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REPORT “ A sero-behavioral survey of the HIV and AIDS situation in Zambian prisons”

REPORT “ A sero-behavioral survey of the HIV and AIDS situation in Zambian prisons” . Presented by: Dr. Chisela Chileshe ,Deputy Commissioner of the Zambia Prison Service at the ICASA Conference, Ethiopia on 7 th December 2011. FUNDING.

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REPORT “ A sero-behavioral survey of the HIV and AIDS situation in Zambian prisons”

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  1. REPORT“ A sero-behavioral survey of the HIV and AIDS situation in Zambian prisons” Presented by: Dr. Chisela Chileshe,Deputy Commissioner of the Zambia Prison Service at the ICASA Conference, Ethiopia on 7th December 2011

  2. FUNDING • UNITED NATIONS OFFICE ON DRUGS AND CRIME(UNODC) • WORLD HEALTH ORGANISATION (WHO) • UNITED NATIONS PROGRMME ON HIV/AIDS(UNAIDS) • THE GLOBAL FUND( GF)

  3. KEY PLAYERS • IMPLEMENTING AGENCIES— • In But Free (IBF), Tropical Diseases Research (TDRC) Here I wish to acknowledge Dr. Oscar Simooya (Principal Investigator of the survey and co-author of this presentation) • PARTNERS • ZAMBIA PRISONS SERVICE (ZPS) • NATIONAL HIV/AIDS/STI/TB COUNCIL (NAC)

  4. Prison Overcrowding

  5. Zambian Prisons Current Infection Control Cells Visit system Entry Revolving door HIV+ HIV+ Undx. TB+ TB+ Undx HIVTB+ Healthy Exit Community

  6. Introduction to the survey In Zambia, the last survey in 1999 reported, HIV rate of 27%, STI 15% and TB 5, 285/100,000. Between 1995 -2000, 2,397 prisoners and staff died of AIDS related illnesses and in 2004 alone 449 prisoners died of AIDS related illnesses

  7. Main Goal The main goal of the survey was to obtain accurate information about the magnitude of the HIV and AIDS epidemic in Zambian prisons. It was planned that the data so obtained would be used to inform policy and programmatic decisions in order to reduce the burden of morbidity and mortality caused by AIDS and syphilis in Zambian prisons.

  8. Specific Objectives To obtain accurate estimates of HIV and syphilis prevalence in Zambian prisons To obtain accurate information on risk behaviours for transmission of HIV in Zambian prisons To obtain information on services available for HIV and AIDS in Zambian Prisons

  9. Methodology Cross sectional survey of prisoners Voluntary, confidential and anonymous Survey protocol approved by Ethical Committee of Ministry of Health Prisoners opting out offered VCT

  10. Sample Size 350 participants at each prison, target – 3,150 participants

  11. Field Procedures Meeting with all prisoners and staff HIV/AIDS Risk Reduction Education Cohort willing to participate Abstentions and exclusions Informed Consent Allocate Study IDs and Collect Questionnaire & bottles

  12. Field Procedures Cont….. Allocate Study IDs and Collect Questionnaire & bottles Interviews Collect Blood 10mls Reference Laboratory at TDRC RPR testing at Prisons Need to Know HIV Status No Need to Know HIV Status

  13. Field Procedures Cont….. Need to Know HIV Status No Need to Know HIV Status VCT Counsellor 3 VCT Counsellor 1 VCT Counsellor 2 HIV Clinic HIV/AIDS Risk Reduction Education & End of Program

  14. Serum testing & data analysis • HIV – 2 ELISAS + Western Blot • Syphilis – RPR + TPHA • Data entered into Epi Info™ 3.5.1 • Data Analysis – SPSS Version 18.0

  15. Results • Survey conducted between April 2009 – July 2010. 1) Seven (7) out of 9 (78%) regional prisons covered 2) 2,244 questionnaires administered and 2,243 blood samples collected

  16. Map of Zambia showing where the survey was conducted

  17. Summary of the findings . • Age distribution– 68% between 25-44years • Males-91%, females-8.2% • Years of imprisonment-40% remand, 34.7% <12months to 5years • 27% HIV –Sero -prevalence rate • 25-44years most infected -65% • Females most infected-43%, males -27% • Multiple sexual partners- 33% infected • Syphilis- 4.5%

  18. Knowledge,attitude,behavour and practices • 99.5%---HIV Knowledge • 74%----knew the risk of getting HIV in Prison • 50%----had VCT done in prison • 64%---knew their status • 87%----knowledge that condoms protect against HIV infection. • 97%--knowledge that shared razor blades was risk • 96%---knowledge that tattooing risk factor • 35% of those tattooed were HIV Positive.

