Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

Cross Track

TUAXO101
Inside voices speak out-prisoners share stories of
living with HIV and HCV
C. McCollum', T. Howard2. 'Prisoners with HIV/AIDS Support Action Network,
Federal Hep C Coordinator, Toronto, Canada, 2BC Persons with AIDS Society,
Prison Outreach Program (POP), Vancouver, Canada
Issues: Prisoners speak out on access to treatment, harm reduction materials
and their lived experience in Federal prisons. Realities of prison health and
actual practices of safer sex/drugs/tattooing for HIV/HCV positive prisoners. To
illustrate the disparity between Corrections Services Canada (CSC) reports and
inmate accounts of access to HAART.
Description: This poster will incorporate prisoner's writing/quotes and artwork,
as well as statistical data from CSC, Canadian HIV/AIDS Legal Network, Prison
Outreach Program and PASAN to illustrate realities and gaps in CSC policy in
terms of the lived experiences of co-infected prisoners. Anecdotal reports from
prisoners will include their lived experience of safer practices and access to
health care/medications for their HIV/HCV. It will illustrate the societal notions
of comfort vs. "real life" for HIV/HCV positive prisoners in Federal prison. Peer
Counsellors report on barriers to providing educational materials and harm
reduction tools on living units.
Lessons learned: Realities of prison life are dramatically different than
perceived or reported. Access to programmes, health care and harm reduction
tools are significantly less than CSC directives provide.
Recommendations: To improve access to harm reduction materials and
health care for HIV/HCV positive prisoners as provided by CSC directives
and regulations. Ensure accountability of provision of harm reduction tools to
prisoners on living units (ie. put "directives" into practice).
TUAX0102
Challenges and opportunities for scaling up HIV/
AIDS care in prisons: a case study from Zambia
O. Simooya, N. Sanjobo. Copperbelt University, Health Services Division,
Kitwe, Zambia
Issues: In Zambia, like in many other countries, HIV rates in prisons are much
higher than those outside prison. However, HIV/AIDS services are still heavily
focussed on providing information and raising awareness. Beginning 2005,
we embarked on a campaign to offer counselling, testing and care (CTC) and
community or "home based" care within the prison setting.
Description: A total of sixty (60) prison officers drawn from the country's
major prisons were trained in psychosocial counselling ( 30 participants) and
"home based" care (30). Standard WHO/UNAIDS curriculum was offered to
the trainees who after graduation were given the necessary tools to start
work. The counsellors were equipped with HIV testing kits and blood collection
equipment. The "home" care team received assorted high protein supplements,
over the counter drugs for minor complaints, hygiene packs, toiletries and
water disinfectants. Following graduation trainees were each presented with
a certificate.
Lessons learned: There are 14,000 inmates in Zambia's prisons and the first
report was received from the Lusaka Central Prison (LCP)which keeps 1,500
prisoners. There are 3 counsellors and two "home care" givers at the LCP.
By August 2005, 100 inmates had volunteered for testing out of whom 64
were tested. Forty- one inmates ( 64%), had HIV antibodies. Of those HIV
positive, 15 were commenced on ARTs while 26 were waiting for CD4 counts. All
those testing positive were referred to the "home" care team for nutritional and
health support. Main problems identified by the two groups of care givers were:
1) demand for service outstrips manpower; 2) lack of office space; 3) lack of
direct link with big ART centre; 4) officers have other duties; 5) insufficient
operational funds;
Recommendations: HIV/AIDS counselling, testing and care facilities are
feasible, desirable and urgently needed in prisons.
TUAXO0103
From evidence to commitment to action:
implementing HIV prevention measures in prisons
in Ukraine
R. Jurgens', N. Kozhan', V. Klisha', S. Ivantchenko', V. Serdiuk',
M. MacDonalds. 'Consultant, Canadian HI V/AIDS Legal Network, Toronto,
Canada, 'State Department of Ukraine for Enforcement of Sentences, Kiev,
Ukraine, 'International Renaissance Foundation, Kiev, Ukraine, 'Vector
Medical Information Center, Kiev, Ukraine, 'Centre for Research into Quality,
Birmingham, United Kingdom
Background: Injecting drug use drives the HIV epidemic in Ukraine. Many
users spend time in prison, and a significant number continue injecting inside.
Introducing effective HIV prevention measures in prisons is an urgent priority.
Methods: (1) A partnership was established between the Ukrainian prison

system, Ukrainian NGOs, and a Canadian NGO with extensive expertise
in the area of HIV/AIDS and IDU in prisons. (2) Research was undertaken,
demonstrating the prevalence of risk behaviours in prisons in Ukraine. (3)
Study tours to methadone maintenance programs in prisons in Canada and to
needle exchange programs in prisons in Spain were undertaken with Ukrainian

