HIV, Drugs & Prisons Photo by Mr. Alessandro Scotti, UNODC Good Will Ambassador Gino Vumbaca

A Beautiful Set of Numbers?  Over 11,000 become infected with HIV everyday in the world  Over 2,600 become infected with HIV everyday in our Region  Over 1,300 people die everyday from HIV in our Region  In Asia, there are over 3 million people officially listed as being in prison

HIV prevalence in injecting drug users Edinburgh Bangkok Myanmar Manipur & Yunnan Ho Chi Minh City Odessa Jakarta Lithuania

Injecting Drugs in Prison Internationally, research shows: n 50-75% of prisoners have injected drugs before prison n 25-50% continue to inject in prison n Frequency of injecting less n Frequency of sharing much greater

Prisons and HIV Prisons are very important in development of HIV epidemic among IDU:  many prisoners are IDU  many IDU have been to prison  many continue to inject in prison  drugs are available in all prison systems  few needles/syringes, so sharing occurs

Prisons and HIV Figures  9% of prisoners in Estonia are HIV positive (2003)  In Ukraine the number of new HIV cases in prisons has risen by 26% compared to 5% in the general population (2002)  In Russian Prisons there are 34,000 HIV positive prisoners with 95% being injecting drug users (2002)  In US Prisons it is estimated that 2% of the prison population is HIV positive (1999)  43% of South African prisoners are estimated to be HIV positive (2002) (Source: Prison Healthcare News)

HIV in Prisons in Asia Iran 1996:2 prisons in Teheran 29% of IDU are HIV-infected 2001:10 prisons in Iran all found HIV among IDUs one prison: 63% HIV-infected (Ref. MAP (Monitoring the AIDS Pandemic) The Status and Trends of HIV/AIDS/STI Epidemics in Asia and the Pacific. MAP. Provisional Report October 4, Melbourne, Australia) Indonesia Salemba penitentiary, Central Jakarta: 1998: first HIV cases - 4% of : 200 prisoners tested - 22% positive (Ref. During R Indonesian prisons begin to accept HIV threat. Asian Times April 20 (on-line ) (Ref. During R Indonesian prisons begin to accept HIV threat. Asian Times April 20 (on-line

HIV in Prisons in Asia (cont) Malaysia August 2001: - number of HIV infections in Malaysian prisons is 1, % of total prison population - main mode of transmission is sharing contaminated needle and syringe (94%) Ref: Prisons Department of Malaysia Programmes related to AIDS prevention and management in Malaysian Prisons Department Rehabilitation and Treatment Division. Selangor. Malaysia.

Vietnam There are approximately 185,000 drug users in Vietnam typically aged between years. HIV prevalence in 2004 was estimated at 28.6% though rates are as high as 70% in some provinces There are approximately 185,000 drug users in Vietnam typically aged between years. HIV prevalence in 2004 was estimated at 28.6% though rates are as high as 70% in some provinces Since the 1990’s authorities have dramatically increased the number of compulsory ’rehabilitation camps’ for drug users to over 80 with approx. 40,000 people now being detained for between 1-5 years each Since the 1990’s authorities have dramatically increased the number of compulsory ’rehabilitation camps’ for drug users to over 80 with approx. 40,000 people now being detained for between 1-5 years each People can be literally removed from the streets and detained by authorities for being in possession of an illicit substance – the camps to not provide any recognised form of drug treatment or HIV education People can be literally removed from the streets and detained by authorities for being in possession of an illicit substance – the camps to not provide any recognised form of drug treatment or HIV education It is estimated that HIV rates in the camps are 50% It is estimated that HIV rates in the camps are 50%

HIV Transmission Risks in Prisons Between prisoners, from prisoners to staff – n Blood contact: –Violence –Blood exposures –Injecting drug use –Tattooing n Sexual contact - Heterosexual and homosexual

Needle & Syringes

Needle After One Use

Needle Used Five Times

Needle Used Five+ Times

A IDU Network HIV -ve B IDU Network HIV +ve C IDU Network HIV -ve D IDU Network HIV -ve C A DB A IDU Network HIV +ve B IDU Network HIV +ve C IDU Network HIV +ve D IDU Network HIV +ve PRISON IDU “Mixing” in Prisons

At Risk HIV Exposures Model of IDU in Prisons ABC Number of IDU in Prison 1,000 HIV +ve (%) 1%10%40% Unsafe injecting episodes per week 555 No. of people sharing injecting equipment A 10 HIV+ve people X 5 episodes X 1 sharer = 50 (HIV risk exposures per week) X 5 sharers = 250 X 10 sharers = 500 B 100 HIV+ve people X 5 episodes X 1 sharer = 500 (HIV risk exposures per week) X 5 sharers = 2,500 X 10 sharers = 5,000 C 400 HIV+ve people X 5 episodes X 1 sharer = 2,000 (HIV risk exposures per week) X 5 sharers = 10,000 X 10 sharers = 20,000 To Reduce Number of at Risk Exposures Prevalence Unsafe Injecting Episodes No. of People Using/Sharing Based on a Model Developed by Dr Wiwat Rojanapithayakorn, UNAIDS SEAPICT

Lithuanian Case Study  Prison population of over 11,000, with over 1,000 IDU  Very few, if any HIV prevention & drug treatment programs in prison system Alytus Prison: 284 Cases  Source: Lithuanian AIDS center 2002 New HIV Cases

Photo by Mr Alessandro Scotti, UNODC Good Will Ambassador