In most countries around the world HIV prevalence is higher among prisoners than in the general population. This is due to a number of factors including the relative lack of knowledge about HIV among prisoners, lack of access to protective measures, often violent conditions, overcrowding and inadequate health services.

To help tackle this situation in Africa, the United Nations Office on Drugs and Crime (UNODC), in partnership with WHO, the World Bank and UNAIDS has launched the African HIV in Prisons Partnership Network (AHPPN).

The initiative was announced at the east and southern Africa consultation which took place on 17 and 18 November 2009. The consultation brought together representatives from prison authorities, civil society,  national AIDS councils, health, research and academic institutions, as well as United Nations agencies from 16 African countries.

Responding to the situation in prisons is not only of the essential for those incarcerated but for society as a whole. When released back into the community prisoners who have been vulnerable to HIV infection while in prison may then go on to engage in high risk behaviours outside of prison. 

Despite such challenges, strategies to address HIV in prisons are often isolated and not well integrated into national AIDS plans and programmes. 

The African HIV in Prisons Partnership Network will support efforts to mount effective, human rights-based responses to HIV in Africa’s prisons. It also hopes to facilitate knowledge sharing and the forging of alliances between a range of partners to encourage a coherent, broad and holistic approach.

Championing this need for coordination, Ms. Elizabeth Mataka, the United Nations Secretary-General’s Special Envoy for AIDS in Africa and keynote speaker at the launch noted, “We cannot work in silos…we need everyone, from government officials, National AIDS Councils, law enforcement agencies, civil society organisations, prisoners and former prisoners, to truly reach the objectives of universal access to HIV prevention, treatment, care and support for this particular sub-population, but also with benefits for society-at-large.”

The network will also ensure that existing gaps in knowledge about the true nature and extent of HIV in prison settings are addressed and that the response is based on sound data and evidence.

Ms Mataka added, “We need more comprehensive information about the HIV situation in prisons across Africa...This information should inform the development of evidence-based comprehensive, HIV prevention, care, treatment and support services for men, women and juveniles in prisons and ex-prisoners; without discrimination. These services, it goes without saying, should be of the same quality and standard, as for non-prisoners; and address linkages with the broader community.”

The remit of the African HIV in Prisons Partnership Network is wide and will focus not only on HIV but on tuberculosis, mental health, drug use and prison overcrowding. The network will also provide technical support to member states.

A regional declaration of commitment on AIDS in prisons was adopted at the consultation forum. Informed by the socio-cultural and economic context in Africa, the declaration will be used as a framework for encouraging an effective response to HIV in the region’s prisons.

The Network, which will be supported financially by the Swedish/Norwegian HIV/AIDS Team for Africa, has created a website to share ideas and experiences across the widest possible forum. The site can be accessed at www.ahppn.com.

A version of this story is also published at UNODC.org

The first national consultation on HIV in prison settings took place in Brasilia 31 March to 2 April 2009.
Credit: UNODC

Much more needs to be done to improve AIDS prevention, treatment and care services in Brazil’s prisons. This was the major conclusion emerging from the first national consultation on HIV in prison settings which took place in Brasilia between 31 March and 2 April.

Organized by Brazil's Ministry of Health and Ministry of Justice in partnership with the United Nations Office on Drugs and Crime (UNODC), the objective of the consultation was to discuss and propose an agenda with an action plan to provide prevention, treatment, care and support services aimed at addressing HIV, other sexually transmitted infections and co-infections such as tuberculosis and hepatitis in prisons.

"UNODC is committed to supporting the Government of Brazil in the provision of HIV prevention and care services to the prison population," said UNODC Representative for Brazil and the Southern Cone, Giovanni Quaglia.

The national consultation was attended by around 150 professionals. These included specialists from the key ministries, representatives from all 26 states of Brazil and the Federal District (where the capital is located), health professionals working in prison settings, members of the national harm reduction network, representatives of the Brazilian segment of the International Commission for Catholic Prison Pastoral Care and members of the National Network of People Living with HIV/AIDS.

