve their national responses to HIV their prison settings in line with the Nelson Mandela Rules.
Call for Action |
Access Equity in Prisons: Towards a Joint Response in Africa
THANK YOU
AFRICAN DECLARATION |