Research and Advocacy to Ensure Health and HIV Services for HIV-positive Women in Chiang Mai Women's Prison Wednesday, July 21 Paisan Suwannawong, Thai AIDS Treatment Action Group (TTAG) International AIDS Conference (2010)

HIV in Thailand 610,000 PLWHA in Thailand “Universal Access” policy >100,000 on treatment Government fails to comprehensively address HIV prev/tx/care for highly marginalized and criminalized populations including IDU, MSM, prisoners, migrants and ethnic minorities

HIV in Thai Prisons Est. 160,000 people in prison (50% over capacity) Majority serving drug-related offenses Prison HIV prevalence higher than general population [Ex., 25% v. 1.5% (Thaisri, 2003)] 5,333 documented HIV cases (MOPH 2008) 5% foreign nationals; also many un- documented ethnic minority nationals (D Wilson 2007) Annual per capita prison health budget 136 THB (USD $3.8)

Women in Prison Women who use drugs who have been incarcerated 5x more likely to have HIV Lack of gender-specific protections and services, and clear guidelines for HIV prev/tx/care in prison Access to HIV prev/tx/care not equivalent to outside Inadequate personnel and budget (Ex. 2 nurses + 1 psychologist to 1,300 inmates in Chiang Mai women’s prison; only 4 nurses to 4,000 inmates in Chiang Mai men’s prison)

Project Rationale Lack of data on experiences of HIV+ women in prison, including needs and challenges While Thai government has promoted a universal access policy for HIV/AIDS treatment, people in prison do not enjoy universal access Unclear policy and practice on handling HIV in prison Recognized need for improved rights standards and prison conditions in women’s prisons (Princess B. Mahidol) TTAG and research partners already providing peer-led HIV support services inside CM Women’s Prison Interest and support from prison administration

Research Methodology 30 qualitative interviews HIV+ women prisoners in Chiang Mai Women ’ s Prison key government personnel from the Department of Corrections and prison health care services Question content focused on right to health: availability, accessibility, acceptability and quality of HIV-related services Interviews conducted peer-to-peer, by specifically-trained women living with HIV and formerly-incarcerated women

Research Findings stigma and discrimination, staff ignorance irregular access to appropriate and services and treatment and test results; extreme delays and barriers to accessing urgent medical care outside shortages of treatment confidentiality concerns denial of opportunistic infection (OI)/ARV treatment for undocumented citizens and migrants

Sample Testimony “ I would like to prison staff to learn about this condition (HIV), they don’t understand and they will give medications late. Some staff know and will give medication on time… those who don’t understand the disease will not care. It sometimes makes us feel that they think that staff can do what they want since we are prisoners.”

Testimony II “It’s very painful, I had been here for 1 year before I got my benefits transferred, and it took 1 more month before I actually got to go out and get treatment..but after that I got out regularly for my follow up visit…Sometimes I still fell that I was lucky, I did not lose both eyes.” - woman who lost her eye due to failure to access timely CMV treatment

Testimony III “After TTAG came, the doctor cooperated more, like checking my viral load.” “Once you are infected, you have to take care of yourself, stay stress free. It’s not like I am the only one infected, there are many others. We have to take care of ourselves. Our life is valuable, even if we can live for only 2 days.”

Conclusion Prison Health is Public Health (WHO) Thailand’s universal access to comprehensive HIV services falls short for women living with HIV in prison The Thai government must urgently promote equal access to voluntary and confidential testing, information, diagnostics and treatment for HIV Government must address resource, staffing, and training/capacity- building needs in order to avoid discrimination in access to comprehensive treatment and services for this highly vulnerable population. Community-based organizations of people living with HIV/AIDS should have increased access to provide peer support and education to women living with HIV/AIDS in prison.

Next Steps TTAG and our research partners continue to provide targeted services inside CM women’s prison as well as upon release Research/service/policy collaboration designated a “model technical program” in northern Thailand by MOPH for replication regionally and nationally Multi-sectoral working group addresses long- term policy advocacy goals and political/structural barriers concerning standard of care of HIV+ women prisoners and all people in prison

Our collaboration; with thanks Thai AIDS Treatment Action Group (TTAG): Bunniam Wongchaikham, Karyn Kaplan, Thanaporn Piuluang, Prapsasorn Kaensan, Paisan Suwannawong Chiang Mai University’s Department of Family Medicine and Community Medicine: Dr. Apinun Aramrattana, Dr. Chaisiri Angkurawaranon, Dr. Wichuada Juengyoosuk, Ms. Donrapa Sirijantho and Dr. Penprapa Sriviroj Female Correctional Institute Director: Ms. Tiwapa Raksat