UNODC is cosponsor of the Joint United Nations Programme on HIV/AIDS - UNAIDS
Article Published by IANS
Preventing Drug Use and HIV in Prisons - A Journey…
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Prison inmates are vulnerable to risk behaviours including drug abuse and HIV. Although no reliable estimates are available for the South Asian region, in most countries, drug use is also a well-recognised problem in prison settings.
Worldwide at any given time, there are approximately 10 million prison inmates, with an annual turnover of 30 million. Thus, after release, millions of prisoners return to social networks in the general community, thereby facilitating the spread of HIV to the community.
Everywhere in the world, rates of HIV-infection among prison populations are generally much higher than in the general population. Drug use in general, and injecting drug use in particular, as well as violence and the practice of men having sex with men are widespread in prisons. Multi-person use of contaminated drug injecting is an important mode of HIV transmission among prisoners. HIV is also transmitted in prisons through unsafe sexual behaviours, sometimes associated with sexual violence. Drug users are often over-represented in prison populations and usually continue using drugs while incarcerated.
Prison overcrowding, lack of access to services, infrastructure etc., increase the inmates' vulnerability to HIV transmission. Most prisons in South Asia are overcrowded. According to the International College for Prison Studies, Kings College, London, the occupancy level in prisons (2004-05) indicates the following- Bangladesh- 277.1%, India- 139%, Maldives- 147.4%, Nepal- 142.6% and Sri Lanka- 193.2%.
Site specific training at Kandy, Sri Lanka
UNODC (United Nations Office on Drugs and Crime) ROSA (Regional Office for South Asia) through Project RAS/H71 in collaboration with Governments and NGOs in South Asia is reaching out to more than 20,000 prisoners and building capacities of 4250 stakeholders (prison officials, welfare officers, doctors, NGOs) to work with issues related to drugs and HIV in select prisons across South Asia.
Currently there is growing awareness and widespread concern about drugs and HIV/AIDS in prisons. The strategy adopted by the project is to build capacities of the stakeholders in rolling out the interventions efficiently.
The legal and institutional framework for working with prisoners in these countries may take a while to change. The project is trying to advocate the use of existing provisions within the laws and regulations to make a better health impact and smoother implementation of HIV prevention initiatives across the South Asia region. ROSA's prison initiative adopts an incremental approach towards implementing a comprehensive package of services to address HIV prevention in prison settings of South Asia.
According to a rapid needs assessment conducted by the project at select prison sites in South Asia the following ground realities were arrived at: overcrowding, constraint of resources, lesser number of convicted prisoners, low awareness about HIV and drug related issues and non existent community participation (including NGOs). There is an urgent need for greater coordination between and training of custodial and rehabilitation agencies.
The project has also identified some key factors for success like: Obtaining a secure buy-in from the authorities; Involving the NGO community and prisoners to make it cost effective and sustainable; Ensuring that the interventions are authored, contrived and owned by stakeholders and are locale- and country-specific and Integrating the programme within the broader prison reform context.
Central Jail 5 Tihar, Delhi
This partnership between the prison authorities, inmates and civil society is the first step towards a change in attitude that will help fight stigma and discrimination and defeat the growing AIDS epidemic in the region.
Crucial areas for future programming…
There are several issues that need attention at large while working with prisons. It would be essential to focus on the following priorities for achieving overall wellbeing of the prison inmates.
Reducing overcrowding, alternative sentencing and diversion programmes. Classification and separation of juveniles from adult prisoners.
Promotion of the right to health care and to HIV and AIDS prevention, care and treatment for inmates, and for prison officials, equivalent to that available in the community at large.
Training of prison staff on prison management.
Offer drug dependence treatment programmes, including drug-free prison wings and opioid substitution maintenance treatment programmes, and offer drug dependence treatment as an alternative to incarceration.
Implementation of a full range of HIV-prevention programmes.
Promotion of universal precautions within prison settings to reduce the risk of HIV infection to prison health and correctional staff. Provision of confidential and voluntary counselling and testing for HIV, psychosocial support and highly active antiretroviral therapy for inmates. Improved hygiene, sanitation and diets for HIV-infected prisoners.
Comprehensive and integrated screening, prevention, treatment and care for HIV, tuberculosis (including multi-drug resistant tuberculosis), sexually transmitted infections and hepatitis B and C, including prisoners living with HIV co-infected with hepatitis B and/or C and tuberculosis.
Facilitation of the active involvement of nongovernmental and community-based organizations in prisons and for after-care services are some of the things that needs attention by member states.
So far, the journey has been challenging but at least good beginnings have been made… A concerted and coordinated effort between all players in the field can make a difference to the lives of millions of prisoners across the globe.
