WORLD BANK – REGIONAL WORKSHOP ON VULNERABLE POPULATIONS AND HIV/AIDS Cape Town, South Africa March 11-13, 2009 HIV/AIDS PREVENTION,CARE, TREATMENT AND SUPPORT IN PRISON SETTINGS A Framework for an Effective National Response Brian Tkachuk – Regional Advisor HIV/AIDS in Prisons – Africa United Nations Office on Drugs and Crime (UNODC)

UNODC INTRODUCTION UNODC : United Nations Office on Drugs and Crime - Established in 1997 through a merger between the United Nations Drug Control Programme and the Centre for International Crime Prevention, MANDATE : Assist Member States in their struggle against illicit drugs, crime and terrorism, as well as fight transnational crime in all its dimensions, THREE PILLARS OF OUR WORK : I. Field-based technical cooperation projects to enhance the capacity of Member States II. Research and analytical work to increase knowledge and understanding of drugs and crime issues and expand the evidence-base for policy and operational decisions III. Normative work to assist States in the ratification and implementation of the international treaties, the development of domestic legislation on drugs, crime and terrorism, and the provision of secretariat and substantive services to the treaty-based and governing bodies.

UNODC INTRODUCTION cont’d UNODC GOVERNING BODIES - Commission on Narcotic Drugs - Commission on Crime Prevention and Criminal Justice - UNAIDS Programme Coordinating Board

UNODC INTRODUCTION cont’d Structure and Staff - Headquarters in Vienna, Austria - Operates in more than 150 countries around the world through its network of field, project and liaison offices. - Has approximately 500 staff members worldwide.

UNODC INTRODUCTION cont’d HIV AND AIDS MANDATE (UNAIDS DISTRIBUTION OF LABOUR) Lead Agency Responsible for Addressing HIV and AIDS : - Amongst Injecting Drug Users (IDU) - In Prison Settings - Amongst people vulnerable to Human Trafficking

UNODC INTRODUCTION cont’d UNODC’s GLOBAL AIDS TEAM - Now more than 85 staff members worldwide - 20 in Southern Africa – based in Pretoria Regional Office, and country project offices in Mozambique, Swaziland, Namibia and Zambia - Staff also based in East Africa (Nairobi), West Africa (Dakar) and North Africa (Cairo) - Country Office in Nigeria

KEY UNODC ACTIVITIES (2007/2008) In November 2007 UNODC, along with UNAIDS, WHO and World Bank organised a Regional Consultation on the prevention of HIV among Injecting Drug Users (IDUs) and in prison settings for 11 Eastern and Southern African countries. During this meeting, held in Mombasa Kenya the countries developed their roadmaps to address the issues of HIV/AIDS prevention, treatment, care and support for IDUs and in prison settings. (Botswana, Malawi, Swaziland, Mauritius, Lesotho, Mozambique, Kenya, Tanzania, Seychelles, Uganda, Zambia). Regional consultation planned for West Africa in 2009 In 2008, supported by the Swedish /Norwegian HIV/AIDS Team for Africa, launched a comprehensive 3 year Regional Programme to address HIV Prevention, Care Treatment and Support in Prison settings in four countries (Namibia, Zambia, Swaziland and Mozambique) including dedicated staff in each. UNODC, in partnership with UNAIDS RST established 3 year programme entitled Increasing access to prevention and Care Services for Drug Use and HIV/AIDS in the Prison Settings”- (Morocco, Lebanon, Jordan, Egypt. The overall objective of the project is to develop a sustainable response to increase access to drug use and HIV/AIDS prevention and care services in the prison settings In Cape Verde and Togo, and supported by the governments of France, Italy Netherlands and Sweden, developed materials and terms of reference for a programme aimed at strengthening of health situation in prison settings. As a first step, training sessions for inmates, prison officers and health professionals are planned for 2009.

