India: Tihar Prisons-Looking Beyond the Bars

Oral Substitution Treatment (OST) for Drug Users in Tihar Prisons

23 June 2009: T here are two growing, interconnected public health problems globally faced by  societies: HIV and AIDS and the illicit use of psychotropic substances. This is a reality and therefore an increasing concern in prisons as well. Prisons are in general high-risk environments for drug use and HIV transmission because of overcrowding, poor nutrition, limited access to health care facilities, continued drug use, unsafe injecting practices and unprotected sex. However, at New Delhi's Tihar prisons  health care of inmates seems to be of immense priority.

Tihar prisons in New Delhi is the largest complex of prisons in South Asia. It has a capacity of 6250 prisoners, but lodges an average of 11,600 prisoners. Despite this, when you pass through its corridors and premises, you feel that this is a different correctional institution. It is because prison authorities put self esteem and well-being of prisoners first. The Tihar Jail complex has open spaces, does not use armed guards and its courtyards are spacious and well maintained with trees and lawns. State of the art surveillance cameras have reduced corruption and abuse. Meditation classes help inmates to come to terms with their past. It is indeed heartening to see a separate crèche and a nursery for children in the female jail. The classrooms for the children are colorful and bright much like any normal nursery school. There are proper recreational and educational facilities for the children. The children lodged in prison are provided with clothes, food, bed, medical care and education by the prison department. One can easily mistake the jail complex as a well maintained rehabilitation and recreation centre, with life size colourful paintings and portraits of prominent national leaders on compound walls drawn by prison inmates.

During a recent visit, the UNODC Representative for South Asia, Ms. Cristina Albertin and the UNAIDS Coordinator for India, Prof. Charles Gilks, paid a visit to Tihar prison to learn about the integrated health services that prison authorities offer in Tihar. The prison offers an array of treatment services for inmates who suffer from various medical conditions like tuberculosis, hepatitis, and drug abuse. To address drug abuse, a Drug De-Addiction Centre (DAC) with a capacity of 120 beds was established in 2007 taking into account that six to eight per cent of the prison inmates are drug dependent at the time of admission, out of which some were injecting drug users. Authorities at the Tihar Jail recognize that drug use in prisons has to be seen in the wider social context; that since there is a high turnover of people from the prison to the community and vice versa, a rehabilitation programme becomes even more significant. If inmates are treated humanely and their rights protected, their reintegration back to society will be safe and beneficial.

In collaboration with the All India Institute of Medical Sciences (AIIMS), UNODC and Non Governmental organizations, the Tihar jail administration initiated a pilot and the ever-first Oral Substitution Treatment (OST) Centre in a prison in South Asia. The process is like this: when admitted to the DAC, inmates are initially treated for withdrawal symptoms and undergo detoxification. A screening of inmates takes place and consent is taken from those clients that fulfill the inclusion criteria for recruitment to the OST programme. After recruitment, they are placed in a separate barrack wherein buprenorphine is clinically administered to them under the supervision of a doctor. Later, they are graduated to a rehabilitation ward for further counseling and monitoring. A dedicated team of three expert doctors stands ready to attend inmates. Also, after release, care is taken as inmates are referred to Drop in Centers which have also OST in place. At present, 60 clients have been recruited under the OST programme out of which 25 have been released. Follow-up, through NGOs is being done to ensure a continuity of services for the released clients. Till date, some clients under the OST programme have reported relief and comfort (with decreased irritability and craving), an increased sense of self-worth and a sense of hope for rehabilitation and their life in general. They are more positive about leading a drug free life. Now, families of inmates are also being informed about the OST process and their help is being sought for follow-up with clients.

The OST center in Tihar is being viewed as a 'model' by other countries in South Asia. Regular visits are being conducted for key government officials from South Asia to help them understand the OST initiative in Tihar prisons including its roll out and implementation modalities. The OST intervention at Tihar Jail also emphasizes that to provide comprehensive rehabilitation, many stakeholders and actors need to be involved. Tihar has proven that a successful partnership of stakeholders coming together can make a difference in the life of a prisoner.

The implementation of the Oral Substitution Treatment (OST) in Tihar prisons is part of the UNODC project "Prevention of spread of HIV amongst vulnerable groups in South Asia" which is possible thanks to the contributions by the Government of Sweden