  19. 90% ---said no to condoms? • 1.5%--- MSM? • 72%---MSM practiced by few to many • 10%---use cannabis (dagga) • 66%--females access Gynae. services • TB---associated with HIV • No condoms supplied to prisoners( staff supplied )

  20. Implications Still very high HIV levels in prisons in 2009/10 – 27% vs 14% national rate In 1988, 1999 prevalence rates 16% , 27 % respectively

  21. Implications …. High prevalence rate in female prisoners Tattooing a risk behavior Most prisoners aware of HIV and AIDS and how it is transmitted Many prisoners afraid of HIV transmission in prison

  22. Implications MSM underreported, in one to one interview but indirect questioning suggests high levels of MSM TB strongly associated with HIV in prisons More than 50% of prisoners have undergone VCT Services for prisoners with HIV few and far

  23. Implications Over 90% of inmates object to distribution of condoms in prisons Female prisoners have good access to gynecological services

  24. Recommendations • Increase coverage of VCT to all prisoners • Provide IEC on tattooing, MSM and other risk behaviors • Provide basic hygiene accessories

  25. Recommendations • Strengthen diagnostic & treatment services for HIV & TB • Develop consensus on risk behaviors in prisons ( ???? Condoms) • Advocate for decongestion of prisons • Male circumcision (MC) a good option

  26. Recommendations • Develop infrastructure to enable ZPS provide single rooms to prisoners • Expand capacity of social service workers in prisons • Provide post exposure prophylaxis to Prison staff in view of accidents and fights

  27. Why do we need to protect prisoners against HIV & AIDS? • prisoners come from, and go back to society • right to health, equality in access to treatment and dignity • sentence to prison must not be a sentence to HIV and AIDS or “ double sentence ”

  28. Conclusion “ HIV infection acquired inside can be transmitted outside: protecting prisoners is in thelong run is protecting the community outside – a good public health and human rights approach ”

  29. Acknowledgements • Zambia Prisons Service staff and inmates • Zambia Prisons Fellowship • District Medical Offices • Provincial Medical Offices • Various NGO’s who assisted in VCT

  30. Thank you !

  31. Study population(n = 2,244)

  32. Study population(n = 2,244)

  33. Study population(n = 2,244)

  34. Study population (n = 2,244)

  35. HIV sero-prevalance ( n = 2,244)

  36. HIV sero prevalance & risk factors(age)

  37. HIV sero-prevalence & risk factors(gender)

  38. HIV sero-prevalence & risk factors(other sexual partners)

  39. Syphilis

  40. Other associations: Significant association between HIV and being married, being self employed/ employer, living in urban centers and having 2 -4 children (p< 0.0001) but, no association between HIV and imprisonment status/years in prison, past history of confinement

  41. Knowledge, Attitude, Behavior & Practices (KABP) 2201/ 2214 (99.5%) know about HIV/AIDS 1991/2216 (90%) AIDS serious problem 1634/2216 (74%) there is risk of getting HIV in prison 2017/2216 (91%) can reduce HIV by having one partner 1924/2213 (87%) condoms protective against HIV

  42. Knowledge, Attitude, Behavior & Practices (KABP) 1904/2215 (86%) no risk by sharing food 1816/2213 (82%) mother to child transmission of HIV is possible 2150/2215 (97%) can get infected by sharing razors 2125/2219 (96%) can get infected by tattooing 1861/2219 (84%) no cure for AIDS

  43. Risk behaviors: (MSM) Male to male sex (MSM) reported by 35/2201 (0.01%), no association with HIV 1579/2208 (72%) of respondents report MSM is practiced by few to many prisoners 2001/2210 (90%) said no to condoms in prisons

  44. Other risk behaviors: tattooing 1476/2216 (67%) say tattooing common in prisons 132/2200 (6%) report having been tattooed in prison 46/132 (35%) of inmates tattooed in prison HIV positive (p <0.05) Instruments used - needles, knives & razors

  45. Other risk behaviors: sharing shaving equipment & Injecting drug use 1870/2095 (90%) have shared shaving equipment but no association with HIV status Less than 1% reported injecting drugs “ Blood sharing ” rituals rare 10% use cannabis (dagga) in prison

  46. Voluntary Counseling and Testing 1110/2214 (50%) have undergone VCT 747/1106 (68%) had VCT at prison 1267/1976 (64%) knew their status 1975/2217 (89%) knew about medicines for HIV 1625/2211 (73%) said ARTs could be sourced at the prison

  47. Other findings: Diagnosis of TB associated with HIV Little information (< 50% of respondents) on condom use, AIDS policy, MSM, injection drug use (IDU) Little support for those with HIV from prison staff and faith based organizations but good support from NGOs and fellow prisoners

  48. Other findings: “ harm reduction” • No condoms supplied in prisons (Given to Staff) • No sterile needles available in prisons • Shaving equipment accessed by 609/1996 (30%) of prisoners • Drug dependence programs not available

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