KEY UNODC ACTIVITIES (2007/2008) Cont’d Conducted prison survey in Uganda. Kenya and Tanzania planned for Provided technical support to the development of Global Fund Proposals (Southern Sudan, Tanzania, Mauritius) Conducted HIV and AIDS Training Workshops for Senior Prison Management (May 2007 Mauritius, February 2008 Southern Sudan) UNODC fact finding Mission/Prison Assessment - DRC (September 2008) In the process of establishing a Professional Network to Support the Development and Implementation of Effective Responses to HIV/AIDS in Prisons in Africa. Currently developing a standardized assessment guide for HIV in Prisons - global application Along with UNAIDS developed a global policy brief on Women and HIV in Prison Settings

KEY UNODC ACTIVITIES (2007/2008) Cont’d Along with UNAIDS and WHO Developed Global Toolkit – HIV and AIDS in Places of Detention - A toolkit for policymakers, programme managers, prison officers and health care providers in prison settings

HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings - A Framework for and Effective National Response (UNODC, WHO, UNAIDS)

OBJECTIVE OF THE FRAMEWORK Provide a framework for mounting and effective national response to HIV/AIDS in prisons that: Meets international human rights standards Prioritises public health Supports the management of custodial institutions

THE FRAMEWORK CONTAINS 11 Principles 9 Key Areas to be Addressed 100 Specific Recommendations for Action

11 PRINCIPLES Good Prison Health is good Public Health Good prisoner health is good custodial management Respect for human rights and international law Adherence to international standards and health guidelines Equivalence in prison health care Holistic approach to health Evidence-based intervention Addressing vulnerability, stigma and discrimination Collaborative, inclusive and inter-sectoral cooperation and action Monitoring and quality control Reducing Prison Populations

PRINCIPLES Good prison health is good public health The vast majority of people committed to prison eventually return to the wider society. Therefore reducing the transmission of HIV in prisons is an important element in reducing the spread of infection in society outside of prisons.

PRINCIPLES Good prisoner health is good custodial management Protecting and promoting the health of prisoners benefits not only the prisoners, but also increases workplace health and safety for prison staff.

PRINCIPLES Respect for human rights and international law Respecting the rights of those at risk of or living with HIV/AIDS is good public health policy and good human rights practice. Therefore States have an obligation to develop and implement prison legislation, policies, and programs consistent with international human rights norms.

PRINCIPLES Adherence to international standards And health Guidelines The standards and norms outlined in established international human rights instruments and public health guidelines should guide the development of responses to HIV/AIDS in prisons.

PRINCIPLES Equivalence in prison health care Prisoners are entitled, without discrimination, to a standard of health care equivalent to that available in the outside community, including preventive measures.

PRINCIPLES Evidence-based interventions The development of prison policy, legislation, and programs should be based upon empirical evidence of their effectiveness at reducing the risks of HIV transmission, and improving the health of prisoners.

PRINCIPLES Holistic approach to health HIV/AIDS is only one of many complex, and often related, health care challenges facing prison officials and prisoners. Therefore, efforts to reduce the transmission of HIV in prisons, and to care for those living with HIV/AIDS, must be holistic and integrated with broader measures to tackle inadequacies in general prison conditions and health care.

PRINCIPLES Addressing vulnerability, stigma, and discrimination HIV/AIDS programs and services must be responsive to the unique needs of vulnerable or minority populations within the prison system, as well as combat HIV/AIDS related stigma and discrimination.

PRINCIPLES Collaborative, inclusive, and inter-sectoral cooperation and action While prison authorities have a central role in implementing effective measures and strategies to address HIV/AIDS, this task also requires cooperation and collaborative action that integrates the mandates and responsibilities of various local, national, and international stakeholders.

PRINCIPLES Monitoring and quality control Regular reviews and quality control assessments, including independent monitoring, of prison conditions and prison health services should be encouraged as an integral component of efforts to prevent the transmission of HIV in prisons and to provide care for prisoners living with HIV/AIDS.

