Transcript Why prisons?

HIV/AIDS prevention and care among
injecting drug users and in prison settings in
Estonia, Latvia and Lithuania
Signe ROTBERGA
UNODC, Baltic States
4/6/2016
5 November 2009
Comprehensive strategy:
• Preventing drug abuse
• Facilitating entry into drug dependence treatment
• Establishing effective harm reduction measures to
reduce adverse health and social consequences of drug
abuse
Project objectives:
• Develop strategies and action plans to address
HIV/AIDS among IDUs and in prison settings
• Improve professional capacity to address HIV/AIDS
• Increase coverage of comprehensive HIV/AIDS
prevention and care services
• Generate and share strategic information to respond
appropriately to evolving HIV/AIDS epidemics
Indicators to measure access to services
• Availability (Y/N? number of sites per 1000 IDUs )
• Coverage (% IDU using services)
• Quality
(Adhering to WHO/UNODC guidelines)
Quality combined with scale-up will make a difference
on the intervention’s impact on the epidemic.
Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for
universal access to HIV prevention, treatment and care for injecting drug users
Comprehensive package of HIV prevention services
for IDUs
 Needle and syringe programmes (NSP)
 Pharmacotherapy (methadone, buprenorphine) and other drug dependence
treatment
 Voluntary HIV Counselling and Testing (VCT)
 Anti-Retroviral Therapy (ART)
 Sexually Transmitted Infections (STI) prevention and treatment
 Condom programming for IDUs and partners
 Targeted Information, Education and Communication (IEC)
 Hepatitis diagnosis, treatment (Hepatitis A, B and C) and vaccination of A&B
 Tuberculosis (TB) prevention, diagnosis and treatment
•
WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access
to HIV prevention, treatment and care for injecting drug users
Small grants programme for HIV prevention
among IDUs and in prisons
• Needle and syringe programmes
• Pharmacotherapy with methadone
• HIV education and care in prisons
Total budget: 673 600 LTL
8 projects
4 projects
2 projects
Grants for harm reduction services in 2009
Capacity building in 2009
•
•
•
•
20 training seminars, 449 participants
2 study tours, 8 participants
11 conferences/meetings, 413 participants
Professional networking and training: participation in 4
international events, 67 persons
Capacity building
• Training needs assessment
• Training topics: pharmacotherapy, peer driven interventions
for IDUs, estimation of IDU prevalence, HIV and drug
education
• Target groups: physicians, nurses, social workers, prison
staff, policy makers, NGOs, police, pharmacists
• All training events evaluated, positive feedback received
Information and education materials
•
FHI material “HIV voluntary counselling and testing: a
Reference Guide for Counsellors and Trainers“ in
cooperation with Lithuanian AIDS centre.
•
Educational material "Diagnostic, Treatment and
Social Support of Opioid Dependent People” in
cooperation with Vilnius Centre for Addiction
Disorders.
•
Manual “Risk reduction for IDUs in prison” in
cooperation with Prison department under MoJ.
•
Information leaflet “Frequently asked questions about
methadone or/and buprenorphine” in cooperation
with Vilnius Centre for Addiction Disorders.
Training modules, guidelines
• Clinical protocol for psychiatrists “Pharmacotherapy of
opioid dependence with methadone”
• Training module for social workers “HIV prevention and
services for drug users”, Siauliai Medical College
Mid-term evaluation: conclusions
• Project is extremely useful and well-run
• Highly relevant to national responses to HIV in the
Baltic states
• Evidence of progress towards objectives and results
Mid-term evaluation: concerns
• Sustainability of activities and systems established
• Strategic information is not always being used to shape
the national response
• Access to HIV tests for IDUs
• Discontinuation of pharmacotherapy with methadone in
prison settings
Mid-term evaluation: recommendations for
Lithuania
• Revise National AIDS programme ensuring focus on
IDUs and prison settings
• Piloting provision of methadone maintenance therapy in
prisons
• Explore ways in which ARV therapy can be financed in
prisons
Why prisons?
National average
HIV prevalence
Prevalence of drug
use
Prisons
0,04%
3,7%
1%
>20 %
Overcrowding
High turnover
Interaction between prison and society
International norms and standards guiding prison
health care
• Prison health is part of public health
• The principle of equivalence
• A human rights approach to prison health
Health is a fundamental human right indispensible from
the exercise of other human rights
UN Committee on Economic, Social
and Cultural Rights
Loss of liberty alone is the punishment, not the deprivation
of fundamental human rights. Like all persons, therefore,
prisoners have a right to enjoy the highest attainable
standard of health.
Every country’s response to HIV ...
• ... is influenced by economic and social conditions, as
well as by cultural, social, and religious traditions, but
• these national conditions do not reduce or negate
government obligations to meet recognized international
prison, health and human right standards.
• International law is clear that a lack of resourses does
not excuse a state from its obligations to provide proper
and humane prison conditions
Achievements in 2009
• Regulation on provision of methadone in arrest houses
• Preparations for introduction of methadone therapy in
remand prisons
Costs of drug dependence treatment per person per year (in US$)
2.722
Out-patient treatment
3.500
Methadone maintenance
therapy
12.467
In-patient treatment
(cocaine)
16.691
39.600
Probation
43.200
Inprisonment
Treatment not prov ided
0
50
00
10
0
00
15
0
00
20
0
00
25
0
00
30
0
00
35
0
00
40
0
00
45
0
00
www.unodc.org/balticstates