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HIV/AIDS in Prisons: A Review of the International Evidence - Ralf Jurgens
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Winnipeg, 23 November 2009 1 | HIV/AIDS in prisons: A review of the international evidence Winnipeg, 23 November 2009 Ralf Jürgens, consultant
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Presentation made by Ralf Jurgens, an international expert in HIV/AIDS in prisons, at the University of Winnipeg, November 23, 2009. The presentation was a part of a panel discussion on Prisoners' Rights to HIV Prevention, Treatment and Care, along with Richard Elliott and Jim Motherall. Dr. Michael Eze, Director of the Global College Institute for Health and Human Potential provided a response to the panel, and the evening concluded with Q&A from the audience.See also the presentation by Richard Elliott: "Clean Switch: The Case for Prison-based Needle and Syringe Programs"
Transcript of HIV/AIDS in Prisons: A Review of the International Evidence - Ralf Jurgens
Winnipeg, 23 November 20091 |
HIV/AIDS in prisons: A review of the international evidence
HIV/AIDS in prisons: A review of the international evidence
Winnipeg, 23 November 2009
Ralf Jürgens, consultant
Winnipeg, 23 November 20092 |
AcknowledgementsAcknowledgements
Annette Verster & Andrew Ball (WHO)
Peer reviewers
UNODC, UNAIDS
Winnipeg, 23 November 20093 |
BackgroundBackground
High rates of HIV in prisons
Hepatitis C rates even higher
Risk behaviours are prevalent in prisons
Outbreaks of HIV in prisons have been documented
High turnover of populationsSources: Dolan et al., 2007, Macalino et al., 2004, Dolan & Wodak, 1999; MacDonald, 2005; Bobrik et al.,
2005; Taylor et al., 1995
Winnipeg, 23 November 20094 |
BackgroundBackground
Drugs can and do enter into prisons
Many prisoners are in prison because of offences related to drugs – people who use drugs outside often find a way to use inside
Other prisoners start using (and/or injecting) drugs in prison
Winnipeg, 23 November 20095 |
HIV prevalence in selected countriesHIV prevalence in selected countries
0.3-1.6% 3.2-20% Brazil
0.8-4.3% 16-32% (5 regions) Ukraine
0.1-0.2% 4-22% Indonesia
0.3-0.9% 28.4% Viet Nam
0.7-1.8% Up to 4% Russian Federation
0.4-1.0% Up to 14% Spain
0.3% 0.6-7% Mexico
0.4-1.0% 1.9% USA
0.2-0.5% 1-12% Canada
Est. Adult HIV Prevalence 2005
HIV Prevalence in Prisons
Country
Winnipeg, 23 November 20096 |
Injecting & needle sharing in prison Injecting & needle sharing in prison
0102030405060708090
100
Au
stralia Lo
w
Au
stralia hig
h
Can
ada
En
glan
d
Greece
RF
Th
ailand
% sharing
010
2030
4050
60
7080
Au
stralia low
Au
stralia hig
h
Can
ada lo
w
Can
ada h
igh
En
glan
d
Greece
Mau
ritius
Mau
ritius h
igh
RF
low
RF
hig
h
Th
ailand
US
A
% injecting
Winnipeg, 23 November 20097 |
Review of the evidenceReview of the evidence
WHO, UNAIDS, UNODC commissioned review:
evidence regarding all interventions that are part of a comprehensive approach to HIV in prison
English & Russian version of all papers:
www.who.int/hiv/topics/idu/prisons/en/
Winnipeg, 23 November 20098 |
Education and informationEducation and information
Information & education programs result in increased knowledge (eg, Vaz, Gloyd & Trindade, 1996)
However, evidence of effect of increased knowledge on behaviour is limited (Braithwaite, Hammett & Mayberry, 1996)
Peer education is more effective (Grinstead et al, 1999)
Education is not enough
Winnipeg, 23 November 20099 |
Needle and syringe programmesNeedle and syringe programmes
First established in Switzerland in 1992
Since then, introduced in 12 countries in western and eastern Europe and central Asia
Several models for distribution: health care, automatic dispensing machines, peer outreach workers
Programs available in all types of prisons: small & large, single cell & barracks, low-, medium- and high-security, prisons for males & prisons for females, etc
Winnipeg, 23 November 200910 |
Evidence NSPsEvidence NSPs
PrisonIncidence HIV&HCV
Needle sharingDrug useInjecting
Am Hasenburg (D)No increaseNo increase
Basauri (Es)No HIVNo increaseNo increase
Hannoversand (D)No increaseNo increase
Hindelbank (CH)No HIVDecreaseNo increase
Lehrter Strasse & Lichtenburg (D)No HIV but HCVNo increaseNo increase
Linger 1 (D)No HIVNo increaseNo increase
Realta (CH)No HIVSingle casesDecreaseNo increase
Vechta (D)No HIVNo increaseNo increase
Vierlande (D)No HIVLittle change or reduction
No increaseNo increase
(Stöver & Nelles, 2003; Stark et al., 2005; Rutter et al., 2001)
Winnipeg, 23 November 200911 |
Evidence NSPs Evidence NSPs
No negative consequences– No increase in drug use or injecting– needles are not used as weapons
Increased referral to drug dependence treatment
Increased staff safety
Winnipeg, 23 November 200912 |
Recommendations NSPs Recommendations NSPs
WHO,UNODC, UNAIDS therefore recommend:
– Introduce NSPs urgently and expand to scale
– Easy and confidential access to NSPs
– Distribution through peers
Winnipeg, 23 November 200913 |
Bleach and decontamination strategiesBleach and decontamination strategies
Feasible and does not compromise securityDoubts about effectiveness
– Conditions in prisons reduce probability of effective decontamination
Bleach programmes cannot replace NSPsProvide information on limited effectivenessContinue efforts to introduce NSPs
Winnipeg, 23 November 200914 |
Drug demand & supply reduction measuresDrug demand & supply reduction measures
Some systems have vastly expanded drug interdiction measures (drug dogs, modern drug detection analysis, urinalysis, “drug-free units”, etc)
Drug use has remained highImproving documentation & evaluation of these
measures should be a priorityPrison systems with drug testing programs should
reconsider testing for cannabis.
Winnipeg, 23 November 200915 |
Conclusion: From evidence to actionConclusion: From evidence to action
“All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community” (WHO, 1993)
Time to move from evidence to action: Universal access to prevention & treatment is also needed for prisoners
For more info:
www.who.int/hiv/topics/idu/prisons/en/
