1. From evidence to commitment to action: implementing HIV prevention measures in prisons in Ukraine XVI International AIDS Conference Toronto, 15 August 2006 Jürgens R, Kozhan N, Klisha V, Ivantchenko S, Serdiuk V, MacDonald M Centre for Research into Quality

2. Acknowledgements Funders Canadian International Development Agency International Harm Reduction Development Swiss Cooperation United Nations Development Programme World Health Organization International Renaissance Foundation Lead agencies Canadian HIV/AIDS Legal Network State Department of Ukraine for Enforcement of Sentences Centre for Research into Quality

3. Background Ukraine has one of the highest HIV rates in Europe. Injecting drug use remains the most common source of infection, contributing to 57.1% of infections among adults (WHO, 2006) Average prevalence of HIV among IDU: 37.2% (2002) HIV epidemic accompanied by high incarceration rate: 419 per 100,000 (Walmsley, 2005) Centre for Research into Quality

4. HIV and HCV Prevalence Research in 5 regions, 7 prisons (2005) n=831 blood testing –HIV: between 16 and 32% (5 regions) –HCV: between 75.5 and 91.5% (2 regions) self-reported status (anonymous questionnaire) –5% HIV, 8% HCV Centre for Research into Quality

5. Drug Use in Prisons Drugs can and do enter into prisons. Many prisoners are in prison because of offences related to drugs. People who use drugs outside often find a way to continue drug use inside. Other prisoners start using drugs in prison. Centre for Research into Quality

6. Injecting Drug Use in Prison Injecting is generally less frequent in prison than in the community, but injecting is more risky due to the scarcity of injecting equipment. Many start injecting in prison. Prisoners have far more changes in injecting partners than IDUs in the community. There is considerable interaction between prisoner and community injecting populations. Centre for Research into Quality

7. HIV Transmission in Prison Outbreaks of HIV infection in prisons in Scotland, Australia, Lithuania, Russia. Ukraine: cohort study in 2 prisons –400 blood samples in Dec 2004, 276 in August 2005 –6 cases of infection (2 in prison 1, 4 in prison 2) Centre for Research into Quality

8. Prison Conditions Contribute to the Problems Severe overcrowding Lack of work and meaningful activities Abuse & corruption Prisoner-on-prisoner violence Decaying physical infrastructure Lack of medical care Lack of nutritious food & clean water Centre for Research into Quality

11. Prevention: providing needles & syringes PNSPs have been introduced in over 50 prisons in eight countries: Switzerland, Germany, Spain, Moldova, Kyrgystan, Belarus, Iran, and Luxembourg. ∙Other countries have announced that pilot projects will start soon, including Armenia, Ukraine, and Portugal. Centre for Research into Quality

12. Evaluation of PNSPs (2) Evaluations have shown: –syringe sharing was “strongly reduced” –no new cases of HIV infection –decrease in fatal and non-fatal heroin overdoses –decrease in abscesses and other injection- related infections –facilitation of referral of users to treatment programs Centre for Research into Quality

13. PNSPs (3) no negative impact on safety and security; in particular, needles have not been used as weapons no reported increase in drug use or injecting Centre for Research into Quality

14. Preparing for PNSPs: Activities partnership between the Ukrainian prison system, Ukrainian NGOs, and the Canadian HIV/AIDS Legal Network research on prevalence and incidence study tours conference on HIV and harm reduction in prisons selection of sites for pilot projects Centre for Research into Quality

15. Preparing for PNSPs: Activities (2) trainings for staff at the prisons and for senior staff of the Ukrainian prison system development of legal framework development of monitoring and evaluation framework Centre for Research into Quality

16. Results initial resistance to implementation of pilot projects could be overcome projects scheduled to start in 2006 other positive effects: sterile equipment for medical services political uncertainty has delayed implementation Centre for Research into Quality

17. Conclusions effective partnerships can be created between prison systems, NGOs in Eastern Europe and NGOs in Western countries a series of well-planned steps, including research, study tours, and trainings, can create the conditions for implementation of PNSPs monitoring and evaluation are important for efforts to scale up such programs political considerations may further delay implementation of such programs Centre for Research into Quality

18. For more info … Contact Morag MacDonald at morag.macdonald@uce.ac.uk or Ralf Jürgens at rjurgens@sympatico.ca Visit the prison section of the website of the Canadian HIV/AIDS Legal Network: www.aidslaw.ca Centre for Research into Quality