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WORLD BANK – REGIONAL WORKSHOP ON VULNERABLE POPULATIONS AND HIV/AIDS
Cape Town, South Africa March 11-13, 2009
HIV/AIDS PREVENTION,CARE, TREATMENT AND SUPPORT IN
PRISON SETTINGS A Framework for an Effective
National Response
Brian Tkachuk – Regional Advisor HIV/AIDS in Prisons – AfricaUnited Nations Office on Drugs and Crime (UNODC)
UNODC INTRODUCTIONUNODC: United Nations Office on Drugs and Crime - Established in 1997 through a merger between the United Nations Drug Control Programme and the Centre for International Crime Prevention,
MANDATE: Assist Member States in their struggle against illicit drugs, crime and terrorism, as well as fight transnational crime in all its dimensions,
THREE PILLARS OF OUR WORK:
I. Field-based technical cooperation projects to enhance the capacity of Member States
II. Research and analytical work to increase knowledge and understanding of drugs and crime issues and expand the evidence-base for policy and operational decisions
III. Normative work to assist States in the ratification and implementation of the international treaties, the development of domestic legislation on drugs, crime and terrorism, and the provision of secretariat and substantive services to the treaty-based and governing bodies.
UNODC INTRODUCTION cont’d
UNODC GOVERNING BODIES
- Commission on Narcotic Drugs
- Commission on Crime Prevention and Criminal Justice
- UNAIDS Programme Coordinating Board
UNODC INTRODUCTION cont’d
Structure and Staff
- Headquarters in Vienna, Austria
- Operates in more than 150 countries around the world through its network of field, project and liaison offices.
- Has approximately 500 staff members worldwide.
UNODC INTRODUCTION cont’d
HIV AND AIDS MANDATE (UNAIDS DISTRIBUTION OF LABOUR)
Lead Agency Responsible for Addressing HIV and AIDS :
- Amongst Injecting Drug Users (IDU)
- In Prison Settings
- Amongst people vulnerable to Human Trafficking
UNODC INTRODUCTION cont’d
UNODC’s GLOBAL AIDS TEAM
- Now more than 85 staff members worldwide
- 20 in Southern Africa – based in Pretoria Regional Office, and country project offices in Mozambique, Swaziland, Namibia and Zambia
- Staff also based in East Africa (Nairobi), West Africa (Dakar) and North Africa (Cairo)
- Country Office in Nigeria
KEY UNODC ACTIVITIES (2007/2008)
In November 2007 UNODC, along with UNAIDS, WHO and World Bank organised a Regional Consultation on the prevention of HIV among Injecting Drug Users (IDUs) and in prison settings for 11 Eastern and Southern African countries . During this meeting, held in Mombasa Kenya the countries developed their roadmaps to address the issues of HIV/AIDS prevention, treatment, care and support for IDUs and in prison settings. (Botswana, Malawi, Swaziland, Mauritius, Lesotho, Mozambique, Kenya, Tanzania, Seychelles, Uganda, Zambia). Regional consultation planned for West Africa in 2009
In 2008, supported by the Swedish /Norwegian HIV/AIDS Team for Africa, launched a comprehensive 3 year Regional Programme to address HIV Prevention, Care Treatment and Support in Prison settings in four countries (Namibia, Zambia, Swaziland and Mozambique) including dedicated staff in each.
UNODC, in partnership with UNAIDS RST established 3 year programme entitled Increasing access to prevention and Care Services for Drug Use and HIV/AIDS in the Prison Settings”- (Morocco, Lebanon, Jordan, Egypt. The overall objective of the project is to develop a sustainable response to increase access to drug use and HIV/AIDS prevention and care services in the prison settings
In Cape Verde and Togo, and supported by the governments of France, Italy Netherlands and Sweden, developed materials and terms of reference for a programme aimed at strengthening of health situation in prison settings. As a first step, training sessions for inmates, prison officers and health professionals are planned for 2009.
