Results from the Spanish experience:A comprehensive approach to HIV and

HCV in prisons

MERCEDES GALLIZO LLAMAS

Secretary-General of Spanish Prison

Administration

1

Public Health and Prison Health• Returning healthier people to the society – both

socially and from a medical point of view

• The society must know that part of its safety depends on the success of our management.

• To ensure that its users –inmates- are provided in prison with health care with the same quality standards

2

Early detection and appropriate treatment• Harm reduction measures and any other measure

related to health promotion are available

• Before their imprisonment, substance abuse and marginalization have caused among inmates many diseases which are regularly found

• Improve health among those communities which inmates come from and to which they return once they serve their sentence.

3

Health action in prisons as an extraordinarily valuable tool

• At a meeting held in Madrid, Spain during 29-30 October 2009 with representatives from 65 countries worldwide, a high number of national and international agencies and experts in prison health and public health issues, including WHO Regional Office for Europe, and The United Nations Office on Drugs and Crime, accepted The MR

• It is a step more towards universal acknowledgement of prison health services as a powerful tool in the fight against social inequalities related to health care.

4

Medical care within prisons: gateway to the rest of public assistance • Our prison health care system is based on the work of

health units set in every prison still dependent on the Spanish Home Office.

• These units count upon physicians and nursing staff to provide primary health care and transfer inmates in need of specialized assistance to specialized services and hospitals dependent on health care services of each autonomous community

5

The first Prevention and Control of Communicable Diseases program

24,2%23,3% 22,7%

18,6%16,6%

12,8%11,2%

9,0%7,8% 7,0%

0%

5%

10%

15%

20%

25%

30%

1.992 1.994 1.996 1.998 2.000 2.002 2.004 2.006 2.008 2.009

VIH infection rates

6

Based on the WHO recommendations • Antibody detection tests available for all inmates• Voluntary test taking, confidentiality regarding results, • No-segregation based on the results, • Free distribution of condoms and lubricant, • Access to Syringe Exchange Programs (SEPs)• Health education and information on HIV/AIDS and other

infectious agents by means of health agents• Access to free treatment equivalent to the one provided outside

prison • Access to parole for inmates suffering from terminal illnesses

when the penitentiary surveillance judge agrees

7

Methadone maintenance program

1572

3192

5162

6589

7866

8816 8729 8778 85858080 7567

7.3447431 7108

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Inmates in MMP

8

Since 1997 the Syringe Exchange Program

0

5000

10000

15000

20000

25000

0

5

10

15

20

25

30

35

40

needles 2582 4943 7056 8584 11339 12970182602235622989 206261399810582 10038

centers 1 2 4 9 11 27 38 35 34 37 31 34 30

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

9

Reduction of Blood borne infections

48,6%46,8%

44,9%42,9%

38,9%37,8%37,2%33,0%

30,0%29,0%27,0%25,3%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1.998 1.999 2.000 2.001 2.002 2.003 2.004 2.005 2.006 2.007 2.008 2.009

HCV infection in prison10

Reduction of Blood borne infections

0

2

4

6

8

10

12

14

16

18

20T

asa

/ 1.0

00 in

tern

os

AIDS 11,3 18,6 16,7 14,1 9,2 5,2 4,9 4,7 3,7 3,1 2,7 2,2 1,6 1,2 1 0,7

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

11

Seroconversions to HIV and HCV in prison have dramatically gone down

0%

1%

2%

3%

4%

5%

6%

% Conv. HIV 0,60% 0,70% 0,14% 0,15% 0,17% 0,15% 0,06% 0,16% 0,09%

% Conv. HCV 5,1% 4,0% 2,8% 2,4% 2,0% 2,0% 1,7% 1,7% 1,5%

2.000 2.001 2.002 2.003 2.004 2.005 2.006 2.007 2.008

12

Prisons cannot be considered as an isolated element of the society

• We also need a change of mentality of all those authorities concerned

• Prisons are the first health care resource for that part of the society which has difficult access to the public health care system

13

There remain important challenges to be faced within the European prison system • Success achieved throughout the last years by the

Spanish prison health, encourage us to face the current health problems with confidence, problems such as mental health, the creation of more humanized prison environments, the improvement of re-socialization means upon release or the improvement of health care within prisons.

14

Thank you very much

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