officials. (4) A conference on HIV and harm reduction in prisons was organized
in Ukraine. (5) Sites for two needle exchange pilot projects in prisons in Ukraine
were selected. (6) Trainings were undertaken for staff at the prisons selected
for the pilot projects, and for senior staff of the Ukrainian prison system. (7)
The legal framework for implementation of needle exchange pilot projects was
created. (8) A monitoring and evaluation framework was developed and is
being implemented.
Results: Initial resistance to implementation of needle exchange pilot
projects could be overcome, and two projects will start in 2006. Conditions
for rapid scale up are being put in place. Because of delays in implementation
of substitution therapy in Ukraine, implementation in prisons has also been
delayed. Other prevention measures (including condoms, bleach, education)
are being implemented.
Conclusions: Effective partnerships can be created between prison systems
and NGOs in Eastern Europe and NGOs in Western countries. A series of wellplanned steps, including research, study tours, and trainings, can create the
conditions for implementation of measures such as needle exchange programs
in prisons. Monitoring and evaluation of these programs are important for efforts
to scale up such programs not only in Ukraine, but also in other countries.
TUAX0104
Injecting reason: prison syringe exchange and the
European convention on human rights
R. Lines. Irish Penal Reform Trust and Irish Centre for Human Rights, Dublin,
Ireland
Issues: High rates of HIV infection and injecting drug use are major concerns
in prisons across Europe. There is a broad international consensus that people
in prison are entitled to ra standard of health care equivalent to that available
outside of prisons. Despite this consensus, only four countries in the region
provide sterile syringes to prisoners as an HIV prevention measure. This gap
between words and actions places prisoners who inject drugs at increased
vulnerability to HIV infection simply because of their status as prisoners, raising
serious human rights and public health concerns.
Description: Ratified by 46 states in Western and Eastern Europe and the
former Soviet Union, the European Convention on Human Rights is an
important tool for advocating for the rights of prisoners across the region to HIV
prevention measures, including syringe exchange. This presentation reviews
the approach of the European Court of Human Rights to questions of prison
conditions and prison health care and identifies the key elements of the Court's
case law that can be used to promote the right of people in prison to HIV
prevention measures, including sterile injecting equipment. It then discusses
in plain language the potential use of the Court's jurisprudence as a tool for
community advocates.
Lessons learned: While there has yet to be a case before the European Court
specifically on prison syringe exchange, the Court's recent case law - specifically
its interpretation of Article 3 prohibitions against "inhuman and degrading
treatment" since 2000 - indicates that European Human Rights Law can be
used to advocate in favour of prison syringe exchange programmes.
Recommendations: European Human Rights Law can be used by HIV/AIDS
and prisoners' rights advocates in Council of Europe countries as a tool to
challenge governments to implement prison syringe exchange programmes.
TUAXOI05
Indonesia introduces the first prison Methadone
maintenance treatment (PMMT) in Asia
I. Atmosukarto', I. Winarso', A.A.G. Hartawan2, P.A. Primatanti2. 'Indonesia
HIV/AIDS Prevention and Care Project/IHPCP-Ausaid, Harm Reduction,
Jakarta Pusat, Indonesia, 2Prison Kerobokan, Medical/Methadone Maintenance
Unit, Denpasar, Bali, Indonesia
Background: Internationally, at least 50% of injectors have been imprisoned
(Ball, A. IDUs in a multi city study WHO 1996). Prisons are characterised by
elevated HIV prevalence, widespread injecting risk behaviour and limited HIV
prevention programs. Only 20 countries (Dolan K)) provide Prison Methadone
Maintenance Treatment (PMMT). In Indonesia, patients on a community
methadone program who were sentenced to prison raised the question of whether
their treatment should be continued in prison. We report on the feasibility of
introducing a prison methadone maintenance program in Indonesia currently
supported by IHPCP (an AusAID/Indonesian Government joint project).
Methods: Indonesian officials visited Australia (2003) and Iran (2004) to
inspect prison methadone programs. In 2004 the Ministry of Health held lengthy
discussions with prison authorities to enable patients to continue treatment
when imprisoned. The PMMT received high level support when it was integrated
into Indonesia's National HIV in Prison Strategy (launched in July 2005).
Results: Since August 2005, staff from the community methadone program
visited the Bali prison daily to dispense methadone to their patients. 31 patients
have continued methadone treatment in prison. There have been no reports of
adverse events to date. Demographic characteristics of 31 male patients
Age yrs: mean, range 2B.3yrs

Marital status: Single %: 60%
Sentence length yrs: range lyr - 6 yr
Drug offence: % 83.9%
Dose of methadone: mean, range 68.2mg
Urine test results 10% (last test 01/01/06)
Started a job in prison 24/31 prisoners
Conclusions: It is feasible to provide methadone maintenance treatment
to prisoners in Indonesia. Recently, PMMT has expanded to allow prisoners

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1