HIV and Incarceration: Prisons and Detention

HIV and Incarceration: Prisons and Detention

Vienna, 23 July 2010

Manfred NowakProfessor for International Human Rights Protection, University of Vienna

Director, Ludwig Boltzmann Institute of Human Rights, ViennaUN Special Rapporteur on Torture

UN Special Rapporteur on Torture


OVERVIEW

1. Fact-finding Missions of current UN Special Rapporteur on Torture2. World Prison Population - Relative per 100,0003. World Prison Population - Overcrowding4. World Prison Population - Pretrial Detention5. Conditions of detention amount to inhuman or degrading treatment6. HIV Prevalence in Prisons7. HIV Transmission Resulting from Risk Behaviour in Prisons8. How to effectively prevent HIV Transmission in prisons?9. Example of Best Practice - Spain10. Care, Treatment, and Support for Prisoners Living with HIV/AIDS11. Conclusions

AcknowledgmentsRalf Jürgens (co-author, Global Fund), Marcus Day (co-author, Caribbean Drug & Alcohol Research Institute), Andrew Ball (WHO), Fabienne Hariga (UNODC), Annette Verster (WHO), Terry White (East Europe & Central Asia Union of PLWH), and colleagues of the Ludwig Boltzmann Institute of Human Rights.

1. FACT-FINDING MISSIONS OF CURRENT UN SPECIAL RAPPORTEUR ON TORTURE

TogoApril 07

China Nov. 05

MongoliaJune 05

Georgia Feb. 05

NepalSept. 05

IndonesiaNov. 07

Sri LankaOct. 07

Equatorial GuineaNov. 08

Denmark & Greenland

May 08JordanJune 06

NigeriaMarch 07

ParaguayOct. 06

UruguayMarch 09

GuantanamoFeb. 06

KazakhstanMay 09

MoldovaJuly 08

(Cuba)2009/10

JamaicaFeb. 10

(Zimbabwe)Oct. 09

(Russia)Oct. 06

SudanOct. 06


Papua New GuineaMay 10

GreeceOct. 10

World Average: approx 145

In total ~ 10 million

Every year 30 million persons enter or leave prison.


2. WORLD PRISON POPULATION - RELATIVE PER 100,000

United States 756

St. Kitts and Nevis 588

Russia 629

India 33

Nepal 24

Liechtenstein 20

Burkina Faso 23 Rwanda 604


3. WORLD PRISON POPULATION - OVERCROWDING

Indonesia 164,7 %Uruguay 136,3 %

Benin 307,1 %

Bangladesh 302,4 %

Brazil 160 %

Iran 170 %About 60 % of all countries have more prisoners than their prisons provide capacity for.

In 41 countries the occupancy rate exceeds 150 %.


4. WORLD PRISON POPULATION - PRETRIAL DETENTION

Liberia 97 %

Mali 88,7 %

USA 20,8 %

Sri Lanka 48,7 %

Nepal 51 %

Nigeria 65,2 %

Jamaica 15 %

Papua New Guinea 49,9 %

5.1. CONDITIONS OF DETENTION AMOUNT TO INHUMAN OR DEGRADING TREATMENT - LACK OF BEDDING


Lack of space, Prison in Malawi Source: UNODC


5.2. CONDITIONS OF DETENTION AMOUNT TO INHUMAN OR DEGRADING TREATMENT - OVERCROWDING

Colombo Remand Prison, Sri Lanka Kathmandu Police Station, NepalSource: UN Special Rapporteur on Torture



Libertad Prison (Las Latas), UruguaySource: UN Special Rapporteur on Torture



Panti Police Station, Lagos, Nigeria Source: UN Special Rapporteur on Torture


5.5. CONDITIONS OF DETENTION AMOUNT TO INHUMAN OR DEGRADING TREATMENT - LACK OF SANITARY FACILITIES

Lack of sanitary facilities, Papua New Guinea Source: UN Special Rapporteur on Torture


6. HIV PREVALENCE IN PRISONS

Country Country wide prevalence 1 Prevalence in prisons (est.)