KEY UNODC ACTIVITIES (2007/2008) Cont’d
2009 - Conducted prison survey in Uganda. Kenya and Tanzania planned for 2009
2008 - Provided technical support to the development of Global Fund Proposals (Southern Sudan, Tanzania, Mauritius)
Conducted HIV and AIDS Training Workshops for Senior Prison Management (May 2007 Mauritius, February 2008 Southern Sudan)
UNODC fact finding Mission/Prison Assessment - DRC (September 2008)
In the process of establishing a Professional Network to Support the Development and Implementation of Effective Responses to HIV/AIDS in Prisons in Africa.
Currently developing a standardized assessment guide for HIV in Prisons - global application
Along with UNAIDS developed a global policy brief on Women and HIV in Prison Settings
KEY UNODC ACTIVITIES (2007/2008) Cont’d
Along with UNAIDS and WHO Developed Global Toolkit – HIV and AIDS in Places of Detention - A toolkit for policymakers, programme managers, prison officers and health care providers in prison settings
HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings - A Framework for and Effective National Response (UNODC, WHO, UNAIDS)
OBJECTIVE OF THE FRAMEWORK
Provide a framework for mounting and effective national response to HIV/AIDS in prisons that:
• Meets international human rights standards
• Prioritises public health
• Supports the management of custodial institutions
THE FRAMEWORK CONTAINS
• 11 Principles
• 9 Key Areas to be Addressed
• 100 Specific Recommendations for Action
11 PRINCIPLES
• Good Prison Health is good Public Health• Good prisoner health is good custodial management• Respect for human rights and international law• Adherence to international standards and health guidelines• Equivalence in prison health care• Holistic approach to health• Evidence-based intervention• Addressing vulnerability , stigma and discrimination• Collaborative, inclusive and inter-sectoral cooperation and action• Monitoring and quality control• Reducing Prison Populations
PRINCIPLES
Good prison health is good public health
The vast majority of people committed to prison eventuallyreturn to the wider society. Therefore reducing the transmissionof HIV in prisons is an important element in reducing the spreadof infection in society outside of prisons.
PRINCIPLES
Good prisoner health is good custodial management
Protecting and promoting the health of prisoners benefits not only the prisoners, but also increases workplace health and safety for prison staff.
PRINCIPLES
Respect for human rightsand international law
Respecting the rights of thoseat risk of or living with HIV/AIDSis good public health policy and good human rights practice. Therefore States have an obligationto develop and implement prisonlegislation, policies, and programsconsistent with international human rights norms.
PRINCIPLESAdherence tointernational standardsAnd health Guidelines
The standards and norms outlined in established international human rightsinstruments and publichealth guidelines should guide the development of responses to HIV/AIDS in prisons.
PRINCIPLES
Equivalence in prison health care
Prisoners are entitled, without discrimination,to a standard of healthcare equivalent to thatavailable in the outsidecommunity, including preventive measures.
PRINCIPLES
Evidence-based interventions
The development of prisonpolicy, legislation, and programs should bebased upon empirical evidence of their effectivenessat reducing the risks of HIV transmission, and improvingthe health of prisoners.
PRINCIPLES
Holistic approach to health
HIV/AIDS is only one of many complex, and often related,health care challenges facing prison officials and prisoners. Therefore, efforts to reduce the transmission ofHIV in prisons, and to care for those living with HIV/AIDS,must be holistic and integrated with broader measures totackle inadequacies in general prison conditions and health care.
PRINCIPLES
Addressing vulnerability, stigma, and discrimination
HIV/AIDS programs and services must be responsiveto the unique needs of vulnerable or minority populations within the prison system, as well as combat HIV/AIDS related stigma and discrimination.
PRINCIPLES
Collaborative, inclusive, and inter-sectoral cooperation and action
While prison authorities have a central role in implementingeffective measures and strategies to address HIV/AIDS, this task also requires cooperation and collaborative actionthat integrates the mandates and responsibilities of variouslocal, national, and international stakeholders.
PRINCIPLES
Monitoring and quality control
Regular reviews and quality control assessments, including independent monitoring, of prison conditions andprison health services should be encouraged as anintegral component of efforts to prevent the transmissionof HIV in prisons and to provide care for prisoners living with HIV/AIDS.
