Tunisia: A Step Towards Health Care Improvements within Tunisian Prisons

01st March 2019  - Tunisia

HIV/AIDS remains one of the major health concerns around the world, and one of its most horrendous faces is having to suffer from it while living within closed settings without access to services. The rates of HIV/AIDS infection and Hepatitis, B, C, and TB among prisoners are often significantly higher than those in the general community. Drug users are over-represented in many prison populations due to the criminalisation of drug use and drug possession. Further, some people start using drugs in prison, start using additional drugs or engage in riskier injecting practices while incarcerated. Syringe sharing among people who inject drugs in prisons is common, exacerbated by a lack of needle/syringe programming in prison settings worldwide. Other HIV risk factors include unsafe sex due to a lack of availability of condoms in prisons, sexual violence, tattooing and piercing.

In addition to HIV risk behaviours highlighted above, factors related to the prison infrastructure, prison management, and the criminal justice system also contribute to vulnerability to HIV, tuberculosis and other health risks in prisons. These factors include overcrowding, violence, poor prison conditions, corruption, denial, stigma, lack of protection for vulnerable prisoners, lack of training for prison staff, and poor medical and social services.

Unfortunately, recommended HIV prevention and treatment services are usually unavailable in prison settings: only about 5% of countries have needle/syringe programmes in prisons and condoms are available to prisoners in only 28 countries, although they are accessible through programmes in community settings. 

While HIV/ AIDS prevalence is considered low within the Tunisian population, figures from The UNAIDS Databook 2017 show that the number of people living with HIV/AIDS in Tunisia almost doubled in the past 10 years with 2,900 recorded cases in 2016 compared to only 1,600 recorded cases in 2010.

To address the issue of people living in closed settings in Tunisia, UNODC signed an agreement with the Tunisian Association to Combat Sexually Transmitted Diseases and AIDS (ATL MST/SIDA Tunis), on the implementation of Voluntary Confidential Counselling and Testing (VCT) services of HIV, HBV, HCV  and related training activities targeting prison staff and inmates in selected Tunisian prisons. Representatives from the Ministry of Justice, Ministry of Health, UNODC, ATL MST SIDA, the Tunisian Society of Addictology (STADD), and Beity attended the ceremony amongst others.

In cooperation with the General Directorate of Prison and Reeducation (DGPR) and the Ministry of Justice, a group of 3 Civil Society Organization (CSOs) was selected to implement harm reduction services in selected Tunisian prisons, namely ATL/SIDA Tunis (lead CSO), Beity and STADD.

The overall strategic goal of the project is to promote human rights-based, gender responsive, public health-centered, and evidence-based approaches and to build the capacities of government officials and civil society organizations to deliver a comprehensive package of HIV/AIDS services in prisons and closed settings. The project is part of UNODC's efforts for " Strengthening prevention and health care services for drug-dependence and blood-borne infections in Tunisian prisons, and promoting the reintegration of inmates."

The selected CSOs will provide harm reduction activities in four adult prison facilities and two juvenile rehabilitation centers. As a result, 6,000 inmates will have access to drug prevention services, HIV/AIDS, TB, Viral Hepatitis and STI prevention, treatment, and care services, and will promote the reintegration of around 2000 inmates. In addition, the CSOs will build the capacities of 500 prison staff members, 75 medical doctors and nurses and 20 psychologists and social workers on the provision of harm reduction services.

The UNODC Regional Programme (2016-2021) for The Arab States to Prevent and Combat Crime, Terrorism and Health Threats and Strengthen Criminal Justice Systems in Line with International Human Rights Standards (2016-2021), stresses on the importance of improving health mechanisms within prison settings. More specifically, Subprogramme V, affirms that access to quality treatment services should be ensured to people in prison settings and people living with HIV/AIDS and should be equivalent to those available in the community.

Recently, UNODC signed a Memorandum of Understanding (MOU) with the League of Arab States under the Regional Programme (2016-2021) intending to strengthen collaboration in the area of health. The MoU provides a policy framework for cooperation between the two entities in the areas of HIV/AIDS prevention and care, drug use prevention, care and treatment of drug disorders.

The activities and programmes are pushed forward by the wider range of work done by the United Nations, such as the Joint United Nations Programme on HIV/AIDS (UNAIDS), which UNODC co-sponsors to implement the UNAIDS Fast-Track Strategy 2016-2021, calling for a 75% reduction of new HIV/AIDS infections, including people who use drugs and people in prisons, by 2020.

The Drosos Foundation funds the activities.