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

12th World AIDS Conference

Abstracts 44193-44198 975

S44193 Management of HIV/AIDS related problems: Situation in
European prisons
Jean-Dominiqeu Laporte1, P. Bolinni2. Programme Plurifacultaire Action
Humanitaire/Center, Medical Universitaire CP CH- 1211. Geneves; 2lnstitut
Universitaire de Medecine Legale, Geneve, Suisse
Aim: to establish the epidemiological situation of HIV/AIDS and its management
in European prisons.
Method: Information from 23 prison systems in 20 countries (average daily
number of prisoners [1996]: 387,000, entrants [1996]: 485,000) obtained from
key informants through a questionnaire.
Results: (a) Extent: HIV/AIDS prevalence in prisons of Western Europe has
not changed significantly since 1989. Prevalence in Eastern European countries
is relatively low.
(b) Information: exists in every system, but is not in congruence with the extent
and the specificity of the problem in its form as well as in its contents.
(c) Condom availability to prisoners is becoming widely accepted. Evaluation
in different settings is necessary to know what categories of prisoners took real
advantage of these policies, through which channels, etc.
(d) Injection material disinfectant is made available to prisoners in half the systems, but sterile injection material is made available in only a few experimental
programs, while methadone therapy is proposed by only 9 systems (176,000
inmates). This means an absence of equivalence to general population services.
(e) Systematic testing of all prisoners without confidentiality of the results is still
in use in 10 of the 23 systems. Tritherapy cannot be offered to positive prisoners
in all these systems.
(f) WHO, Council of Europe and national recommendations are followed in respectively 10, 11 and 13 systems. Four systems have no recommendations at all.
(g) Mental health problems are the most often cited "Major problems not under control" on a 3 grades scale, while HIV/AIDS is more often cited as "Minor
problem" or "Major problem under control".
Conclusion: Prison systems must be considered as open systems. Problems
must be solved taking into account interactions with other systems, including the
fact that a prison stay is very often a short stage in a multistage process.
44194 The hard core of justice departement against AIDS
Molse Noudjingar, N. Djaouga1, Y.P. Alexandre2. 1Department of Justice
Najamena; 2Population and AIDS Control Project, Chad
Issue: The project of fight against AIDS/STD in prisons and amidst offenders is
justified by the specifity of the the support of justice department specially noticeable in prisons where there is prostitution, homosexuality, drug addiction, etc. The
project is carried out taking into account the statistics services of PNLS which
showed that in Chad, HIV/AIDS/STD is an epidemic wich has an unbelievable
rate of infection. The two cases identified in 1986 have reached the figure of 6,931
in August 1997. In Chad the problem of HIV/AIFS/STD is not only that of health
affection. But it goes beyond this sector and turn to be a real social problem,
affecting all the sectors specially the most vulnerable groups.
Project: The aim of the project is to take an affective participation in the fight
of HIV and to reduce its transmission in the target population and the make
them aware of the danger. Besides, the project aim to take care of HIV-positive
AIDS sufferers, to develop a specific teaching or didactic equipement for prisonners, and finally to implement a genuine reinforced educational programm of a
psycho-Medico-Social support to the profit of the target population.
Results: (a) More than fourty five (45) employees of prisons of Chad are
trained; (b) More than 2,065 prisonners made aware of the problem resulting in
a noticeable decrease of infection rate of HIV/AIDS/STD in prisons.
Lessons Learned: Prisons are favorable places for the transmission of
HIV/AIDS/STD. An effective and urgent ation is necessary to reduce the impact of this epidemic. And the hard core of justice department with the help of
other organizations is carrying out this activity. The project should be reinforced
and uphold.
44195 Harm reduction peer project for prisoners
Anne Marie DiCenso. 517 College Street, Suite 237 Toronto, Ontario, M6G4A2,
Canada
Issue: Drug criminalization policies in Canada have resulted in a vast majority
of incarcerated people being drug users. Lack of access to safer drug use information and materials place this population at increased risk of HIV infection,
and further places prisoners living with HIV/AIDS at increased risk for other drug
related health problems.
Project: Prisoners with HIV/AIDS Support Action Network (PASAN) formed in
1991 as a grassroots response to the AIDS crisis in the Canadian prison system.
Today, we are the only organization in Canada exclusively providing HIV/AIDS
advocacy, education and support to prisoners, ex-prisoners and young offenders. PASAN works from a harm reduction perspective, and integrates the use
of Peer education within our outreach and education programs. Peer educators