PRINCIPLES
Reducing prisonpopulations
Overcrowded prison conditionsare detrimental to efforts toimprove prison living standardsand prison health care services, and to preventing the spread ofHIV infection among prisoners. Therefore, action to reduce prison populations and prison overcrowdingshould accompany, and be seen as an integral component of, a comprehensive prison HIV/AIDS strategy.
9 KEY AREAS TO BE ADDRESSEED
1. Political leadership2. Legislative and policy reform3. Prison conditions4. Funding and resources5. Health standards and continuity of care and
treatment6. Comprehensive and accessible HIV/AIDS services7. Staff training and support8. Evidence-based practice9. International, national and regional collaboration
KEY AREAS TO BE ADDRESSEED
1. Political leadership
Acknowledge that high risk behaviours for the transmission of HIV occur within prisons (especially injecting drug use, sexual activity, and sexual abuse/violence)
KEY AREAS TO BE ADDRESSEED
2. Legislation and Policy Reform
At national and international level: Drug control laws and penalties, Criminal laws and penalties, Sentencing laws and practices, Drug control laws and health services, Drug control laws and health services.
Policy and rules: Ensure guaranteed protection against discrimination on grounds including gender, age, race, ethnicity, culture, religion, language, sexual orientation, gender identity, and HIV status
KEY AREAS TO BE ADDRESSEED
3. Prison Conditions
Improve prison conditions to meet minimum international standards, and take specific, concrete steps to achieve that objective.
KEY AREAS TO BE ADDRESSEED
4. Funding and Resources
Identify prisoners as a key vulnerable
population when allocating national and
international resources to combat
HIV/AIDS.
KEY AREAS TO BE ADDRESSED
5. Health Standards and Continuity of Care and Treatment
Ensure that existing national disease programs are fully integrated into the prison health system.
KEY AREAS TO BE ADDRESSED
6. Comprehensive and Accessible HIV/AIDS Services PREVENTION: Provide at no cost and on a continuing basis access to accurate, non-judgemental, and accessible information on HIV/AIDS in various formats.
VCT: Ensure prisoners are provided with information to enable them to make an informed choice.
CARE, TREATMENT. AND SUPPORT: Provide options for the early release of prisoners in advanced stages of HIV related illness.
DRUG DEPENDANCY: Encourage the development and support of self-help and peer-support groups
KEY AREAS TO BE ADDRESSED
7. Staff Training and Support
Consult with staff on the development of education materials and Programmes
KEY AREAS TO BE ADDRESSED
8. Evidence Based Practice
Prioritise funding and resources for interventions that demonstrate needs and evidence base.
KEY AREAS TO BE ADDRESSEED
9. International, National and Regional Collaboration
Provide the services of experts and technical advisors on effective and ethical prison management and
HIV/AIDS
IMPLEMENTING THE FRAMEWORK AT THE NATIONAL LEVEL
BUILDING MOMENTUM
• Identify and educate key stakeholders “Talk to your Prime
Minister”
• Include prison representative within coordinating bodies
• Identify and support “champions” to lead implementation efforts
• Encourage the development of working committees working on
HIV/AIDS in prison
• Build regional networks and collaborations
• Establish a concrete multi-year work plan and assessment of
national response
BUILDING KNOWLEDGE
1. Develop data on HIV/AIDS and risk behaviour
among prisoners
2. Raise national awareness of HIV/AIDS and prisons
issues among decision makers
3. Increase professional training opportunities on
HIVAIDS in prison and prison health generally
4. Utilise technical assistance from other countries
BUILDING CAPACIY
Develop collaboration between prison and community services in order to promote quality and sustainability
Learn from community practice, but develop responses based on
prison settings
Use pilot test of new projects and mainstream quickly based upon evaluations
Identify and link into existing networks
Sustaining funding
BUILDING PARTNERSHIPS • Develop co collaboration between prison and
community services to promote quality and sustainability
• Learn from community practice, but develop responses based on prison settings
• Identify and link into existing networks
• Sustaining funding
CONCLUSION
We must take responsibility for
Putting HIV in prisons into the
national AIDS response.
