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Needle and syringe programmes in prisons

Needle and syringe programmes in prisons. Dr Fabienne Hariga Senior Adviser UNODC HIV/AIDS Section. HIV in prisons: a public health issue The facts. 30 million people go through prisons each year People who i nject d rugs represent up-to 70% of prison population

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Needle and syringe programmes in prisons

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  1. Needle and syringe programmes in prisons Dr Fabienne Hariga Senior Adviser UNODC HIV/AIDS Section

  2. HIV in prisons: a public health issue The facts • 30 million people go through prisons each year • People who inject drugs represent up-to 70% of prison population • Number of PWID go 1-6 times through prisons during life • HIV prevalence prisons up-to 50 times higher than general population • HIV transmission via injection equipment does occur in prisons • Ex: Thailand: HIV incidence 4.18 per 100 person--yearsamong all inmates - 11.10 injection inmates (Thaisri et al 2003) • Hepatitis C xx? times more • HIV and TB first causes of mortality in prisons in many countries

  3. DRUG INJECTION IN PRISONS • Injection in prisons: • Reduced • Initiation • In the absence of NSP, people share syringe and needles and/ home made syringes Source: The Fix

  4. WHO/UNODC/UNAIDS Comprehensive package for HIV and PWID Needle and syringe programs (NSPs) Opioid substitution therapy (OST) and other evidence-based drug dependence treatment HIV testing and counselling (HTC) Antiretroviral therapy (ART) Prevention and treatment of sexually transmitted infections (STIs) Condom programmes for people who inject drugs and their sexual partners Targeted information, education and communication (IEC) for people who inject drugs and their sexual partners Prevention, vaccination, diagnosis and treatment of viral hepatitis Prevention, diagnosis and treatment of tuberculosis (TB) (52 CND Political declaration ECOSOC resolution E/2009/L.23)

  5. Drug consumption by participating stable or decreased No reported instances of initiation of injecting Sharp decline in reported sharing of needles and syringes - virtually non-existent No reported new HIV, hepatitis B or hepatitis C Facilitate the referral to drug treatment Reduce the occurrence of abscesses No reported use of needles or syringes as weapons No accidental puncture for prison officers The evidences: Feasibility & Effectiveness of NSP in prison settings

  6. Harm reduction in prisons works

  7. HIV in prisons: a human rights issueGlobal policies on access to health care/HIV in prisons • Alternatives to imprisonment (GA A/RES/S-20/3) Declaration on the Guiding Principles of Drug Demand Reduction – (CND Res 55/12)Alternatives to imprisonment for certain offences as demand reduction strategies that promote public health and public safety and GAA/RES/45/110 (Tokyo rules) • Article 12 of the Covenant on Economic, Social and Cultural Rights, “[t]he States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” RES AG 2200 A (XXI) (1966) …..the obligation of States to respect the right to health implies to refrain from ‘denying or limiting equal access for all persons, including prisoners or detainees (…) to preventive, curative and palliative health services • Basic Principles for the Treatment of Prisoners, Principle 9, that “Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation.” GA RES 45/ (1990)

  8. Equivalence ? Needle and syringe programmes in community and in prisons (2013) • Afghanistan ( pilot) • Germany (1) • Iran • Kyrgyzstan (all) • (Luxembourg) • Moldova (9) • Portugal? • Romania • Spain (38) • Tajikistan 1 (pilot) • Switzerland (7) • Australia? • France? • Canada ? Adapted from Global State of Harm Reduction, 2012

  9. Prison Needle & Syringe ProgrammesModels of Distribution Photographs by Rick Lines Photograph UNODC Moldova Romania Germany

  10. Observations • Very limited number of pre-trial or penitentiary establishments with needle and syringe in prisons • Low coverage • Many programmes do not work very well: • Too strict control / lost of privileges • Lack of confidentiality and anonymity • Peer based NSP seemed to be the most effective and the most sustainable

  11. CASE STUDY: PORTUGAL • By-law 3/2007 and Order 22 144/2007 Ministry of Health and Justice authorized a pilot PNSP in Lisbon and Paços de Ferreira in 2008–2009. • The participant, after giving specific information on his pattern of use, received a kit with two syringes, filters, disinfecting towel, clean cup, citric acid, bi-distilled water and a condom. • The rules were that the kit should be kept inside its box; if the cell were inspected, the inmate should state that he is in possession of the kit; and the kit should only be taken outside the cell to be exchanged by the health-care unit. After 12 months no syringes were exchanged in either of the prisons

  12. Conclusions • Mixed system seems the best measure(Peer based /dispensing machines/health service) • No exceeding control measures • Training • Quality control and M&E • Part of comprehensive package of interventions including overdoses prevention & management

  13. Part I :Background • Evidences • Legal framework Part II: Elements of PNSP • Models advantage/disadvantages • Guides of an effective programme • Materiel Part III: Advocacy for PNSP Part IV: Planning and implementation • Preparation • Programme framework • Budget • Implementation Part V: Quality assurance • Monitoring • Evaluation • Training Annexes

  14. General Principles • A commitment to public-health objectives & to the rights to health. • Clear policy direction and oversight of the programme • Consistent guidelines and protocols + flexibility to take into account variations in population profile and security levels. • Participation of prisoners and staff in the planning and operational process • Training to raise understanding, allay fears of staff and prisoners and encourage prisoner participation.

  15. Information, education, communication Condom programmes Prevention of sexual violence Drug dependence treatment including OST Needle and syringe programmes Prevention of transmission through medical services Prevention through tattooing, piercing and other skin penetration Post exposure prophylaxis HIV testing & counselling HIV Treatment, care and support Prevention, diagnosis and treatment of TB PMTC Prevention of STIs Vaccination, diagnosis & treatment of hepatitis Protecting staff from occupational hazards Part of a comprehensive approach

  16. Acknowledgements HeinoStöver Participants in different consultations

  17. Thank You Fabienne.Hariga@unodc.org UNODC HIV Website LINK

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