(themselves HIV positive ex-prisoners and drug users) assist PASAN educators
work with prisoners to develop specific harm reduction strategies which can be
successfully initiated by individuals within the restrictive conditions imposed by
incarceration.
Results: Incorporating Peer Educators within PASAN programs has resulted
in an increase in credibility of PASAN's educational messages among prisoners.
This has in turn raised the profile of the organization within the prison system, and

led to increased contact from prisoners requesting harm reduction information
and/or AIDS support. Success has also been indicated by increasing numbers of
prisoners joining PASAN's Peer Education team upon their release.
Lessons Learned: Harm reduction education programs within prison environments are most effective and relevant when developed and delivered in
cooperation with members of the target population.
44196 HIV prevention policies in prison
Paola Bollini, J.D. Laporte2. 1Formed - Les Chales, 1983 Evolene; Institut
Universitaire de Medecine Legale, Geneva, Switzerland
Background: Studies conducted in various countries have shown a great variability in HIV/AIDS prevention activities in prisons, in spite of the availability of
international guidelines on prevention and management of HIV infection in prison.
Methods: A comparative policy study has been conducted in Italy, Switzerland,
Hungary and Moldova to identify factors associated with adoption of harm reduction strategies in prison. Information on current policies has been collected during
country visits by interviews with officials in charge of prisoners' health, NGOs,
visits to prisons, and review of published material.
Results: All the countries considered adopted specific policies in response to
the HIV/AIDS epidemic in prison. However, only Switzerland implemented management of care and prevention of HIV/AIDS according to the 1993 Guidelines
of the World Health Organization. In the remaining countries, information was
made available to prison and staff, while harm reduction strategies (provision of
condoms, bleach, sterile needs) were much less developed.
Conclusions: The availability of harm reduction strategies in prison was still
unsatisfactory in three of the four countries studied -Italy, Hungary and Moldovawhile -it was well developed in Switzerland. Prevention and care policy in prison
mirrored the policy adopted in the community, in turn influenced by the prevailing
attitude towards drug addiction and its hazards, including HIV infection.
44197 Admission criteria, treatment and accommodation in
neuropsychiatric institutions of psychiatric patients
associated with HIV virus infection
Juan Carlos Gonzalez-Blanco, A. Portas, G. Sica, G. Tortora, L. Florio. San Juan
3276 1233, Neuropsychiatric Hospital Jose T Borda, Buenos Aires, Argentina
Numerous and different are the difficulties doctors have to face in practice when
AIDS is associated with a psychiatric syndrome which requires a hospital admission. We do know that AIDS is not discriminating that is why it may be associated
with syndromes such as Schizofrenia, addictions and personality disturbances
among others. In practice, we find ourselves having to deal with laws which
regulate our activity and in Argentina, the law for psychiatric admission, the law
for AIDS and the one which regulates our activity, have to be compatible. In
addition to this medical, legal and ethical situation, we have to add, more frequently each time, the fact of those increasing patients who are infected or with
a risk of being infected with an associated psychiatric syndrome who have not
got a definite place for admission and treatment. Psychiatric pathologies are and
have always been discriminated and now we have to add the fact of a double
discrimination: the one of being infected with the human inmunodeficiency and
the mental illness. Since the infection began, there have been many problems
we, the ones who deal with HIV positive patients in psychiatric institutions, have
had to face. Said problems arouse from colleagues, judges, relatives and those
patients who were either infected with HIV or not. This task is carried out at the
"Jose T. Borda" Neuropsychiatric Hospital where there are over 1,100 patients
admitted at present. This research is carried out with a view to giving advice
on 1. Those aspects related to admission to an institution. 2. Accomodation in
the Wards. 3. Preventive measures and how to approach them 4. Acceptance
and fulfillment of treatments with the new antiretroviral therapies. 5. Prescription
and use of psychiatric medicines. 6. The psychotherapeutics approach. 7. Biosafety regulations for everyday life within the hospital. 8. The prevention of those
diseases with a great epidemic impact such as Multiresistant Tubercolosis.
The object of this research is the protection of the psychiatric patients who are
either HIV transmissors or not, safeguarding thier right to life and health, trying
to get a balance between the ethical, medical and juridical responsibility of the
professionals and in particular of the patients with a restricted autonomy which is
the case of mentally ill patients.
| 44198 Treatment education in prison: Facing the challenges of a
controlled environment in New York State
Carlos H. Arboleda. 119 West 24th Street, New York, NY 10011, USA
Issue: Prison population and medical providers do not control all the aspects of
treatment for HIV infection, thus the need for specially designed interventions that
take into account the prison's environment.
Project (Ongoing): By law, in New York State, inmates have to be offered the
same standards of care as the rest of the population. This does not guarantee

that the access to treatment, in particular for HIV and AIDS is in accordance with
the current standards. The main obstacles are: 1) Most prisons can independently
decide what drugs to offer, regardless of their suitability in prison's environments.
2) Security prevails over medical considerations. 3) Guards, not medical professionals, are the ultimate gatekeepers and decision-makers for medical care. The
project includes a series of workshops for inmates and some staff, which gives
inmates tools for choosing therapies (if at all possible) that are more convenient