Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts WeOrE1321-WeOrE1324 193

programs in any jail or prison. Methadone maintenance programs are not readily
available, nor are traditional drug treatment programs.
Description: This presentation will look at the punitive and abstinence-based
policies of U.S. prisons and compare them to the harm reduction programs of
European, Canadian, and Australian prisons. This presentation will be based on
interviews with prisoners, a literature review, and personal experiences as a member of the HIV/HCV in Prison Committee of California Prison Focus.
Lessons Learned: High-risk activities for HIV and HCV transmission such as
unprotected sex or needle sharing (both for injection drug use and tattooing) continue to occur in U.S. jails and prisons. It is widely accepted that community-based
harm reduction measures such as syringe exchange or condom distribution are
extremely effective in reducing HIV and HCV transmission. The international experience with harm reduction programs in prison show that these measures can
be effective prevention measures.
Recommendations: The HIV/HCV in Prison Committee is committed to guarantee prisoners equal access to quality health care and prevention measures. We
call on U.S. prisons to adopt harm reduction programs such as condom and dental dam distribution, methadone maintenance, and the provision of bleach kits.
We urge all HIV and harm reduction activists to put the HIV prevention needs of
prisoners on their agenda.
Presenting author: Andrew Reynolds, 187 Golden Gate Ave., San Francisco,
CA, 94102, United States, Tel.: [phone], Fax: [phone], E-mail:
andreynolds @hotmail.com
WeOrEl321 IHIV, STD, and hepatitis risk behavior among 18-29
year old men incarcerated in the United States
D.W. Seal1, A.D. Margolis2, D. Binson3, K.M. Morrow4, G.D. Eldridge5,
D. Kacanek6, L. Belcher2, J.M. Sosman7. 'Medical College of Wisconsin,
CAIR/MCW, 2071 N. Summit Avenue, Milwaukee, W153202, United States; &
Project START Study Group; 2Centers for Disease Control and Prevention,
Atlanta, United States; 3CAPS, University of California, San Francisco, United
States; 4Brown Medical School, Providence, United States; 5Jackson State
University, Jackson, United States; 6Harvard University, Boston, United States;
7 University of Wisconsin, Madison, United States
Background: HIV/STD/hepatitis transmission among incarcerated men has been
documented. Yet, little research has assessed in-prison risk behavior.
Method: A longitudinal study of HIV/STD/hepatitis risk behavior among 80 men
(ages 18-29) released from prison in 4 U.S. states included open-ended questions about their knowledge of and experience with substance use and sexual
behavior during any adult incarceration(s). Thematic content analyses were used
to identify key themes.
Results: (1) Substance use perceptions: Even though men believed that any
drug could be obtained in prison, men in all 4 states most often mentioned marijuana, alcohol, and cocaine; men in CA and RI also mentioned heroin. Drugs
were used whenever they could be obtained from other inmates, guards, and visitors; alcohol was typically brewed in prison. Drugs and alcohol were commonly
used as barter for money or favors, to celebrate, and to reduce boredom/stress.
(2) Sexual behavior perceptions: Men believed that inmates needed sexual release while incarcerated, and either masturbated, or had sex within 4 types of
sexual partnerships: older men with younger men, female guards with male inmates, between men labelled as homosexual, or on conjugal visits (MS only).
(3) Risk reduction perceptions: Most men said that little could be done to reduce in-prison HIV/STD/hepatitis risk behavior due to prison regulations and a
lack of concern among inmates about protective behavior. Educational programs
and condom/clean needle distribution in prison were advocated. (4) Men's own
in-prison behavior: 49% of men reported substance use while incarcerated, most
often marijuana or alcohol (77% and 33% of users, respectively). 14% of men
reported sex while incarcerated (73% reported female partners, 27% male partners).
Conclusions: These data document in-prison substance use and sexual behavior, and highlight the need for health promotion strategies for incarcerated men.
Presenting author: David Seal, CAIR/MCW, 2071 N. Summit Avenue, Milwaukee, WI 53202, United States, Tel.: [phone], Fax: [phone], E-mail:
[email protected]
WeOrE1322 Challenging AIDS behind bars: time for
commitment to action
OO. Simooya, N.E. Sanjobo. Copperbelt University Copperbelt University
Jambo Drive, Riverside, P 0 Box 21692, Kitwe, Zambia
Issues: Following a national survey of HIV seroprevalance and risk behaviours
in Zambian prisons, 27% of inmates were HIV positive while risk behaviours included sex between men, tattooing, injecting drug use and sharing of shaving
appliances. No condoms were available in prisons and measures for harm reduction were absent. We concluded that the risk of HIV transmission in the country's

