Transcript Tackling HIV/AIDS in prisons in Ukraine

Tackling HIV/AIDS in prisons
in Ukraine
Deputy Head State Prison Department
Prof. Dr. Ed. Natalya Kalashnik
Prison system capacities in
Ukraine
 Number of Prisons – 149 with 130,000
inmates
 10 female settings (6,800)
 11 for adolescent (2,200)
 Pre-detention centers – 32 with 31,000
inmates
 22 health care facilities
 10 TB clinics
Policy & Legal environment
1. Law of Ukraine “ Addressing HIV and social
protection of the population”
2. Decree Cabinet of Ministers of Ukraine (2004)
“Strategic concept of GoU on prevention
spread of HIV/AIDS by 2011”
3. Decree Cabinet of Ministers of Ukraine (2004)
“National AIDS Program 2004-2008”
4. State Prison Department: Sectoral AIDS
Program (2004) harmonized with National
AIDS Program
State Prison Department
AIDS Program
AIDS program:
 Goals:
 Prevention of HIV transmission
 Scaling up access to treatment
 Specific objectives:
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IEC targeting inmates and staff
Behaviour change among inmates
Decrease mother to child transmission
Access to diagnostic, treatment and support
Set up and scale up “harm reduction” programs
Establishing collaboration with NGOs
Epidemiology HIV and TB in
prisons
HIV prevalence
TB Prevalence
2005
2006
SPD
1234.4
per
100,000
1188.3
per
100,000
SPD
1826.1 1357.1
per
per
100,000 100,000
Ukraine
133.5
per
100,000
154.3
per
100,000
Ukraine
219.1
218.7
per
per
100,000 100,000
2005
2006
HCV prevalence*
 * - HCV notification and reporting is not
incorporated in national regulations
 According to sentinel surveillance data
(2004) among inmates/IDU – HCV
prevalence – 98%
HIV testing in prisons
 According to SPD regulations (differ from
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National HIV testing protocol)
Voluntary and confidential (code system)
Pre- and post-test counseling as part of service
Trained staff (specially assigned for each of the
prison)
HIV test result delivered by trained staff
(specially assigned physician-consultant in each
setting)
In 2006 – 15.8% of inmates were tested
HIV/AIDS education
 HIV education is embedded in the National and
SPD AIDS programs
 For inmates (program implementing upon arrival
and before release):
 Channeled through physician-consultant (lectures,
individual consultations, etc.)
 Channeled through NGOs: (peer concept,
distribution of info brochures, individual
consultations, self-support groups incl. theater
performance) + church (FBO) + students
volunteers
 For staff:
 Lectures and info brochures (as part of education
and post-education curricula)
 Post-graduate education (incl. study tours,
trainings)
 Special attention to PEP and HIV on workplace
Sexual behaviour
 According to the policies condoms is not
included in the “list of prohibited items”
 Distribution mainly through NGOs (where
projects are available) – 35 projects
 Starting from 2007 plan to procure condoms
through the World Bank Loan and distribute (free
of charge)
 Strategies to address aggressive sexual
behaviour: education/information/religion/use of
psychologists
Transmission by injection
Up to date
 Special measures to reduce drug supply
 Surveillance and search among inmates and visitors, ad hoc
search in premises, surveillance of staff and vehicles
 Collaboration with Dept. On illicit drug supply (OBNON) to
prevent drug traffic
 Medical observation of inmates/drug users
 Measures to decrease drug demand and use
 Primary and secondary prevention (Information, Education and
Communication campaign, disinfectants)
 Treatment (detoxification and “drug-free” programs)
 Rehabilitation
 Reform inside SPD
Transmission by injection
Planned for 2007
 Introduction of substitution therapy (ST) in
prisons is under the question (ST in Ukraine is
limited by pilot programs with buprenorphine, while scaling up ST
and start use of methadone still challenging)
 Jointly with Canadian HIV/AIDS Legal
Network and International Harm Reduction
Association planned pilot needle and
syringe program (NSP) in 2 prisons
Antiretroviral treatment (ART)
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Ukraine started scaling up ART since 2004 (State budget and GFATM) - up to
date around 5,000 pts. on ART (while the needs 17,500)
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Since 2006 ART available in prisons (55 received, needs -200)
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ART regimens correspond to the national treatment guidelines (also WHO)
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Provision of ART jointly with NGOs (with donors financial support)
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CD4 available through regional AIDS centers and 1st and 2nd line regimens
according to the national treatment protocols (NNRTI and PI-based regimens)
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Treatment of opportunistic infections: according to the national protocols
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PMTCT: starting from 2nd trimester: coverage 100%
Management of HIV infected
prisoners
 HIV status is confidential (results deposited in
secure place)
 HIV tests results (encoded) accessible only for
physician-consultant and without informed
consent cannot inform other medical staff
 HIV infected imprisoned under general
conditions
 Comprehensive measures to prevent stigma and
discrimination (voluntary testing, confidentiality,
general conditions of imprisonment, trainings for
staff)
Technical assistance needed
 Improve legislation
 Develop standards and model package of
services for inmates
 Local evidence to confirm NSP and ST
benefits and operational modalities
 Involve NGOs and supervise the quality of
services provided through NGOs
 Develop comprehensive IEC
The way forward
 Re-socialization through
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empowerment and education
Change society attitude towards
inmates (especially outside the
system)
Provide incentives for seeking
prevention and treatment
Increase self-estimation of inmates
New programs: “Be good for
everybody” and “Save your life”