International Conference on AIDS/HIV and STI in Africa Ministry of Justice National Prison Service – Health Department Protection Behind Bars: Peer-education as a tool to HIV prevention in prisons in Mozambique Authors: Cumba, Alcindo Gimo, Manuel, Maria Cacilda, Alberto, Alice Isabel, Zawangoni, Amélia International Conference on AIDS/HIV and STI in Africa Addis Ababa, 04-08 December 2010

Mozambique HIV Prevalence by Region (2009) Prisons in Mozambique Mozambique HIV Prevalence by Region (2009) Population (2007): 20.366.795 HIV Prevalence among adults (2009): 11.5% Ministry of Justice – Unified National Prison Service 15,533 inmates (June 2011) - 2% female; 2,380 staff (12% are women) 117 prisons in the country Overall, prison premises are in really bad conditions Overcrowding and lack of ventilation High turn-over rates Insufficient health services Poor nutrition and food North 9% Center 18% South 21%

HIV in Prisons 1. A cross-sectional, descriptive study (2002), carried out in Maputo Province revealed that: HIV prevalence was 32.1% 35.7% of drug users shared needles and syringes; 40.7% informed that they had already had STIs; 77.8% confirmed that there is sex practices inside the prisons; 2. National KAP Study in Prisons (2007), showed that: Unprotected sexual intercourse (75%) and the sharing of syringes (71%) are the most well known forms of HIV transmission; 52.1% of men and 53.9% of women did not use condoms in any sexual encounters in the previous 12 months. 3. SNAPRI Report 2010 – HIV is the main cause of death amongst inmates

Projecto Inclusão Partnership between Ministry of Justice, UNFPA and Pathfinder International started in July 2008 Main goal is to develop a framework for HIV prevention in prison settings in Mozambique Strategies: Peer education Referrals to health services Access to BCC materials Strengthening the capacity of Ministry of Justice

Why Peer-Education in Prisons? Efficient strategy for behavior change Hard to reach population Greater involvement and full participation of inmates and staff in health education initiatives Leading role of the beneficiaries Deep knowledge of contextual issues – designing of appropriate prevention strategies Good communication between inmates and between staff members Openness to discuss polemic issues (such as same-sex relationships or drug-use) Develop skills to engage in health promotion activities beyond the prison; Lack of capacity in the system to provide health educations services

Projecto Inclusão – Activities & Results Training of inmates and staff as Peer Educators; Access to information through individual counseling, health libraries, BCC materials and events; Referrals to health and social services; M & E – quarterly supervision meetings with continuous training sessions Years Individual Counseling Sessions Referrals BCC materials distributed 2009 482 334 924 2010 4210 1396 1545 2011 (June) 3634 1030 505 TOTAL 8326 2760 2974

Challenges & Way Forward Ministry of Justice technical guidance on retention of peer-educators in prisons where the program is running Advocacy for condom distribution to prisoners Support the development of HIV, TB and STI needs assessment in prisons (currently being implemented) Enhance linkages between prisons and health facilities Increase the number of skilled trainers within prison system High turn-over and transfer rate among inmates (including peer-educators) Condom distribution not allowed for prisoners Need of information and evidence on HIV in prisons – prevalence, co-infection, high risk practices Improve health information systems and flows, to design interventions upon contextual information

Muito Obrigada! Thank you! Merci Beaucoup!