prisons was high and a conference to develop a response was subsequently held.
Description: The conference adopted the following measures; intensive
HIV/AIDS education, provision of IEC materials relevant to prisons, training of
staff and inmates as peer educators and counsellors, provision of voluntary counselling and testing (VCT) and funding for the treatment of STIs and TB. Other
policies recommended were use of non custodial sentences for juvenile and first
offenders, conjugal visits and release of inmates terminally ill with AIDS. However,

participants rejected condom distribution and the provision of sterile needles and
bleach as it waw felt that this would encourage illegal acts. Tattooing was banned
forthwith.
Lessons learnt: Although the model outlined above is commendable, it does not
go far enough to address the risk behaviours noted in prisons. In Zambia, like in
many other countries, the development of effective and appropriate interventions
in jails has been hampered by often competing public health and legal and security concerns. There is therefore little consesus about what should be standard
HIV/AIDS prevention and care in prisons.
Recommendations: Given the fact that many prisoners are in prison for a short
time only and indeed most return to their families, HIV acquired inside can be
readily transmitted outside. Protecting inmates against HIV infection is therefore
in the long term protecting society from AIDS. Action to provide inmates with public health measures comparable to those outside jail are needed urgently.
Presenting author: Oscar Simooya, Copperbelt University, Jambo Drive, Riverside, P O Box 21692, Kitwe, Zambia, Tel.: [phone], Fax:
[phone]/222881/228319, E-mail: [email protected]
WeOrE1l323 Awareness, perception and risk behaviours of
drug users in the prisons
C. Paul1, S. Das Gupta2, S. Sharma2, M. Deb3. 1 Tribal Development Society,
15, Ayarbadi, Tirukalukundram, Kanchee District, Tamil Nadu -603109, India;
2B.PKoirala Institute of Health Sciences, Dharan, Nepal; 3Lady Hardinge
Medical College And Hospital, New Delhi, India
Background: HIV has consistently been higher among prisoners than general
public. Injecting drug use is the main route for HIV infection in the prisons, The
aim of this study is to determine the awareness, risk perception and risk taking
behaviour of prisoners who use drugs and to implement effective health education
programmes in the prisons.
Method: Qualitative data collected using key informant interviews, Focus group
discussions and in-depth interviews. Out of 724 inmates of 5 prisons of Eastern
region of Nepal, which consists 16 districts, 160 inmates participated in 19 focus
groups and 95 inmates participated in in-depth interviews.
Results: In-depth Interviews revealed 28% of the participants were drug users
with median age of 24. Median of drug use starting age was 21 (range 13-34).
Median number of years drug use was 5 (range 1- 14 years). 37% completed
high school and 33% dropped out of school. 71% of the drug users consumed
oral and intravenous drugs and 75% of them always-shared needles. 38% of
them said they had casual partners and 30% had frequent visits to sex workers.
None of them ever used condoms. Only 14% perceived that they might have HIV.
Awareness on HIV/AIDS was very limited with many misconceptions.
Drug use and male-to-male sex is not openly discussed but "happens".
Conclusion: This study shows a rather high rate of risk behaviours and low level
of knowledge. These necessitate availability of HIV testing, as well as the implementation of education and risk reduction programmes in the prisons
Presenting author: Chitra Paul, 15, Ayarbadi, Tirukalukundram, Kanchee District, Tamil Nadu -603109, India, Tel.: [phone], E-mail: [email protected]
WeOrE1l324 Blood borne viruses and drug using risks for
juvenile justice clients: An analysis of
interventions and worker practices in Victoria,
Australia
M.L. O'Brien, M.K. Pitts, J.W. Grierson. ARCSHS, LaTrobe University ARCSHS,
LaTrobe University, 215 Franklin Street, Melbourne VIC 3000, Australia
Background: Injecting drug users (IDUs) internationally are vastly overrepresented in correctional institutions. The high prevalence of hepatitis C virus
is a significant concern in Australian correctional systems. Previously, examination of how the risk for blood borne virus (BBV) transmission and other drug use
risks are managed for those in correctional systems have largely concentrated on
adult, rather than juvenile justice contexts.
Aim: This paper reports on research on the management of BBVs and other drug
use risks within the juvenile justice system in one Australian State.
Method: Eighty-five in-depth semi-structured qualitative interviews were conducted with health and generalist staff who supervise young people in both custodial and non-custodial settings. Thematic analysis of interviews using a grounded
theory approach elaborated themes relating to risk management.
Results: Introduction of harm reduction measures included methadone prescription, condom distribution and syringe disposal. Barriers to the successful implementation of harm reduction measures include: the difficulties in balancing the
imperatives of health and corrections; the challenge of continuity of care across
complex systems; and the viewing of 'risk' as not only resulting from individual
behaviours, but also resulting from the systemic and institutional practices that
provide the context in which individuals act.

Presenting author: Mary O'Brien, ARCSHS, LaTrobe University, 215 Franklin
Street, Melbourne VIC 3000, Australia, Tel.: [phone], Fax: [phone],
E-mail: j.grierson @ latrobe.edu.au