30 million at risk for HIV in prisons and other closed settings:

How to respond?

The Comprehensive Package of Interventions 15 Key interventions

1. Information, education and communication
2. HIV testing and counselling
3. Treatment, care and support
4. Prevention, diagnosis and treatment of tuberculosis
5. Prevention of mother-to-child transmission of HIV
6. Condoms provision
7. Prevention and treatment of sexually transmitted infections
8. Prevention of sexual violence
9. Drug dependence treatment
10. Needle and syringe programmes
11. Vaccination, diagnosis and treatment of viral hepatitis
12. Post-exposure prophylaxis
13. Prevention of transmission through medical or dental services
14. Prevention of transmission through tattooing, piercing and other forms of skin penetration
15. Protecting staff from occupational hazards

Each year over 30 million men and women spend time in prisons and other closed settings; over one-third of them are in pre-trial detention. Virtually these men and women will return to their community, many within a few months to a year.

26 April 2012 (Vienna) - Yesterday, on the margins of the twenty-first session of the Commission on Crime Prevention and Criminal Justice, UNODC, organised a side event addressing HIV and AIDS in prisons and other closed settings. The event, chaired by Ms. Valerie Lebaux, Chief of UNODC's Justice Section, was well attended by Member States and civil society organisations representatives. The session provided an opportunity to underline the disproportionate vulnerability of prisoners to HIV and it enabled the speakers to emphasise the importance of mounting and sustaining HIV prevention, treatment, care and support responses in places of detention. The presentations touched on the HIV interventions needed in all stages of detention and on the importance of meaningfully involving correctional staff in rolling them out in prisons.

Dr. Fabienne Hariga, UNODC Senior HIV Advisor, provided an overview of the global HIV situation in prisons. Dr. Hariga illustrated, with national examples, the positive impact that evidence-informed and comprehensive HIV programmes in prison can have in reversing and even halting an epidemic in prisons. In advocating for greater coordination among national stakeholders, she emphasised that HIV in prisons is a multi factorial issue requiring a multidisciplinary response; namely that it was of concern for the public health, occupational health, criminal justice, gender, human rights, prison management sectors.

Dr. Hariga, presented the newly developed comprehensive package of HIV prevention, treatment care and support interventions recommended in prisons and other closed settings. The package of interventions, consisting of 15 key interventions covering prevention as well as treatment and taking into account related issues such as tuberculosis, viral hepatitis, and sexually transmitted infections into account, is the fruit of extensive consultation culminating with an international technical consultation held in Vienna in late 2011. The final document will be launched this summer at the International AIDS Conference taking place in Washington in July.

Ms. Kerstin McCourt, Senior Advocacy Advisor at the Open Society Justice Initiative, addressed an often forgotten population, a population that is persistently ignored in the development of health programmes and in the delivery of services, namely prisoners in pre-trial detention. She highlighted the fact that detention is mostly the result of a split-second decision; one that has long lasting and adverse consequences for prisoners in pre-trial detention. The impact of incarceration is felt at all levels, one will lose income and employment, will have poorer access to healthcare, it can signify the end of schooling and it can have intergenerational impacts in cases where children are incarcerated with young children. She provided an overview of this overlooked population which represents over three million people on any given day and over ten million people per year and which originate from the poorest and most marginalised groups in society. The detention periods illustrated ranged from a few months to close 4 years; long years without due legal process and without adequate access to health services. In some countries, pre-trial detainees represented the vast majority of incarcerated individuals, up to 97% of them. The small amount of services offered to pre-trial detainees is also mirrored in the amount of research and data collection in this field; the lack of sound information makes it difficult to tailor services responding to their needs. Ms. McCourt also recommended greater collaborations between the health and legal professional, access to health checks and healthcare at every stage of detention and she saw a need for global advocacy. She briefly introduced the OSI recent publication: Pretrial Detention and Health: Unintended Consequences, Deadly Results.

Finally, Mr. Gary Hill, Director of Training and Development at the International Corrections and Prisons Association, made a case for the greater involvement of correctional personnel in the implementation of HIV programmes in prisons. He stressed the importance of putting greater emphasis on staff training which, in his opinion, always benefits both staff and prisoners. His approach to the training of prison staff was harnessed in what he called "taking fear out of the equation"; knowledgeable staff and knowledgeable prisoners lead safer lives and increase the possibility of reaching HIV stigma-free working and living environments. In the current economic climate, he also mentioned that in order to improve the situation as it relates to HIV in prisons, it was not only a matter of injecting financial resources in the prison systems, but also matter of increasing significantly the HIV and AIDS knowledge of staff. The speaker also addressed the need to tailor training programme and the teaching method to ensure their success; he supported a peer-to-peer approach to capacity building and suggested that training opportunities can also combine staff and prisoners, leveling the prevention and awareness field for everyone. Mr. Hill briefly introduced the International Corrections and Prisons Association staff training platform.