National Programme for limiting spread of HIV/AIDS in Latvia 2008–2012

Prison system of Latvia 14 prisons and 1 juvenile correctional institution – under Prisons Administration (Ministry of Justice); more than 3000 employees in Prisons administration; Medical unit in every prison (ambulatory care) and one prison hospital (in new premises of Olaine prison since August 2007). 6496 prisoners in January, 2008 (1712 pre – trial detainees).

Prisons in Latvia

Main Problems of Health Care in Prisons 1. Two parallel systems of health care in the country (health care of prisoners is not integrated in general public health care system); 2. High level of infectious diseases – HIV/AIDS, hepatitis C; 3. Addiction problems – sharing needles as one of main routes of HIV transmission; 4. Lack of finances - negative impact on ability to diagnose diseases.

National Programme for limiting spread of HIV and AIDS in Latvia 2008–2012 This program has been prepared with financial support from the Government of France through WHO Latvian Representation and Dutch Government and the World Bank through UNODC, involving foreign and local consultants.

Main problems regarding HIV In 2006, prisoners contributed 16% of all new HIV cases, which used to be 30-33% during 2000-2003 respectively. The number of individuals tested by the prisons decrease. If in 2000 the prison system tested 8,722 individuals these numbers declined to 2,600 in 2006 (new entries per year approx. 3,500). The incidence of HIV in prison is 36 times higher than in the community. Therefore, the situation within penitentiary system remains challenging and still poses risk for the HIV spread. Such risks are due to the fact that approximately 6.1% of prison population (Dec 31, 2006) is HIV positive.

Target groups in National Programm Primary target groups include: Intravenous drug users Prisoners Commercial sex workers Men who have sex with men

Goal of National Programm The Goal of this program is to limit the spread of HIV infection and reduce its negative impact on individuals and society at large. To reach this Goal five strategic objectives were identified: Reduce new HIV cases among groups-at-risk (IDU, MSM, CSW and Prisoners) through targeted HIV prevention activities and through promoting changes in HIV risk related behaviour; Implement wider prevention strategies among general population; Improve quality of life of HIV infected and AIDS patients through provision of health and social care as well as avoiding stigma and discrimination; Generate and use evidence for response planning and implementation management; Strengthen national coordination capacity to respond to HIV and AIDS.

Activities planned in National Programm (for prisoners) Improve testing and diagnosis of HIV/AIDS and linkage to other infectious diseases (TB, Hepatitis, STIs). In order to prevent HIV spread within prisons system it is essential to increase the knowledge, competencies, and skills of the prison staff and prisoners about HIV/AIDS and other infectious diseases through providing training with the manual “Risk Reduction for Drug Users in Prisons” and other media. Initiate harm reduction (provision of substitution treatment, needle exchange programs) and Opioid Substitution Therapy (OST) in prison system and involving sizable number of intravenous drug users. Involvement of outside agencies (governmental and NGOs) delivering HIV-prevention and curative services.

Activities planned (continued) ARV and TB treatment along with treatment for co-infection will be offered to prisoners through financing and involving the public health agencies (i.e. Latvia Infectology Center and State Agency of Tuberculosis and Lung Diseases of Latvia) and establishing “Triangular Clinics” as a medical response to the spread of three major threats within the prison system.

Expected results Increased awareness among prison staff and prisoners about the transmission and prevention of blood-borne infections that will help lower risk-behaviour; Increased number of prisoners being tested (and therefore timely treated) for various diseases. Timely detection of HIV and TB cases or any co-infection will help initiate treatment as well as potentially will contribute to less risky behaviour among prisoners. Increase of availability of services; Harm reduction and OST services become available to prisoners therefore risk of HIV spread within prison system will be lowered and new cases of infection averted; Prisoners will receive comparable health care services to the rest of Latvian population and their confidentiality will be guaranteed that will help increase the trust in providers and most likely will improve outcomes of offered treatment.

Thank you for attention! Kristine Kipena Head of Punishment Execution Policy Unit Department of Sectoral Policy Ministry of Justice of the Republic of Latvia e-mail: Kristine.Kipena@tm.gov.lv