As in most countries, Brazil has a higher HIV prevalence in the prison population than among the general population. According to the most recent research, a local study published in 2007, found rates of 5.7% among certain prisoners. In contrast, UNAIDS reports that by the end of 2007, general adult prevalence was 0.6%.

It is estimated that the country has approximately 420,000 prisoners living in often violent conditions where overcrowding, lack of access to medical services and unsanitary surroundings can lead to greater vulnerability to HIV and other infectious viruses such as tuberculosis and hepatitis. These conditions can also increase AIDS-related deaths and undermine attempts to implement an effective response to the epidemic in prisons.

Liliana Pittaluga, Technical Adviser at the Prevention Unit of the National STD and AIDS Programme, said that the consultation was a symbol of the solid partnership between the Government of Brazil and UNODC. "The cooperation between sectors is crucial to improve the health care and prevention services made available inside prison settings. We are confident that the results of this consultation will not only result in an exchange of experiences, but also in building a process of actions that will have a positive effect in the prison system at the country level."

The main outcome of the consultation was the commitment made by the Ministry of Health, the Ministry of Justice and UNODC to form a working group which will design a national operative plan with guidelines, targets and deadlines. In addition, civil society organizations, the Pan-American Health Organization (PAHO) and UNAIDS will be part of this group.

As well as UNODC, UNAIDS and PAHO/World Health Organization, also participating in the meeting were the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the United Nations Population Fund (UNFPA). Health and justice experts from the Southern Cone region also attended as observers, at the invitation of UNODC.

(from left) Sylvie Bertrand, UNODC Regional Programme Coordinator HIV and AIDS in Prison Settings - Southern Africa; Dr Johnson Byabashaija, Commissioner General Uganda Prisons Service
Credit: UNAIDS/Mamadou Gomis

“If we do not implement adequate measures to prevent HIV infection in prisons, people incarcerated will always be vulnerable to the disease,” said Mr Gallo Diop, a former prisoner and AIDS advocate from Senegal.

Mr Diop was speaking on Friday 5 December at an ICASA session organized by the United Nations Office on Drugs and Crime (UNODC) titled “HIV and AIDS prevention, care, treatment and support in prison settings”.

He emphasized that the movement of people in and out of prisons is also contributing to the spread the virus among those outside of prison settings.

Session participants analyzed the impact that HIV is having inside African prisons and there was consensus that addressing HIV situation in prisons is a key component of effective responses to AIDS.

Overcrowded prisons with poor facilities and sanitary conditions combined with a lack of HIV prevention services, health care and adequate nutrition are contributing to the spread of the virus argued participants. They identified the need for more data and research to identify the nature and patterns of risky behaviours.

Brian Tkachuk, the United Nations Office on Drugs and Crime (UNODC) Regional Advisor for HIV and AIDS in prisons - Africa
Credit: UNAIDS/Mamadou Gomis

“There is still a knowledge gap in understanding the magnitude of the epidemic in African prisons and its multiplier effect on the non-prison population in the region,” said Brian Tkachuk, the United Nations Office on Drugs and Crime (UNODC) Africa Regional Advisor for HIV and AIDS in prisons during his presentation.

In order to mitigate the impact of HIV in prisons, Mr Tkachuk highlighted the need to raise awareness of HIV among prisoners, promote peer education and provide access to prevention interventions like availability of condoms, safe tattooing and injecting equipment, and access to private visits with partners. He also underscored the need to provide access to HIV treatment and adequate nutrition for prisoners living with HIV.

Mr Tkachuk noted that “the HIV situation in prisons remains a highly neglected area that needs immediate attention,” and he called for the adding of HIV in prisons into National AIDS responses.

“You can never succeed in addressing the AIDS situation in prisons if you don’t have total political commitment,” said Dr Johnson Byabashaija, Commissioner General Uganda prisons Service. At the same time, he emphasized, there is a need to establish strong information management systems to collect qualitative data for the development of focused advocacy and HIV prevention programmes for prison settings.

