1. International Conference on AIDS/HIV and STI in Africa
Ministry of Justice National Prison Service – Health Department Protection Behind Bars: Peer-education as a tool to HIV prevention in prisons in Mozambique
Authors: Cumba, Alcindo Gimo, Manuel, Maria Cacilda, Alberto, Alice Isabel, Zawangoni, Amélia
International Conference on AIDS/HIV and STI in Africa
Addis Ababa, December 2010

2. Mozambique HIV Prevalence by Region (2009)
Prisons in Mozambique
Mozambique HIV Prevalence by Region (2009)
Population (2007):
HIV Prevalence among adults (2009): 11.5%
Ministry of Justice – Unified National Prison Service
15,533 inmates (June 2011) - 2% female;
2,380 staff (12% are women)
117 prisons in the country
Overall, prison premises are in really bad conditions
Overcrowding and lack of ventilation
High turn-over rates
Insufficient health services
Poor nutrition and food
North 9%
Center 18%
South 21%

3. HIV in Prisons
1. A cross-sectional, descriptive study (2002), carried out in Maputo Province revealed that:
HIV prevalence was 32.1%
35.7% of drug users shared needles and syringes;
40.7% informed that they had already had STIs;
77.8% confirmed that there is sex practices inside the prisons;
2. National KAP Study in Prisons (2007), showed that:
Unprotected sexual intercourse (75%) and the sharing of syringes (71%) are the most well known forms of HIV transmission;
52.1% of men and 53.9% of women did not use condoms in any sexual encounters in the previous 12 months.
3. SNAPRI Report 2010 – HIV is the main cause of death amongst inmates

4. Projecto Inclusão
Partnership between Ministry of Justice, UNFPA and Pathfinder International started in July 2008
Main goal is to develop a framework for HIV prevention in prison settings in Mozambique
Strategies:
Peer education
Referrals to health services
Access to BCC materials
Strengthening the capacity of Ministry of Justice

5. Why Peer-Education in Prisons?
Efficient strategy for behavior change
Hard to reach population
Greater involvement and full participation of inmates and staff in health education initiatives
Leading role of the beneficiaries
Deep knowledge of contextual issues – designing of appropriate prevention strategies
Good communication between inmates and between staff members
Openness to discuss polemic issues (such as same-sex relationships or drug-use)
Develop skills to engage in health promotion activities beyond the prison;
Lack of capacity in the system to provide health educations services

6. Projecto Inclusão – Activities & Results
Training of inmates and staff as Peer Educators;
Access to information through individual counseling, health libraries, BCC materials and events;
Referrals to health and social services;
M & E – quarterly supervision meetings with continuous training sessions
Years
Individual Counseling Sessions
Referrals
BCC materials distributed
2009
482
334
924
2010
4210
1396
1545
2011 (June)
3634
1030
505
TOTAL
8326
2760
2974

7. Challenges & Way Forward
Ministry of Justice technical guidance on retention of peer-educators in prisons where the program is running
Advocacy for condom distribution to prisoners
Support the development of HIV, TB and STI needs assessment in prisons (currently being implemented)
Enhance linkages between prisons and health facilities
Increase the number of skilled trainers within prison system
High turn-over and transfer rate among inmates (including peer-educators)
Condom distribution not allowed for prisoners
Need of information and evidence on HIV in prisons – prevalence, co-infection, high risk practices
Improve health information systems and flows, to design interventions upon contextual information

8. Muito Obrigada! Thank you! Merci Beaucoup!