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Prisons and HIV

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					HIV, Drugs & Prisons




     Gino Vumbaca
                Photo by Mr. Alessandro Scotti, UNODC Good Will Ambassador
                        A Beautiful
                          Set of
                        Numbers?


   Over 11,000 become infected with HIV everyday in the world
   Over 2,600 become infected with HIV everyday in our Region
      Over 1,300 people die everyday from HIV in our Region
 In Asia, there are over 3 million people officially listed as being in
                                prison
         HIV prevalence in injecting drug users

                    90
                                                                   Myanmar
                    80

                    70
                                                                           Manipur &
HIV prevalence, %




                    60                                                      Yunnan
                                Edinburgh                                                  Ho Chi Minh
                    50
                                                                                               City                               Lithuania
                                                       Bangkok
                    40
                                                                                                                Odessa
                    30

                    20

                    10
                                                                                                                                  Jakarta
                    0
                         1983   1984   1985   1986   1987   1988   1989   1990   1991   1992   1993   1994   1995   1996   1997    1998     1999

                                                                                 Year
    Injecting Drugs in Prison

Internationally, research shows:

   50-75% of prisoners have injected drugs
    before prison
   25-50% continue to inject in prison
   Frequency of injecting less
   Frequency of sharing much greater
           Prisons and HIV

Prisons are very important in development of HIV
epidemic among IDU:

      many prisoners are IDU
      many IDU have been to prison
      many continue to inject in prison
      drugs are available in all prison systems
      few needles/syringes, so sharing occurs
          Prisons and HIV Figures

   9% of prisoners in Estonia are HIV positive (2003)
   In Ukraine the number of new HIV cases in prisons has
    risen by 26% compared to 5% in the general population
    (2002)
   In Russian Prisons there are 34,000 HIV positive
    prisoners with 95% being injecting drug users (2002)
   In US Prisons it is estimated that 2% of the prison
    population is HIV positive (1999)
   43% of South African prisoners are estimated to be HIV
    positive (2002)

(Source: Prison Healthcare News)
         HIV in Prisons in Asia

Iran
1996:             2 prisons in Teheran
                  29% of IDU are HIV-infected
2001:             10 prisons in Iran all found HIV among IDUs
                  one prison: 63% HIV-infected
   (Ref. MAP (Monitoring the AIDS Pandemic). 2001. The Status and Trends of HIV/AIDS/STI
   Epidemics in Asia and the Pacific. MAP. Provisional Report October 4, Melbourne, Australia)


Indonesia
Salemba penitentiary, Central Jakarta:
1998:             first HIV cases - 4% of 509
2001:             200 prisoners tested - 22% positive
    (Ref. During R 2002. Indonesian prisons begin to accept HIV threat. Asian Times
    April 20 (on-line http://www.atimes.com/se-asia/DD20Ae05.html)
 HIV in Prisons in Asia (cont)


Malaysia
August 2001:
  - number of HIV infections in Malaysian prisons is 1,834

  - 6% of total prison population

  - main mode of transmission is sharing contaminated needle
       and syringe (94%)

  Ref: Prisons Department of Malaysia. 2001. Programmes related to AIDS
  prevention and management in Malaysian Prisons Department 2001.
  Rehabilitation and Treatment Division. Selangor. Malaysia.
                      Vietnam

   There are approximately 185,000 drug users in Vietnam
    typically aged between 18-25 years. HIV prevalence in
    2004 was estimated at 28.6% though rates are as high as
    70% in some provinces
   Since the 1990’s authorities have dramatically increased
    the number of compulsory ’rehabilitation camps’ for drug
    users to over 80 with approx. 40,000 people now being
    detained for between 1-5 years each
   People can be literally removed from the streets and
    detained by authorities for being in possession of an illicit
    substance – the camps to not provide any recognised
    form of drug treatment or HIV education
   It is estimated that HIV rates in the camps are 50%
HIV Transmission Risks in Prisons


 Between prisoners, from prisoners to staff –
    Blood contact:
      – Violence
      – Blood exposures
      – Injecting drug use
      – Tattooing


    Sexual contact
      - Heterosexual and homosexual
Needle & Syringes
Needle After One Use
Needle Used Five Times
Needle Used Five+ Times
           IDU “Mixing” in Prisons


   A            B           C                 D
  IDU           IDU         IDU               IDU
Network       Network     Network           Network
HIV -ve       HIV +ve     HIV -ve           HIV -ve




          PRISON
                                    A
                            B           D
                                C




  A              B              C                 D
  IDU           IDU          IDU                IDU
Network       Network      Network            Network
HIV +ve       HIV +ve      HIV +ve            HIV +ve
       At Risk HIV Exposures Model of IDU in Prisons     Based on a Model Developed by Dr Wiwat Rojanapithayakorn, UNAIDS SEAPICT


                                        A                              B                                   C
     Number of IDU in
         Prison                       1,000                          1,000                              1,000

          HIV +ve
            (%)                        1%                            10%                                 40%

      Unsafe injecting
     episodes per week                  5                               5                                  5

    No. of people sharing
     injecting equipment              1-5-10                        1-5-10                              1-5-10


A     10 HIV+ve people X 5 episodes X 1 sharer =      50 (HIV risk exposures per week)
                                    X 5 sharers =    250
                                    X 10 sharers =   500
B     100 HIV+ve people X 5 episodes X 1 sharer = 500 (HIV risk exposures per week)
                                     X 5 sharers = 2,500
                                    X 10 sharers = 5,000
C 400 HIV+ve people X 5 episodes X 1 sharer = 2,000 (HIV risk exposures per week)
                                 X 5 sharers = 10,000
                                 X 10 sharers = 20,000

                                To Reduce Number of at Risk Exposures

          Prevalence           Unsafe Injecting Episodes                      No. of People Using/Sharing
                              Lithuanian Case Study
400
                    New HIV Cases 1988 - 2002                                                                                                    344
350

300
                                                                                               Alytus Prison: 284 Cases 

250                          HIV
200

150

100                                                                                                                                      72
                                                                                                                         66      65
                                                                                                                  52
50                                                                                                        31
                                   8                     5          4          9          11      12
             1          1                     1
 0




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      19



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                                                                                                                                             t2
                                                                                                                                           us
                                                                                                                                         ug
                                                                                                                                        A
       Source: Lithuanian AIDS center 2002




                  Prison population of over 11,000, with over 1,000 IDU
                  Very few, if any HIV prevention & drug treatment programs in prison system
Photo by Mr Alessandro Scotti, UNODC Good Will Ambassador
Photo by Mr Alessandro Scotti, UNODC Good Will Ambassador
Photo by Mr Alessandro Scotti, UNODC Good Will Ambassador
Photo by Mr Alessandro Scotti, UNODC Good Will Ambassador
Photo by Mr Alessandro Scotti, UNODC Good Will Ambassador
Photo by Mr Alessandro Scotti, UNODC Good Will Ambassador

				
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posted:7/31/2011
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