HIV Prevention, care, support and treatment for IDU prison inmates in Indonesia
Ade Aulia Erwin IDU Intervention Unit – ASA Program Family Health International
Current Situation
National Estimation 2006 N ti l E ti ti 6
• • • • • Number of person with HIV/AIDS Number of IDU HIV prevalence among IDU Number of Prison inmates HIV Prevalence among prison inmates : 190,000 : 220,000 , : 52% : 115,000 : 115 000 : 15‐20%
Prison Situation
• 60‐65% inmates has been convicted on drugs offenses. • Over capacity (mostly prison in big cities) • HIV high risk practices: share injecting equipment, (drugs, tattoo, piercing) male genital accessories, u p otected se unprotected sex • Limited budget for health: US$ 0.5o per inmates annually • Limited human resources and program capacity
High risk behavior in prison
100 90 80 70 60 50
BSS IDU Jakarta, Bandung, Surabaya and Medan 2005
Percent (% %)
Among ever in Prison
43 37 27 18 16 41 42 31 32 35 27 28
40 30 20 10 0
Ever in Prison Jakarta (n = 402)
Ever injecting drug in Prison Bandung (n = 343) Surabaya (n = 496)
Ever getting HIV-AIDS Infromasion in Prison Medan (n=250)
Program Brief
2001 Started IDU Intervention in community 2003 High HIV cases in prison. FHI initiate HIV/AIDS program in prison setting 2004 Advocacy to prison authorities. Expanded HIV intervention in community and prison setting. 2005 Prison HIV National Strategy 2005 – 2008 Technical assistance to strengthen prison institutional capacity. Support 24 T h i l i t t t th i i tit ti l it S t NGOs intervention at 37 city/district and 47 prisons. 2008 – 2009 support 18 NGOs intervention at 31 city/district and 34 prisons t 8 NGO i t ti t it /di t i t d i
FHI Collaboration with Directorate General of Prison System G l f P i S
• • Technical assistance in developing Prison National Strategy (2005‐2009) Facilitate TOT for prison staffs on Behavioral change, Harm Reduction, IMAI, CST, VCT, TB‐HIV, Addiction Counseling Development of BCC/HR Module SOP Development on VCT, CM and CST Technical support in developing national and provincial prison working groups
• • •
ASA PROGRAM COVERAGE: IDU and Prisoner
Sumut 2 IA
Kepri
(1 IA)
Jakarta
6 IAs
0 500 1000
Kilometers
West Java
4 IAs 2 IA
Central Java
3 IAs
East Java
Prison Intervention Framework
Detention Court
Prison
Detention:
Basic Information
Release: Referral
Release: Referral
Prison Intervention
Strengthen prison authorities institutional capacity p y
(Strategic plan, workshop Coordination meeting prison AIDS team)
HIV/AIDS & Drugs education for prisoners (big group)
Case Management
Capacity building for p y g Prison staff (Drug dependency, IMAI, HCT, TB HIV)
HIV/AIDS & Drugs education for prison staff
Pre release
Networking Referral system (service provider) Resource Mobilization
Peer educator
HIV and drug dependency HIV d d d d counseling
Intervention Data Intervention Data – by December 08
Prison working group established 6 provinces Prison have AIDS team 50 prisons Prison staff trained with IMAI, CST, HCT, TB HIV 303 P i ff i d i h IMAI CST HCT TB HIV NGOs Prison staff received HIV/AIDS & Drugs education Prisoners trained: Peer educator: 1,936 1 936 45,365 586
Lesson Learned
Prison HIV program initiate by NGO can be optimize with adequate support from Prisons AIDS team Involvement of inmates and prison staff in the program is crucial Support from the Chief Warden and prison staffs are critical to program implementation Demand on health services are high, it is importance to mobilize Demand on health services are high it is importance to mobilize resources from other provider to support prison programs NOG take an importance role in facilitate program implementation and endorse networking with health providers outside the prison NGO works delivered new innovative activates in developing/design prison program (ex: Pre release, post release, TB HIV, MMT, health promotion, counseling, and education)
Challenge g
• • • • • Budget for prison program (mainly from foreign funding) Cross sector coordination Human resource & experiences Commitment on program implementation p g p Referral to external health services
Recommendation
• • • • • • Due to limitation of human resource within prison system, NGO involvement in HIV prison program is required p p g q Develop referral network for HIV treatment with other institution is a must Activate prison AIDS working group in provincial level Prison HIV program initiate by NGO can be optimize with support from Prisons AIDS team. Post release network need to established Involving BAPAS (parole & probation office) in prison HIV intervention program is highly recommended.
Thank You