Yury Fedotov

Director General/Executive Director


Remarks at the opening of the Global Consultation on HIV Prevention, Treatment, Care and Support in Prison Settings

16 October 2014

Ladies and gentlemen,

It gives me great pleasure to welcome you to the opening of the Global Consultation on HIV Prevention, Treatment, Care and Support in Prison Settings.

Each year, more than 30 million men and women spend time in prison. More than one third are pre-trial detainees.

Globally, at any given time, some 10 million people are incarcerated.

Almost all of them will return to their communities, many within a few months to a year.

In many places around the world, HIV prevalence is much higher in prisons than in the wider society outside. The rates of other infectious diseases, such as hepatitis, syphilis and tuberculosis, are also generally higher.

Experience has shown that a lot can be done to prevent the spread of these diseases. But for that to occur, we must first recognize the existence of certain risk factors and forms of behaviour in prisons.

In many countries, the populations most vulnerable to or affected by HIV are also communities at increased risk of criminalization and incarceration.

The overuse of imprisonment for drug use is of particular concern. The incarceration of significant numbers of drug users increases the likelihood of unsafe injecting practices in prisons and therefore the risk of HIV transmission.

Moreover, overcrowding, violence, inadequate ventilation and lack of protection from extreme climate conditions are common in prisons.

When these conditions are combined with inadequate personal hygiene, malnutrition and poor health services, the vulnerability of prisoners to HIV infection and other infectious diseases is increased.

Therefore, a comprehensive approach needs to be taken, including for the protection of prison staff.

In 2013, UNODC, jointly with ILO, UNDP, WHO and UNAIDS, published a policy brief on a comprehensive response to HIV in prisons.

This includes a comprehensive package of 15 interventions, which are essential for effective HIV prevention and treatment in prisons.

It must also be emphasized that incarceration is not a treatment for drug use.

I strongly recommend that countries implement alternatives to imprisonment for drug use by diverting drug users from the criminal justice systems to community-based health and social services.

Ladies and gentlemen,

Diseases contracted in closed settings, or made worse by poor conditions of confinement, become matters of public health as the vast majority of people in prisons eventually return to the world outside.

It is, therefore, pivotal to foster and strengthen collaboration, coordination and integration among all stakeholders, including the ministry of health and other ministries with responsibilities in prisons, as well as civil society and community-based service providers.

We must remember that health in prison is a right guaranteed in international law, as well as in international rules, guidelines, declarations and covenants.

Prisoners should have access to medical treatment and preventive measures without discrimination.

Access to health services in prisons needs to be consistent with medical ethics, national standards, guidelines and control mechanisms. Prison staffs also need a safe workplace and have the right to proper protection and adequate occupational health services.

Last but not the least, we must not forget that women in prisons are particularly vulnerable, especially due to the sexual violence and abuse many of them may have suffered outside or inside prisons.

Therefore, health programmes should be gender responsive and tailored to meet the needs of women in prisons.

Ultimately, addressing HIV in prisons can't be separated from wider human rights. It means respecting, protecting and promoting prisoners' right to health, and upholding the principle of equivalence of care.

In closing, I wish you all a very fruitful discussion and productive consultation.

Thank you.