Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe

Mounting an effective challenge to HIV in prison settings is a key part of the AIDS response at national, regional and global levels. To define standards for HIV prevention and treatment and the protection and promotion of prisoners’ human rights, it is important to consolidate as much data as possible about the epidemic in this environment. The newly established Monitoring Centre for HIV and Prisons in Latin America and the Caribbean is set to become the key regional repository for such vital information. 

The Monitoring Centre—called the Observatorio VIH y Cárceles de LatinoaMÉrica y el Caribe in Spanish—gathers data from 23 countries which is accessible via a web site. Its primary aim is to help governments and civil society define and implement national HIV prison policies based on international standards. Up and running in Spanish since mid-February, an English language version will be launched 30 April 2011.

The United Nations Office on Drugs and Crime (UNODC) is spearheading the initiative with support from the UN Educational, Scientific and Cultural Organisation (UNESCO), the Pan American Health Organization (PAHO), the World Bank, the UN Development Programme (UNDP) and UNAIDS.

According to José Vila del Castillo, UNODC Regional Advisor, “The Monitoring Centre shows the United Nations system ‘delivering as one’. Addressing HIV in the region’s prisons has become a priority. The centre is an important tool to catalyze prison reform processes and HIV penitentiary programmes.” 

Providing a permanent public space for informed reflection and dialogue, the virtual centre develops methodologies for collecting, processing, analysing and validating the scientific data gleaned on what works, and how best to proceed, in addressing HIV in prisons. It will highlight existing information and encourage ongoing research. Training and technical support are also offered through reference directories, online consultations, discussion forums and virtual classrooms.

In Latin America and the Caribbean, as elsewhere, many prisoners are vulnerable to HIV due to a number of factors, including the relative lack of knowledge about the virus among this population, overcrowding, lack of access to protection and good quality health services and violent conditions.

Across the region, where data are available, several countries have higher HIV prevalence in the prison population than in the general population. For example, according to data collected by UNODC this year, in Peru there are more than eight times as many people living with HIV in prison than outside (4.03% versus 0.4%). In Bolivia the situation is even starker; the same source documents show that in nine prisons in the country, 10% of prisoners are reported as HIV positive, compared to 0.2% prevalence in the wider society. 

César Antonio Núñez, Director of UNAIDS’ Latin America Regional Support Team, believes the Monitoring Centre will provide a valuable insight into the lives of a neglected population, “The Centre will really help us to know the true HIV situation in the penitentiary system, and shed light on human rights-related issues. It is probably in the environment of HIV and prisons where UNAIDS’ commitment to being ‘the voice of the voiceless’ is most needed and appropriate.”

ICPA Executive Director, Mr. Ed Wozniak presenting the award to Dr Fabienne Hariga, Senior Expert, HIV/AIDS Section at UNODC who accepted the award on behalf of the network.

The African HIV in Prisons Partnership Network (AHPPN) has been presented with the prestigious 2010 Healthcare Award by the International Corrections and Prisons Association (ICPA).The award was given during the Association's Annual Conference which took place in Ghent, Belgium from 24 - 29 October.

The Executive Director of ICPA, Mr Ed Wozniak, noted that the award was given in light of the “remarkable and innovative work in the area of HIV of the African HIV in Prisons Partnership Network (AHPPN)”.   

The AHPPN is an initiative of the United Nations Office on Drugs and Crime (UNODC). It was created to support governments in their efforts to mount an effective, human rights-based response to HIV and TB in prisons in Africa, and to offer a platform for national, international and multi-sectoral cooperation and action.

According to a 2007 UNODC report existing data suggest high HIV prevalence rates among African prisoners as compared to the general adult population. A study cited in the report indicated HIV prevalence as high as 40% among prisoners in some prisons in South Africa. (The study was conducted in a limited number of prisons and not considered representative of the entire prison population in South Africa.).

Formally launched in November 2009 by UNODC, in partnership with the World Health Organization, the World Bank and UNAIDS, the work of the AHPPN is guided by the belief that ‘good prison health is good public health’.

The network’s efforts include a new website, and has built a comprehensive data collection questionnaire to gather up-to-date and reliable primary source data on HIV in prison settings.

Accepting the ICPA Healthcare Award on behalf of the AHPPN was Dr Fabienne Hariga, Senior Expert, HIV/AIDS Section at UNODC and AHPPN Steering Committee member and Zambian Commissioner of Prisons, Mr Percy Chato.

Michel Sidibé meets with H.E. Mohammad Reza Rahimi, First Vice President of the Islamic Republic of Iran. Credit: UNAIDS

In nearly all countries, HIV prevalence among prisoners is significantly higher than in general population. A variety of factors contribute to the spread of HIV in prison settings, including unsafe injecting drug use, unprotected sex, tattooing with contaminated equipment and poor prison health services.

In the Islamic Republic of Iran, HIV prevalence among prisoners is about eight times higher than in the general population. Injecting drug use is the main mode of HIV transmission, accounting for more than 70% of reported HIV cases in Iran.

A visit this week to Iran by UNAIDS Executive Director Michel Sidibé highlighted the country’s progressive work in addressing its HIV epidemic in prisons and among people who inject drugs. Iran’s 250 prisons, rehabilitation camps and juvenile correctional centers house approximately 180 000 inmates. Nearly half of all inmates are imprisoned on drug-related charges.

“What I saw in Qezel Hessar Prison is an evidence-based approach marked by tolerance, pragmatism and compassion,” said Mr Sidibé after touring the largest detention center in the region.  “I am impressed with the comprehensive package of HIV prevention, treatment, care and psychosocial support that the prison provides.”

Located near Karaj City, the Qezel Hessar Prison has 19 000 inmates, the majority incarcerated on drug-related offences. The facility offers a wide range of HIV-related services, including opioid substitution therapy, antiretroviral therapy, voluntary testing and counselling, access to condoms and sterile razors, psychotherapy and other behavioral interventions.

Qezel Hessar Prison provides methadone maintenance therapy to more than 2700 inmates on a daily basis, a 30-fold increase since 2003. Like most other prisons in country, married prisoners are allowed conjugal visits with their spouses and are provided with private rooms and condoms.

Executive Director meets senior Iranian officials and people living with HIV

Michel Sidibé meets with a group of HIV-positive people at the "Positive Club" in the Iranian Research Center for HIV and AIDS. Credit: UNAIDS

In meetings with First Vice President Mohammad-Reza Rahimi and other top Iranian officials, Mr Sidibé urged authorities to work towards the goals of “zero new HIV infections among drug users” and “zero newborns with HIV.” Iranian authorities expressed the commitment of the Islamic Republic of Iran to address the HIV epidemic based on the Islamic concept, “If you save one life, you are saving humanity.”

As part of his official mission, Mr Sidibé also visited a “Positive Club” located in the Iranian Research Center on HIV and AIDS. Addressing a group of people living with HIV, he said: “When I hear the words “hope,” “happiness” and “job,” I feel that our efforts have not been wasted.”

During the visit, Mr Sidibé emphasized the work of Iranian health authorities in helping restore the lives and dignity of people living with HIV through the establishment of such Positive Clubs and the provision of information, antiretroviral medicines and other HIV-related services.

Speaking on behalf of people living with HIV, the head of the Positive Club’s council told Mr Sidibé that AIDS is a very difficult area to address. “It requires courage and patience, and you are one of those people who have the courage and patience to work in this area,” he said. “We are happy to have your support, and we are ready to work with you together.”

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