1. Dr. Monica Beg, Chief, HIV/AIDS Section, UNODC
Regional Harm Reduction Conference 2017 HARM REDUCTION IN THE NEW ENVIRONMENT Harm Reduction in Prison Settings
Dr. Monica Beg,
Chief, HIV/AIDS Section,
UNODC
4 April 2017,
Vilnius, Lithuania

2. Facts and Figures
30 million people in closed settings/year million people incarcerated at any given time
PWUDs can constitute up to 50% of the prison population
Over-representation
of key populations
Predominantly male

3. HIV, Hep B&C and TB in Prisons
Prevalence of HIV, hepatitis B&C and TB among prison populations is 2 to 10 times higher
TB incidence rates average 23 times higher

4. Women and HIV in Prisons
Women represent 5-10%
HIV prevalence is higher
among women in prisons
Women’s specific health needs are not met
In particular, people who inject drugs and sex workers are relatively overrepresented in women prisons.

5. Prison Conditions
Overcrowding, poor ventilation and other substandard living conditions can increase the risk of HIV transmission and TB infection among people living in prisons

6. Global Commitments to Uphold the Rights of People Living in Prisons
The Nelson Mandela Rules
The Bangkok Rules
UNAIDS Fast-Track Strategy
2016 – 2021
The 37th UNAIDS PCB meeting
decisions
UNGASS 2016

7. 2030 Agenda for Sustainable Development
To end AIDS, TB and combat hepatitis and other communicable diseases and achieve universal health coverage
To empower all women and girls
Including those in prisons and other closed settings
To reduce inequalities, eliminate discriminatory laws and policies and promote social protection policies
To promote the rule of law to ensure equal access to justice for all, develop effective, accountable, and transparent institutions at all levels

8. WHAT WORKS: Effective HIV services for people in prisons
UNODC, ILO, UNDP, WHO, UNAIDS comprehensive package of interventions:
1. Information, education and communication 2. Condom programmes 3. Prevention of sexual violence 4. Drug dependence treatment, including OST 5. Needle and syringe programmes 6. Prevention of transmission through medical services 7. Prevention of transmission through tattooing, piercing and aa other forms of skin penetration 8. Post-exposure prophylaxis 9. HIV testing and counselling 10. HIV treatment, care and support 11. Prevention, diagnosis and treatment of tuberculosis 12. Prevention of mother-to-child transmission of HIV 13. Prevention and treatment of STIs 14. Vaccination, diagnosis and treatment of viral hepatitis 15. Protecting staff from occupational hazards

9. Gaps in HIV services in prisons
Health care in prison settings is typically limited and not equivalent to those provided in the community
Lack of continuity of care, ARVs, OST, SRH and PMTC.
Mandatory HIV testing and lack of confidentiality
Absence of or limited harm reduction programmes in prisons, especially OST, NSP and condom provision
Absence or limited interventions to address drug related post release mortality.
International/domestic funding uncertainty to support harm reduction in prisons.

10. Global Availability of NSP in Prisons
Source: The Global State of Harm Reduction 2016

11. Global Availability of OST in Prisons
Source: The Global State of Harm Reduction 2016

12. UNODC’s Support to Countries
Develop normative guidance on HIV in prisons
Promote human rights based, age, gender responsive and evidence-informed approaches
Support to review, adapt, develop  and implement effective legislation, policies and strategies including on alternatives to imprisonment
Build capacities of government agencies, CSOs and other national partners

13. UNODC List of Operational Countries on HIV in Prisons

14. Way Forward To end the AIDS epidemic by 2030
Evidence-informed, rights-based, age and gender-responsive HIV prevention treatment and care
Improved quality and coverage of comprehensive HIV services
Criminal justice reform programmes including alternatives to incarceration
Prison reform initiatives including improving the working and living conditions
Strategic information to guide policies, strategies and actions
To end the AIDS epidemic by 2030

15. Thank You!
@UNODC_HIV