Representatives of governments, civil society and
international organizations from Latin America
attending the meeting

Managua – One of the key meetings taking place in the framework of the V Central American Congress on AIDS (CONCASIDA) was the Second meeting of the Americas on AIDS, prisons and confinement which was held in Managua on 4th and 5th November.

Under discussion were the poor conditions many inmates are facing in prisons across Latin America, exacerbated by the lack of access to health services, dilapidated infrastructure, overcrowding and mistreatment.

The particularly negative effects these conditions are having on inmates who are living with HIV were outlined and participants described how the lack of access to adequate health services contributes to a rapid deterioration in health, affecting both the mental and physical wellbeing of people living with HIV. They also stressed that without proper health care and access to medicines the life expectancy for people living with HIV is often dramatically reduced.

Another important issue discussed at the meeting was how to address the rapid spread of HIV and other sexually transmitted diseases which occur in prisons with inadequate infrastructure and services. 

Participants agreed that urgent action is needed to improve the living conditions of people living in prisons in order to reduce their vulnerability to HIV infection.

Regional Director for UNAIDS, Cesar Nunez highlighted the need to strengthen strategies and actions addressing HIV and prisons within the framework of the “Three Ones” principles. He said, “We need to elaborate an action plan that coordinates the efforts of all actors involved in the response to the epidemic in prison settings. We also need to create or strengthen a coordinating body on HIV on a national level and implement a common monitoring and evaluation system at country level, in order to achieve the goal of universal access to HIV prevention, treatment, care and support for all people living with HIV, wherever they are.

Participants were united in their support for joint efforts and agreed that the way forward was for all actors involved in this particular area of the AIDS response to work together to promote effective HIV prevention strategies and advocate for better conditions in prisons.

As part of these efforts the Latin American Institute for the Prevention of Crime and Treatment of Offenders (ILANUD) will act as facilitator in the process and will be advising governments in decision making processes concerning HIV and prisons on behalf of all the groups concerned. 

Jose Vila del Castillo, ILANUD Regional Advisor highlighted his commitment to take effective and sustainable action in responding to the AIDS epidemic in the region, particularly for people living in prison settings.

GENEVA, 15 January 2009 – UNAIDS deplores the arrest and imprisonment of nine members of an association called AIDES Senegal since December 22nd, 2008. On 6 January, 2009 they were tried before the court in Senegal and sentenced for acts against nature and the creation of an association of criminals. The case is currently on appeal.

A coalition bringing together organizations from civil society, the public sector and partners such as UNAIDS, UNDP, the French Embassy and the Swedish Embassy representing the European Union has been working towards the release of the detainees.

“There is no place for homophobia. Universal access to HIV prevention, treatment, care and support must be accessible to all people in Senegal who are in need—including men who have sex with men,” said UNAIDS Executive Director Michel Sidibé. “This will only happen if the men convicted are released and steps taken to rebuild trust with affected communities.”

Homophobia and criminalization of consensual adult sexual behaviour represent major barriers to effective responses to HIV. Such responses depend on the protection of the dignity and rights of all those affected by HIV, including their right and ability to organize and educate their communities, advocate on their behalf, and access HIV prevention and treatment services.

UNAIDS urges the Government of Senegal to take steps to eliminate stigma and discrimination faced by men who have sex with men and create an enabling legal environment for them and the organizations working with them so as to protect their rights and increase access for HIV prevention, treatment, care and support services. Failure to do so will jeopardize Senegal’s target of achieving the goal of universal access by 2010.

UNAIDS would like to see the creation of a social and legal environment that guarantees respect for human rights. UNAIDS recommends that criminal law prohibiting sexual acts between consenting adults in private should be reviewed with the aim of repeal.

UNAIDS urges the Senegalese authorities to take the necessary legal steps for the release of the nine detainees.

Contact: Sophie Barton-Knott | tel. +41 22 791 1697 | bartonknotts@unaids.org