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HIV, Drugs & Prisons. Gino Vumbaca. Photo by Mr. Alessandro Scotti, UNODC Good Will Ambassador. A Beautiful Set of Numbers?. Over 11,000 become infected with HIV everyday in the world Over 2,600 become infected with HIV everyday in our Region
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HIV, Drugs & Prisons Gino Vumbaca Photo by Mr. Alessandro Scotti, UNODC Good Will Ambassador
A Beautiful Set of Numbers? • Over 11,000 become infected with HIV everyday in the world • Over 2,600 become infected with HIV everyday in our Region • Over 1,300 people die everyday from HIV in our Region • In Asia, there are over 3 million people officially listed as being in prison
HIV prevalence in injecting drug users Myanmar Manipur & Yunnan Edinburgh Ho Chi Minh City Lithuania Bangkok Odessa Jakarta
Injecting Drugs in Prison Internationally, research shows: • 50-75% of prisoners have injected drugs before prison • 25-50% continue to inject in prison • Frequency of injectingless • Frequency of sharingmuch greater
Prisons and HIV Prisons are very important in development of HIV epidemic among IDU: • many prisoners are IDU • many IDU have been to prison • many continue to inject in prison • drugs are available in all prison systems • few needles/syringes, so sharing occurs
Prisons and HIV Figures • 9% of prisoners in Estonia are HIV positive (2003) • In Ukraine the number of new HIV cases in prisons has risen by 26% compared to 5% in the general population (2002) • In Russian Prisons there are 34,000 HIV positive prisoners with 95% being injecting drug users (2002) • In US Prisons it is estimated that 2% of the prison population is HIV positive (1999) • 43% of South African prisoners are estimated to be HIV positive (2002) (Source: Prison Healthcare News)
HIV in Prisons in Asia Iran 1996: 2 prisons in Teheran 29% of IDU are HIV-infected 2001: 10 prisons in Iran all found HIV among IDUs one prison: 63% HIV-infected(Ref. MAP (Monitoring the AIDS Pandemic). 2001. The Status and Trends of HIV/AIDS/STI Epidemics in Asia and the Pacific. MAP. Provisional Report October 4, Melbourne, Australia) Indonesia Salemba penitentiary, Central Jakarta: 1998: first HIV cases - 4% of 509 2001: 200 prisoners tested - 22% positive (Ref. During R 2002. Indonesian prisons begin to accept HIV threat. Asian Times April 20 (on-line http://www.atimes.com/se-asia/DD20Ae05.html)
HIV in Prisons in Asia (cont) Malaysia August 2001: - number of HIV infections in Malaysian prisons is 1,834 - 6% of total prison population - main mode of transmission is sharing contaminated needle and syringe (94%)Ref: Prisons Department of Malaysia. 2001. Programmes related to AIDS prevention and management in Malaysian Prisons Department 2001. Rehabilitation and Treatment Division. Selangor. Malaysia.
Vietnam • There are approximately 185,000 drug users in Vietnam typically aged between 18-25 years. HIV prevalence in 2004 was estimated at 28.6% though rates are as high as 70% in some provinces • Since the 1990’s authorities have dramatically increased the number of compulsory ’rehabilitation camps’ for drug users to over 80 with approx. 40,000 people now being detained for between 1-5 years each • People can be literally removed from the streets and detained by authorities for being in possession of an illicit substance – the camps to not provide any recognised form of drug treatment or HIV education • It is estimated that HIV rates in the camps are 50%
Between prisoners, from prisoners to staff – Blood contact: Violence Blood exposures Injecting drug use Tattooing Sexual contact - Heterosexual and homosexual HIV Transmission Risks in Prisons
A B D C IDU “Mixing” in Prisons A IDU Network HIV -ve C IDU Network HIV -ve B IDU Network HIV +ve D IDU Network HIV -ve PRISON A IDU Network HIV +ve D IDU Network HIV +ve B IDU Network HIV +ve C IDU Network HIV +ve
At Risk HIV Exposures Model of IDU in Prisons Based on a Model Developed by Dr Wiwat Rojanapithayakorn, UNAIDS SEAPICT A 10 HIV+ve people X 5 episodes X 1 sharer = 50 (HIV risk exposures per week) X 5 sharers = 250 X 10 sharers = 500 B 100 HIV+ve people X 5 episodes X 1 sharer = 500 (HIV risk exposures per week) X 5 sharers = 2,500 X 10 sharers = 5,000 C 400 HIV+ve people X 5 episodes X 1 sharer = 2,000 (HIV risk exposures per week) X 5 sharers = 10,000 X 10 sharers = 20,000 To Reduce Number of at Risk Exposures PrevalenceUnsafe Injecting Episodes No. of People Using/Sharing
Alytus Prison: 284 Cases Source: Lithuanian AIDS center 2002 Lithuanian Case Study New HIV Cases 1988 - 2002 • Prison population of over 11,000, with over 1,000 IDU • Very few, if any HIV prevention & drug treatment programs in prison system