Transcript Brian Tkachuk

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)
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.
UNODC INTRODUCTION cont’d
UNODC GOVERNING BODIES
- Commission on Narcotic Drugs
- Commission on Crime Prevention and Criminal Justice
- UNAIDS Programme Coordinating Board
UNODC INTRODUCTION cont’d
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.
UNODC INTRODUCTION cont’d
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
UNODC INTRODUCTION cont’d
UNODC’s 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
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.
KEY UNODC ACTIVITIES (2007/2008) Cont’d
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
KEY UNODC ACTIVITIES (2007/2008) Cont’d
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
HIV/AIDS Prevention, Care, Treatment and Support in Prison Settings - A
Framework for and Effective National Response (UNODC, WHO, UNAIDS)
OBJECTIVE OF THE
FRAMEWORK
Provide a framework for mounting and
effective national response to HIV/AIDS in
prisons that:
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Meets international human rights standards
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Prioritises public health
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Supports the management of custodial institutions
THE FRAMEWORK CONTAINS
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11 Principles
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9 Key Areas to be Addressed
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100 Specific Recommendations for Action
11 PRINCIPLES
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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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
9 KEY AREAS TO BE ADDRESSEED
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2.
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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
KEY AREAS TO BE ADDRESSEED
1. 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)
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
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.
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.
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.
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
KEY AREAS TO BE ADDRESSED
7. Staff Training and Support
Consult with staff on the development
of education materials and
Programmes
KEY AREAS TO BE ADDRESSED
8. Evidence Based Practice
Prioritise funding and resources for
interventions that demonstrate needs
and evidence base.
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
IMPLEMENTING THE FRAMEWORK
AT THE NATIONAL LEVEL
BUILDING MOMENTUM
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Identify and educate key stakeholders “Talk to your Prime
Minister”
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Include prison representative within coordinating bodies
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Identify and support “champions” to lead implementation efforts
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Encourage the development of working committees working on
HIV/AIDS in prison
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Build regional networks and collaborations
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Establish a concrete multi-year work plan and assessment of
national response
BUILDING KNOWLEDGE
1.
Develop data on HIV/AIDS and risk behaviour
among prisoners
2.
Raise national awareness of HIV/AIDS and prisons
issues among decision makers
3.
Increase professional training opportunities on
HIVAIDS in prison and prison health generally
4.
Utilise technical assistance from other countries
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
BUILDING PARTNERSHIPS
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Develop co collaboration between prison and
community services to promote quality and
sustainability
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Learn from community practice, but develop responses
based on prison settings
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Identify and link into existing networks
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Sustaining funding
CONCLUSION
We must take responsibility for
Putting HIV in prisons into the
national AIDS response.
THANK YOU
Email: [email protected]