Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 43404-43407 925

It is expected that more cantons will follow suit. This presentation will elaborate
recent developments in the field of needle distribution in the prison setting in
Switzerland.
Results: The pragmatic approach to needle distribution in the prison setting
has proven effective in Switzerland. The recently adopted political and legal
statement will support this approach and could lead to needle distribution in all
Swiss prisons.
Lessons Learned: A pragmatic approach to the introduction of needle distribution in the Swiss prison setting has helped the acceptance of this measure on
a political level. This political acceptance should help generalise the adoption of
needle distribution programmes in Swiss prisons.
43404 A model for corrections and community health:
A Canadian experience
Judith A. Portman', L.Y. Lior2, F. Galvon3, W. Smith', C. Archibald2.
1Correctional Service Canada, 340 Laurier Avenue West Ottawa Ontario;
2Bureau HIV/AIDS & STD Health Canada, Ottawa ON; 3Novascotia Department
of Health Truro NS, Canada
Issues: Canada's prison system presents an opportunity to provide important
public health interventions. In particular collaboration between correctional facilities and public health departments should be enhanced and encouraged in
the area of testing or screening for STD's and blood-borne pathogens. There is
a need to improve linkages to public health as 80% of prisoners return to the
community.
Project: In March 1996, the death of an inmate diagnosed with AIDS who
shared IDU equipment with 40 other inmates prompted Correctional Service
Canada (CSC) institutional health services to initiate contract tracing, HIV and
Hepatitis B/C testing. With the support from the warden, the chair of the Inmate
Committee and the Chief of Health Services of Springhill Institution, a team
was formed under the leadership of CSC Health Services, to develop a broader
response to include the Provincial Public Health Department and the Laboratory
Centre for Disease Control, Health Canada. A three pronged approach was initiated: epidemiological investigation, education for inmates and staff and a review
of existing CSC policies.
Results: Springhill Institution is a medium security federal institution located in
Springhill, Nova Scotia which houses 580 male and approximately 10 female inmates. Partnerships were developed with the inmate committee who participated
in the development of the protocol and the questionnaire and the dissemination
of information about the investigation to the prison population as well as the
services of counsellors and health services staff. Various recruitment strategies
were developed. Participation was voluntary, and included completion of an interviewer-administered questionnaire, blood tests for HIV, HBV, and HCV with
pre and post-test counselling. The provincial public health nurse who provided
regular public health services within the facility was contracted by CSC to conduct
the interviews, provide the counselling, draw blood samples and provide the test
results. All attempts were made to provide individuals with their results prior to
their anticipated release or transfer date.
Lessons Learned: The key to effective intervention is to develop close collaboration between community health and correctional health services. This study
involved collaboration between the Correctional Service Canada (CSC), the Laboratory Centre for Disease Control and the Provincial Public Health Department
and this model could be used to address similar problems in other settings.
43405 1Public health/corrections collaborations in the
prevention and treatment of HIV/AIDS, STDs, and TB:
Results of a national study
Theodore M. Hammett1, J.R. Miles2, C.A. Crawford3, R.F. Voigt2, K.M. Krane2,
P. Harmon', R. Widom4. 1ABT Associates Inc. 55 Wheeler Street Cambridge
MA 02138; 2CTRS for Disease Control & Prevention Atlanta GA; 3National
Institute of Justice Washington DC; 4 University of Arizona Tucson AZ, USA
Issues: Prison and jail inmates are disproportionately affected by HIV/AIDS,
STDs, and TB and these health problems, in turn, affect the health of the
larger communities to which the vast majority of inmates return. Because of this,
corrections and public health agencies have begun to collaborate on interventions targeting inmates, even though these agencies may seem to have distinct
missions and interests.
Project: Patterns of collaboration and factors making for successful collaborations were explored through questionnaire responses from all state/federal
correctional systems and 41 of the largest city/county jail systems, and through
site visits to 6 states and 5 city/county jurisdictions.
Results: Virtually all correctional systems (96%) reported at least some collaboration with a public health department. Collaborations are occurring in many
areas, including education and prevention programs for inmates and staff; testing, screening and surveillance; lab services; counseling; partner notification;
outbreak investigation; treatment/prophylaxis; quality assurance; discharge planning; legislation and policy development. However, serious gaps remain - e.g.

