CONFRONTING OBSTACLES OF ACCESS TO HIV, TB PREVENTION AND TREATMENT By Abdus Samad Dulloo I.Goomany Treatment Centre, Mauritius

DETAINEES … Pre-trial detainees Life sentence prisoners Elderly Infants,Juveniles, Young Prisoners under death sentence Women ( with different problems ) High-risk prisoners

INTRODUCTION/SOME FACTS 10 % of the worlds prison population, roughly 918,000 are in African prisons. Prisoners are perceived as deviants and social outcasts who have wronged society. “Same sex” behavior in prisons, though not denied, is society’s homophobia. Consensual or coercive sex without condoms, rape, put prisoners at higher risk of HIV infection. Detainees who inject drugs and share contaminated injecting materials are on the increase. Tattooing with non-sterile objects is common Blood flashing ?? Overcrowding and poor hygiene increase the risk of TB and other infections. Undernourishment prevails. THE HEALTH OF PRISONERS MEANS ALSO THE HEALTH OF THE COMMUNITY

Priority areas of Intervention Providing same health services to detainees as for people outside prisons Identify alternatives to Custody Bridging the gap between prisons and the wider community GOALS Provide additional safeguards to detainees as a result of their status. Prisoners should not leave the prisons in a worse condition than when they entered. Combat over-crowding of our prisons which is the source of all the hurdles in the prevention and care of HIV, TB and Hep C.

Goals for the 3 priority areas Provide additional safeguards to detainees as a result of their status. Prisoners should not leave the prisons in a worse condition than when they entered. Combat over-crowding of our prisons which is the source of all the hurdles in the prevention and care of HIV, TB and Hep C.

Providing same health services… Medical screening at entry to evaluate 1. General Health of detainee. 2. Mental predisposition to suicide 3. Two-way risk of TB, Hep C, STI, and HIV This assessment will be determinant to help prevent suicide andfurther health problems and infections

ALTERNATIVES TO CUSTODY Preamble : The world is witnessing a massive expansion in the use of imprisonment. As a consequence, allocation of resources, financial and human remains a challenge particularly for poorer countries.

Alternative measures to custody Reduce length of stay Early or compassionate release for the sick Good conduct early release (remission ) Non-prison sanctions: 1. Prescribed treatment in rehabilitation centres for PWUDs. 2. Community Service Order. Half-way house, furlough( permission). Deferred sentence Parole, Pardon

Bridging the gap between prisoners and the wider community OBJECTIVES Rehabilitate and reform Change the prospects of life of ex-detainees and marginalized. Help protect the wider community from infections Prisoners should not leave the prisons in a worse condition than when they started their detention

Measures Recognising the prisoner as a unique Individual with respect and inherent dignity Provide for work/skills training sanctioned by a certificate Educational authorities provide education/values /culture training programs Pre-release schemes by NGO and CBO ( second chance Relatives’ visits ( incl foreign prisoners ), telephone calls, newspapers, mails, contacts with legal advisers Clear Morality Certificate/or ‘character’ after detention period Referral/Follow-up of medical problems in community health services A question ! What are individuals forced to do in order to survive… if their access to society Is denied?

Conclusion and discussion What do you think about the following : Should criminal justice and health work hand in hand, or merge in prisons. Support Don’t Punish advocacy CCM should imperatively have firm members and alternates from prisons depts and are accountable to the latter.