HIV Comprehensive Package of Services in Moldovan Prisons
Transcript of HIV Comprehensive Package of Services in Moldovan Prisons
HIVComprehensivePackageofServicesinMoldovanPrisons
lieutenant-colonelDr.SvetlanaDoltu
AdvisoronMedicalIssuestotheHeadofPrisons(MinistryofJustice)intheRepublicofMoldova
UNAIDS37th PCBMeetingGeneva,27October2015
GeneralOverview
Moldovapopulation– 4mlnPrisonpopulation– 7643inmates,5%womenand2%juvenileTotalNumberofprisons– 17Incarcerationrate– 175per100,000populationOccupancyrate– 90%
Officialdata:HIVprevalence(1,6%)– 126,including81inARVHVCprevalence(4,6%)– 353 inmatesTBprevalence (1,3%)– 101,including78MDRTB
*dataasofJune2015datafromtherightbankonly
Prisonnr.15- CricovaPicturesbyInaTcaci
MoldovanPrisonAuthoritiescontinuouslydemonstratedhighlevelofcommitmentfor
buildingacomprehensivestrategyonHIV/AIDSprevention,treatmentandcare inprisonsby
ensuringaccessofinmatestoservicesequivalenttothoseavailableinthecommunity
Currently, theMoldovanprisonsystemis
implementing13outof15interventions
recommendedwithinthecomprehensivepackageof
servicesforPWIDsinprisons
TheMostImportantSteps1999- Startingneedleexchangeandcondomprovisionprograms;2001- Implementation ofDOTSintuberculosis treatment;2004- ImplementingantiretroviraltherapyanddevelopmentofthefirstDIPordinanceforHIV/AIDsprevention,treatmentandcare;2005- Implementation ofpharmacotherapywithMethadone,alsoin2005implementation ofDOTS(plus)fortuberculosis patients;2007- EndofthemandatoryHIVtestingofprisonersonenteringprison;2008– InitiationofHIVVoluntaryTestingandCounselling servicesandthe HIV–TBcollaborativeinprisons;2012- (GeneXpert)themethodforrapiddiagnosisoftuberculosis isimplemented;2013 – VCTservicesprovidedthroughNGOonsalivaavailableforinmates;2014- Overdosemanagement– allNSPsites inprisonshavebeenequippedwithNaloxoneforoverdosemanagement;2015– GuidingProcedureManualsforprisonmedicalservicesonOSTandNSPdevelopedandapproved.Inaddition:2015- Biologicalwastemanagement– withthesupportofUNODC,equipmentwasprocuredtoensuresafedisposalofneedleandsyringescollectedthroughNSP
CoveragewithInterventionsIntervention Since Availability
NSP 1999 Yes,in13
OST(treatmentandpsycho-socialpeer topeersupport)
2005 Yes,in13
HIVvoluntary testing(bloodandsaliva viaNGOs)
Yes Yes,inall
ARV 2004 Yes,inall(64,3%)
Peertopeerinformativesessionsand selfsupportgroups
1999 Yes,inall
Condomdistribution 1999 Yes, inall
Distributionofantiseptics 1999 Yes,in13
OverdoseManagement (Naloxone) 2014 Yes,in13
IECdistribution 1999 Yes, inall
NSP(picturesbyInaTcaci)
OST(picturesbyInaTcaci)
FinancingandPartners• Currently,HarmReductionprogramsinprisonsarefinancedbytheGFATM.In2013,theDPItookoverthemanagementforNSP.Since2014,2NSPsitesarefinancedfromtheDPI(MoJ)budget.
• Keypartners:UNODC,GFATM,SorosFoundation-Moldova,PompidouGroup/CouncilofEurope,UNAIDS,WHO,CSONewLifeandCSO“AFI”,Norlam.
• Since2014quarterlymeetingoftheTWGonDrugUseandHIV/TBPreventioninprisonstakeplace.Chair– theHeadofPrisons.
Impactofintervention
IBSSresultsamongstinmatesshowadecrease inblood-bornediseases suchasHIVandviralHepatitis.
Indicator 2007 2010 2012
% of people who inject drugs in the last year 4,7 3,0 2,7
% usage of sterile equipment in the last month100,0 100,0 100,0
% integrated indicator regarding the knowledge/information about HIV/AIDS
30,8 43,4 44,0
HIV Prevalence % 4,2 3,4 1,9
HVB Prevalence % 11,3 16,3 13,1
HVC prevalence % 21,0 15,5 8,6
Successes• ComprehensivepackageofservicestoHIVcanbeadaptedtotheprisonsystemconditions
• ThepartnershipwiththeCSOshasapositiveimpact
• NSPinprisonshavenotledtoanyincidentsrelatedtosyringesheldforpersonaluse
• NSPdeterminebehavioralchangesleadingtothereductionofdruguse-associatedharmsinprisons
Challenge• Advocacyandcapacitybuildingtargetingprisonstaffshouldbeongoing
• WhendevelopingandimplementingNSPinprisons,thenatureofprisonsshouldbeconsidered.
• Expandingthecomprehensivepackageofservices
• Needtorevisetheexistentlegalframework,CriminalCode
• NationalbudgetneedstograduallytakeoverthefinancingburdencoveredmostlybytheGFATM.
Commitment• Inacknowledgingtheimportanceoftheseinterventions,DPI‘sHealthManagementUnitintendstocontinuewiththeimplementationoftheseactivities,promotingthereforethefinancingfromthestatebudgetand/orseekingalternativesourcesoffunding.
• Strengtheningthecapacitybuildingandpsycho-socialcomponentofprisonservices;andenhancingthecooperationwithnon-governmentalorganizations.
• CreationoftherapeuticcommunitiesforPWIDsinprisons(startingin2016).2TCinP.7andP.9.
UndertheguidanceofUNODCMoldovainpartnershipwiththeDPI,2013-2014,2GuidingProcedureManualsforprisonmedicalservicesinimplementingNSPandOST
programs,approvedbyviaDPIOrdinance237/17.08.2014and237/19.08.2014
Prisonnr.15- CricovaPicturesbyInaTcaci