Ukraine 1,2 - 2,0 % 15 - 30 %2)

Russia 1,1 % up to 4,2 %5)6)

South Africa 18,1 % up to 41,4 %3)

Brazil 0,6 % 3 - 20 %3)

Argentina 0,5 % 4 - 10 %3)

India 0,3 % up to 9,5 % (female)4)

Indonesia 0,2 % up to 21,3 % 6)

1) 2008 Report on the Global Epidemic, Adult (15–49) prevalence percent 20072) Zhivago, 2005 as cited in WHTO/UNODC/UNAIDS, Effectiveness of Interventions to address HIV in Prisons, Evidence for Action Technical Papers, Geneva 2007.3) Dolan J, Kite B, Aceijas C, Stimson GV. HIV in prison in low-income and middle-income countries. Lancet Infectious Diseases 2007; 7 : 32-43.4) SG Nagaraj, M Sarvade, L Muthanna, R Raju, S Aju, and NM Sarvade. HIV seroprevalence and prevalent attitudes amongst the prisoners: A case study in Mysore, Karnataka state, India. Paper presented at XIII International AIDS Conference, Durban, July 2000.5) A. Bobrik et al., “Prison health in Russia: the larger picture,” Journal of Public Health Policy 26 (2005): 30-59.6) WHO/UNODC/UNAIDS, Effectiveness of Interventions to address HIV in Prisons, Evidence for Action Technical Papers, Geneva 2007.


7. HIV TRANSMISSION RESULTING FROM RISK BEHAVIOUR IN PRISONS

Using non-steril drug injecting equipment Sexual contacts (consensual and non-consensual) Additional factors: e.g. tattooing, sharing of razors,

piercing, improper sterilisation of medical and dental instruments

8. HOW TO EFFECTIVELY PREVENT HIV TRANSMISSION IN PRISONS?

Deprivation of liberty, not liberties Information and education HIV testing and counselling Provision of condoms and prevention of rape, sexual

violence and coercion Needle and syringe programmes (NSPs):

11 countries, e.g. Switzerland, Moldova Bleach programmes: only if NSPs are not available Opioid substitution therapy (OST) and other drug

dependence treatments: 40 countries Reduction of Overcrowding


9.1. EXAMPLE OF BEST PRACTICES - SPAIN


1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

5000

10000

15000

20000

25000

0

5

10

15

20

25

30

35

40

Needles Prisons (NSPs)

Nee

dles

Pris

ons

Needles and Syringes Programme


199019911992199319941995199619971998199920002001200220032004200520062007200820090

1000

2000

3000

4000

5000

6000

7000

8000

9000

1572

3192

5162

6589

7866

8816 8729877885858080

756773447431

7108

Num

ber o

f pris

oner

s in

MM

Ps

9.2. EXAMPLES OF BEST PRACTICES - SPAINMethadone Maintenance Programme

19891990

19911992

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20090

5

10

15

20

25

30

35

32

28

2423 22

1816

13 119 8 7


9.3. EXAMPLES OF BEST PRACTICES - SPAINHIV prevalence in Spanish Prisons


10. CARE, TREATMENT AND SUPPORT FOR PRISONERS LIVING WITH HIV/AIDS

Provision of antiretroviral therapy (ART) Prison health system under authority of ministry of health Special attention to female prisoners and children

11. CONCLUSIONS

Evidence-based intervention vs moralism Prison health is public health Prevention is better than cure Prisoners with HIV or AIDS have a human right to

medical care, treatment and support Urgent need for comprehensive criminal justice and prison

reforms



Thank you for your attention.

UN Special Rapporteur on Torture, OHCHR/Genevahttp://www.ohchr.org/english/issues/torture/rapporteur

Ludwig Boltzmann Institute of Human Rights, Viennahttp://bim.lbg.ac.at

Atlas of Torturehttp://www.atlas-of-torture.org

Presentation & Speech Download:http://bim.lbg.ac.at

Documents

HIV and Incarceration: Prisons and Detention