only 10% of state/federal prison systems and 5% of city/county jail systems offer
a comprehensive HIV prevention program for inmates including instructor-led
education; peer-led programs; HIV counseling and testing; and multi-session
prevention counseling - indicating that more collaboration is needed. Key facilitators of collaboration include: data demonstrating the disease burden; mutual
recognition of the importance of inmate health to public health; mutual respect
for the differing missions and priorities of public health and corrections; improved

communication, including representation of corrections on HIV prevention planning groups; improved exchange of clinical and other information; and increased
public health funding of interventions for inmates.
Lessons Learned: Public health and correctional agencies can and should
collaborate to provide comprehensive interventions for the prevention and treatment of HIV/AIDS, STDs, TB, hepatitis B and C, and other infectious diseases
among prison and jail inmates. Collaborative approaches are an efficient way to
take advantage of an important public health opportunity. (Supported by National
Institute of Justice (NIJ) and Centers for Disease Control and Prevention (CDC)
through NIJ Contract #OJP-94-C-007)
43406 Association between mental illness and HIV risk among
incarcerated women
Joseph L. Goulet1, F.L. Altice2, A.S. Thompson2, K. Khoshnood2, K. Balacos2,
P.A. Selwyn2. 1135 College Street Suite 323, New Haven, Connecticut
06510-2483; 2 Yale University AIDS Program, New Haven, CT USA
Objectives: Many studies report a high prevalence of HIV infection among persons with mental illness (MI). While the number of women incarcerated in the
US is increasing, there is little information on their prevalence of MI. This study
examines MI among incarcerated women, and its association with risk for HIV
infection.
Methods: Standard intake information on 4,210 unique entrants to Connecticut's correctional facility for women from 11/94-07/96 was used to examine
self-report of past and current medical conditions, MI, substance use, and sexual
history. MI was defined as; past or present psychiatric condition, a history of hospitalization for mental illness, psychiatric treatment, or a prior or current attempt
to hurt or kill oneself.
Results: Nearly 40% (n = 1,665) were defined as having MI, which was
associated with:

Risk factor for HIV infection
Sex work
Needle sharing
HPV
Gonorrhea
Chlamydia
Any STD

OR
1.77
1.49
1.43
1.30
1.28
1.20

95%CI
1.55, 2.06
1.17, 1.91
1.06, 1.92
1.11, 1.53
1.07, 1.53
1.05, 1.38

MI was also associated with a younger age at first intercourse (15.0 vs 15.6
y, p - 0.05), a greater number of male sex partners in the 30 days prior to
incarceration (7.5 vs. 4.4, p - 0.05), and being HIV positive (OR = 1.35, 95% =
1.06, 1.73)).
Multivariate models revealed that STDs presented greater risk for HIV positivity
for women with MI, for those without MI, sharing drug injection equipment had
the greater risk.
Conclusion: Incarcerated women have a high prevalence of MI, which may
place them at risk for HIV infection. Prison facilities may be an important site of
contact for women not receiving treatment for their MI needs, or who are out of
treatment due to incarceration. The identification and treatment of MI, HIV prevention efforts tailored to their needs, and appropriate referrals upon discharge,
may help decrease the incidence of HIV infection both within the prison setting
and in the community.
43407 STD/AIDS prevention through intimate visit program on
the prison system of Rio de Janeiro
Eugenia M. M. Midlej1, E.J. Biondi1, L.P. Veiga1, J.L. Fialho1, C. Rosa1,
D.G.L. Vieira1, V.B. Portela2. <CHECKTEXT>Superintendencia</CHECKTEXT>
de Saude-Desipe-Sejint, Rua Senador Dantas 15 90 Andar,
20031-201-Centro-Rio de Janeiro; Hospita Heitor Carrilho- Desipe-Sejint, Rio
de Janeiro RJ, Brasil
Issue: Prisoners and their sexual partners are particularly exposed to STD/AIDS
due to their usual risk behavior. Therefore they need an appropriate prevention
programme.
Project: In the prisons of Rio de Janeiro prisoners request intimate visit (private
sexual intercourse) to the official social service at the prison unit. Social workers
inform the Health care Coordination which supplies educational and prevention
meetings concerned with reproductive organs, family planning, contraception,
hygiene, STD/AIDS, safer sex and condom use. These meetings are conducted
weekly by psychologists, social workers and nurses. Voluntary questionnaires
are distributed to evaluate the existing knowledge of the participants. Appropriate
information materials are used (booklets, videos, leaflets and mini-infocards) and
condoms distributed. Different strategies have been established to guarantee
condom access along with the intimate visit.
Results: In 1997 116 meetings with 1.323 prisoners and 71 meetings with
1.039 sexual partners were hold. 589 assessed questionnaires revealed 45% to
be 20-29 year old, 41% had low scholarity, 10% illiterates. 46% live in stable
relationship, 25% met their partner in prison, 76% have children, 33% and without
planning. 54% use contraception methods (pill: 40%, condoms: 15%, sterilization:
8%), 29% made abortions. 88% were informed about STD/AIDS transmission,
although 29%/10% had wrong ideas. 20% never used condoms, 26% sometimes,
30% always. 21% believe their use is unnecessary, 11% have difficulties to use
them and 22% pretend to use them.
Lessons learned: The intimate visit information programme is useful, as it
improves knowledge and prevention attitudes through information exchange and