Skills Building Workshop – Conducting Situation and Needs Assessments in Prison Settings HIV and AIDS in Prisons Overview of Issues and Challenges Brian Tkachuk – UNODC Regional Advisor HIV and AIDS in Prisons -Africa

Why talk about HIV and other infectious diseases in prison settings? In prisons, the levels of HIV infections tend to be much higher than in the general population. Prisoners are more vulnerable to TB, Hepatitis B and C, as well as sexually transmitted infections. HIV epidemic has struck prison settings around the world with particular severity. HIV is a serious threat in prisons because of the nature of the prison population (sex workers, drug users including IDU, gang members) as well as the extent and nature of various risk behaviours that occur in prisons (Risk behaviours described further in the presentation). Prisons have grossly disproportionate rates of HIV infection and confirmed AIDS cases. Ratio examples: Uganda: 2:1, USA: 6:1, Switzerland: 27:1, Mauritius: 50:1 (past)

Global Overview (HIV in Prisons) On any given day there is about 9 million men, women, children and young people living in prisons around the world. Prison populations are growing rapidly. Worldwide, there are around 30 million people going through the prison systems annually. This is a large turn-around implying that most prisoners do return to their communities. This pattern clearly the demonstrates the principle of “Good Prison Health is Good Public Health”. Overcrowding and poor physical conditions of prisons pose significant health concerns, especially for HIV and TB prevention.

Global Overview (cont.) Prisons populations are predominantly male (including staff). Over a million women and girls are incarcerated worldwide and they are especially vulnerable to sexual abuse. (We also know that very little health and social services in prisons are tailored to women’s need - including those of their children living with them). Men having sex with men are frequent occurrences in prison. Injecting drug use, which is one of the most efficient modes of HIV transmission, occurs in prisons. If we take out the African continent (2/3 of all infections), IDU accounts for the largest number of HIV infections. Drug use does take place in prisons. Rape and other forms of sexual violence do take place in prisons. Victims at are risk of contracting HIV (The behaviors do not only take place between prisoners but may also involve staff).

Global Overview (cont.) Blood rituals, tattooing and skin piercing do occur in prisons and they do pose a threat due to reuse and sharing of equipment. Health services for prisoners should be equitable to those offered to the general community, but the reality is that accessibility and quality of health services for prisoners are usually inferior. Opportunities for HIV and health awareness creation for both staff and prisoners are scarce. This situation coupled with the lack of access to prevention commodities impacts on overall infection rates. It increases infection vulnerability as well as stigmatizing and discriminatory behaviours in prison settings.

African Prisons and its Population There is approximately 918,000 prisoners in Africa. Approximately 14,000 of them are women and girls (African imprisonment rate of women are much lower than the rest of the world) 668,000 of almost a million are incarcerated in Saharan- Africa

African Prisons and its Population (cont’d) Although Southern African countries make up about 10% of the total population of the continent, they host one-third of the total prison population.

African Prison Populations - Rates of Imprisonment

African Prison Populations - Pre Trial Detention/Remand

African Prison Populations - Pre Trial Detention/Remand Cont’d

HIV in African Prisons and HIV Prevalence Evident that prison populations are extremely vulnerable and programmes need to be developed for the needs of prisoners and prison staff.

HIV in African Prisons and HIV Prevalence (recent findings)

Factors contributing to HIV infections in Prisons in Africa In addition to risk behaviours mentioned earlier: 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

Way forward… National AIDS programmes & strategies and prison management policies need to be inclusive of HIV and AIDS, along with TB, Hepatitis and STI’s. We need a holistic approach (measures to tackle inadequacies in prison conditions and health care). Access to prevention, treatment, care and support, services. Legal reforms need to be done to ensure that they are inline with more up-to-date national strategies addressing HIV and need to include the development of alternatives to imprisonment. Raise (public) awareness on the higher risks of infectious diseases transmission in prison. Promote and support Information, Education and Communication initiatives. Networks (national and international) need to be created to engage all involved in the HIV in prison settings responses (AHPPN). Develop Regional Guidelines to support the response to the issues of HIV and AIDS, along with TB, Hepatitis and STI’s

Way forward cont’d… To support all of these: We need evidence to develop tailored responses to address HIV and AIDS in prison settings, nationally and regionally. HIV and AIDS Situation and Needs Assessments are critical to gather this evidence.

Who should be involved in the development of a response A comprehensive response demands consolidated efforts from all stakeholders Policy makers, politicians, parliamentarians Judiciary Prison authorities, prison managers, prison staff (including Health service providers in prisons) Prisoners Civil Society Organisations National Programmes/Commissions (AIDS, Human Rights, TB) Line Ministries, such as Interior, Justice, Health Regional bodies and governments (e.g. SADC) International Organisations (Multi-Lateral, Bi-Laterals)

Thank You!