WORLD BANK REGIONAL WORKSHOP ON VULNERABLE POPULATIONS AND HIVAIDS

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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 Africa
• United Nations Office on Drugs and Crime (UNODC)

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UNODC INTRODUCTION UNODC 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.
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• UNODC INTRODUCTION contd
• UNODC GOVERNING BODIES
• - Commission on Narcotic Drugs
• Commission on Crime Prevention and Criminal
  Justice
• UNAIDS Programme Coordinating Board

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• UNODC INTRODUCTION contd
• 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.

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• UNODC INTRODUCTION contd
• 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

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• UNODC INTRODUCTION contd
• UNODCs 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

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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.
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KEY UNODC ACTIVITIES (2007/2008) Contd 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
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KEY UNODC ACTIVITIES (2007/2008) Contd 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
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HIV/AIDS Prevention, Care, Treatment and Support
in Prison Settings - A Framework for and
Effective National Response (UNODC, WHO, UNAIDS)

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• 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

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• THE FRAMEWORK CONTAINS
• 11 Principles
• 9 Key Areas to be Addressed
• 100 Specific Recommendations for Action

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• 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

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• PRINCIPLES
• Good prison health is
• good public health
• The vast majority of people
• committed to prison eventually
• return to the wider society.
• Therefore reducing the transmission
• of HIV in prisons is an important
• element in reducing the spread
• of infection in society outside of
• prisons.

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• 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.

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• PRINCIPLES
• Respect for human rights
• and international law
• Respecting the rights of those
• at risk of or living with HIV/AIDS
• is good public health policy and
• good human rights practice.
• Therefore States have an obligation
• to develop and implement prison
• legislation, policies, and programs
• consistent with international human
• rights norms.

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• PRINCIPLES
• Adherence to
• international standards
• And health Guidelines
• The standards and norms
• outlined in established
• international human rights
• instruments and public
• health guidelines should
• guide the development of
• responses to HIV/AIDS in prisons.

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• PRINCIPLES
• Equivalence in
• prison health care
• Prisoners are entitled,
• without discrimination,
• to a standard of health
• care equivalent to that
• available in the outside
• community, including
• preventive measures.

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• PRINCIPLES
• Evidence-based
• interventions
• The development of prison
• policy, legislation, and
• programs should be
• based upon empirical
• evidence of their effectiveness
• at reducing the risks of HIV
• transmission, and improving
• the health of prisoners.

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• 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 of
• HIV in prisons, and to care for those living with
  HIV/AIDS,
• must be holistic and integrated with broader
  measures to
• tackle inadequacies in general prison conditions
  and
• health care.

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• PRINCIPLES
• Addressing vulnerability, stigma, and
• discrimination
• HIV/AIDS programs and services must be responsive
• to the unique needs of vulnerable or minority
  populations
• within the prison system, as well as combat
  HIV/AIDS
• related stigma and discrimination.

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• PRINCIPLES
• Collaborative, inclusive, and inter-sectoral
• cooperation and action
• While prison authorities have a central role in
  implementing
• effective measures and strategies to address
  HIV/AIDS,
• this task also requires cooperation and
  collaborative action
• that integrates the mandates and responsibilities
  of various
• local, national, and international stakeholders.

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• PRINCIPLES
• Monitoring and quality control
• Regular reviews and quality control assessments,
• including independent monitoring, of prison
  conditions and
• prison health services should be encouraged as an
• integral component of efforts to prevent the
  transmission
• of HIV in prisons and to provide care for
  prisoners living
• with HIV/AIDS.

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• PRINCIPLES
• Reducing prison
• populations
• Overcrowded prison conditions
• are detrimental to efforts to
• improve prison living standards
• and prison health care services,
• and to preventing the spread of
• HIV infection among prisoners.
• Therefore, action to reduce prison
• populations and prison overcrowding
• should accompany, and be seen as
• an integral component of, a
• comprehensive prison HIV/AIDS
• strategy.

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• 9 KEY AREAS TO BE ADDRESSEED
• Political leadership
• Legislative and policy reform
• Prison conditions
• Funding and resources
• Health standards and continuity of care and
  treatment
• Comprehensive and accessible HIV/AIDS services
• Staff training and support
• Evidence-based practice
• International, national and regional
  collaboration

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• KEY AREAS TO BE ADDRESSEED
• 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)

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• 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

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• 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.

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• 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.

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• 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.

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• 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

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• KEY AREAS TO BE ADDRESSED
• 7. Staff Training and Support
• Consult with staff on the development of
  education materials and Programmes

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• KEY AREAS TO BE ADDRESSED
• 8. Evidence Based Practice
• Prioritise funding and resources for
  interventions that demonstrate needs and evidence
  base.

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• 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

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• IMPLEMENTING THE FRAMEWORK AT THE NATIONAL LEVEL

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• 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

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• BUILDING KNOWLEDGE
• Develop data on HIV/AIDS and risk behaviour among
  prisoners
• Raise national awareness of HIV/AIDS and prisons
  issues among decision makers
• Increase professional training opportunities on
  HIVAIDS in prison and prison health generally
• Utilise technical assistance from other countries

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• 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

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• 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

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• CONCLUSION
• We must take responsibility for
• Putting HIV in prisons into the
• national AIDS response.

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• THANK YOU
• Email brian.tkachuk_at_unodc.org