PRINCIPLES Reducing prison populations Overcrowded prison conditions are detrimental to efforts to improve prison living standards and prison health care services, and to preventing the spread of HIV infection among prisoners. Therefore, action to reduce prison populations and prison overcrowding should accompany, and be seen as an integral component of, a comprehensive prison HIV/AIDS strategy.

9 KEY AREAS TO BE ADDRESSEED 1. Political leadership 2. Legislative and policy reform 3. Prison conditions 4. Funding and resources 5. Health standards and continuity of care and treatment 6. Comprehensive and accessible HIV/AIDS services 7. Staff training and support 8. Evidence-based practice 9. International, national and regional collaboration

KEY AREAS TO BE ADDRESSEED 1. Political leadership Acknowledge that high risk behaviours for the transmission of HIV occur within prisons (especially injecting drug use, sexual activity, and sexual abuse/violence)

KEY AREAS TO BE ADDRESSEED 2. Legislation and Policy Reform At national and international level: Drug control laws and penalties, Criminal laws and penalties, Sentencing laws and practices, Drug control laws and health services, Drug control laws and health services. Policy and rules: Ensure guaranteed protection against discrimination on grounds including gender, age, race, ethnicity, culture, religion, language, sexual orientation, gender identity, and HIV status

KEY AREAS TO BE ADDRESSEED 3. Prison Conditions Improve prison conditions to meet minimum international standards, and take specific, concrete steps to achieve that objective.

KEY AREAS TO BE ADDRESSEED 4. Funding and Resources Identify prisoners as a key vulnerable population when allocating national and international resources to combat HIV/AIDS.

KEY AREAS TO BE ADDRESSED 5. Health Standards and Continuity of Care and Treatment Ensure that existing national disease programs are fully integrated into the prison health system.

KEY AREAS TO BE ADDRESSED 6. Comprehensive and Accessible HIV/AIDS Services PREVENTION: Provide at no cost and on a continuing basis access to accurate, non-judgemental, and accessible information on HIV/AIDS in various formats. VCT: Ensure prisoners are provided with information to enable them to make an informed choice. CARE, TREATMENT. AND SUPPORT: Provide options for the early release of prisoners in advanced stages of HIV related illness. DRUG DEPENDANCY: Encourage the development and support of self-help and peer-support groups

KEY AREAS TO BE ADDRESSED 7. Staff Training and Support Consult with staff on the development of education materials and Programmes

KEY AREAS TO BE ADDRESSED 8. Evidence Based Practice Prioritise funding and resources for interventions that demonstrate needs and evidence base.

KEY AREAS TO BE ADDRESSEED 9. International, National and Regional Collaboration Provide the services of experts and technical advisors on effective and ethical prison management and HIV/AIDS

IMPLEMENTING THE FRAMEWORK AT THE NATIONAL LEVEL

BUILDING MOMENTUM Identify and educate key stakeholders “Talk to your Prime Minister” Include prison representative within coordinating bodies Identify and support “champions” to lead implementation efforts Encourage the development of working committees working on HIV/AIDS in prison Build regional networks and collaborations Establish a concrete multi-year work plan and assessment of national response

BUILDING KNOWLEDGE 1.Develop data on HIV/AIDS and risk behaviour among prisoners 2.Raise national awareness of HIV/AIDS and prisons issues among decision makers 3.Increase professional training opportunities on HIVAIDS in prison and prison health generally 4.Utilise technical assistance from other countries

BUILDING CAPACIY Develop collaboration between prison and community services in order to promote quality and sustainability Learn from community practice, but develop responses based on prison settings Use pilot test of new projects and mainstream quickly based upon evaluations Identify and link into existing networks Sustaining funding

BUILDING PARTNERSHIPS Develop co collaboration between prison and community services to promote quality and sustainability Learn from community practice, but develop responses based on prison settings Identify and link into existing networks Sustaining funding

CONCLUSION We must take responsibility for Putting HIV in prisons into the national AIDS response.

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