access equity in prisons: towards a joint response in africa › documents › hiv-aids › 2016 ›...

Access Equity in Prisons:

Towards a Joint Response in Africa

20 July

18:30 – 20:30

Session Room 2

HIV Prevention, Treatment and Care in Prison

Settings: Public Health and Human Rights

Approach

AIDS 2016 Conference

Durban, South Africa

20 July 2016

Ehab Salah,

Adviser, Prisons and HIV

UNODC Vienna

Addressing HIV in PrisonsGuiding Principals

Prison health is public health

Human rights based, evidence informed and gender sensitive approaches

The Right to Health

The right to enjoy facilities, services and conditions at the highest attainable standards of health

- Availability

- Accessibility

- Acceptability

- Quality

The Principle of Equivalence

Prisoners should enjoy the same standards of health care that are available in the community, and should have access to necessary health-care services free of charge without discrimination on the grounds of their legal status.

Health policy in prisons should be integrated into and compatible with National Health Policy.

A MULTI FACTORAL ISSUE REQUIRING A MULTIDISCIPLINARY RESPONSE

Public Health

Occupational health

Criminal Justice

Gender policies

Human Rights

Prison management

Upholding the Rights of People

Living in Prisons

• The revised UN Standard Minimum Rules for the treatment

of Prisoners (Nelson Mandela Rules)

• Political Declaration on HIV and AIDS: Intensifying our

Efforts to Eliminate HIV and AIDS

• The Rules for the Treatment of Women Prisoners and Non-

custodial Measures for Women Offenders (the Bangkok

Rules)

• The UNAIDS Strategy acknowledges existing gaps in

health services in prisons and closed settings.

Sustainable Development Goals

To end AIDS,

TB and

combat

hepatitis and

other

communicabl

e diseases

To reduce

inequalities,

eliminate

discriminatory

laws and

policies

To promote the

rule of law to

ensure equal

access to

justice for all,

To empower all

women and

girls

Including those

in prisons and

other closed

settings

HIV in prisons - Gaps • Health care in prison settings is

typically limited and not equivalent to

those provided in the community

• Lack of continuity of care

• Health care in prisons is often

provided by the ministry responsible

for prison

• Lack of SRH and PMTCT

• Mandatory HIV testing and lack of

confidentiality

UNODC’s Support to Countries• Develop normative guidance on HIV in

prisons

• Promote -human rights based, age-gender

responsive and evidence-informed

approaches

• Support to review, adapt, develop and

implement effective legislation, policies and

strategies including on alternatives to

imprisonment

• Build capacities of government agencies,

CSOs and other national partners

Way ForwardEvidence-informed,

rights-based, age and gender-responsive HIV prevention treatment

and care

Improved quality and coverage of

comprehensive HIV services

Criminal justice reform programmes

including alternatives to incarceration

Prison reform initiatives including

improving the working and living

conditions

Strategic information to guide policies, strategies and

actions

To end the

AIDS

epidemic

by 2030

Thank you

@UNODC_HIV

Access Equity in Prisons in Africa? Epidemiology, Programmes and Practice in Africa

PK ChatoCommissioner General – Zambia Prisons Service

Chairperson - AHPPN

Advocacy & Sensitization

( 1,2,3,6,9,13)

Strategic Information

(Monitoring, Evaluation &

Research)

(4,5,7,14,)

Capacity Building

(8)

Enabling Environments

(Policy & legislation, Coordination, networking

& partnerships

(11, 12, 16)

Service Delivery

(10, 15)

AHPPN DECLARATION OF COMMITMENT


( 1,2,3,6,9,13)

5

Advocacy and Sensitization

0

10

20

30

40

50

60

70

50

70

0

27 26

0 0 0 0

5

51

5

40

52

22

4 45

3 3 4

15

4 4 3

Nr.

of p

eopl

e re

ache

d

Member States

High level Meetingstargeting Judiciary, MPs, Ministers & Corrections Chiefs

2010 2012 2014

7

African HIV in Prisons Partnership Network (AHPPN)


( 1,2,3,6,9,13)



Research)

(4,5,7,14,)

9

HIV Sero-prevalence and Behavioural Studies in Prisons

0

5

10

15

20

25

30

35

ETHIOPIA LESOTHO MALAWI MOZAMBIQUE NAMIBIA* SWAZILAND TANZANIA ZAMBIA ZIMBABWE

1.3

23.6

11 11.313.8

25.9

5.3

13.5 13.7

4.2

31.4

27.5

24.5

13.2

34.9

9.96

27.4 28

Pre

vala

nce

rate

-%

Countries

HIV Prevalence in Community vs Prisons in Selected Sub-Saharan African Countries

HIV Prevalence in % Community HIV Prevalence in % Prisons

Other Strategic Information

Selected Sub-Saharan African Countries were supported to

undertake other activities aimed at collecting evidence to

support interventions in prisons.

These include:

• Reviews and Inventory of HIV programmes implemented

in prisons

• TB Prevalence Studies

• Modes of Transmission assessment in prisons

• Impact of Condom programmes in prisons

• Assessment of drug use in prisons


( 1,2,3,6,9,13)



Research)

(4,5,7,14,) Enabling Environments


& partnerships

(11, 12, 16)

Development of a Model Policy and Strategic Framework

• Supported countries in Sub-

Saharan Africa to develop prison

specific HIV, TB & Other

communicable infections policies

and strategies

• A model policy to assist

development of prison specific HIV

policies is currently being finalised.

It is aimed at providing step-by

step guidance and template for

development of HIV policies in

prisons.

These Reviews were

expected to lead to

reforms to establish

enabling legal and

policy environments.


( 1,2,3,6,9,13)



Research)

(4,5,7,14,)

Capacity Building

(8)



& partnerships

(11, 12, 16)

18

0

50

100

150

200

250

4 4 4 4 4 4 4 4 6

130

60 5945

60

9478

30

201

Nr.

Of p

eopl

e tr

aine

d

Member States

People Trained as Trainers on an integrated Approach to HIV in Prisons

Regional Master Trainers NationalTotal


( 1,2,3,6,9,13)



Research)

(4,5,7,14,)

Capacity Building

(8)



& partnerships

(11, 12, 16)

Service Delivery

(10, 15)

Before After

Challenges

Weakness of the criminal justice and judicial systems Overcrowding Lack of resources for maintenance of existing penal

institutions Inadequate nutritional considerations for sick prisoners Poor or non-existent health and social services Lack of prevention commodities Lack of humanity - Social stigma/Institutional and society

neglect

25

Challenges

Resistance due to cultural barriers

Lack of adequate data for evidence;

Widening the reach to include everyone within prison settings (e.g. children residing with their parents)

Lack of coordination at national and regional level;

Transitional mechanisms seems to be a challenge with changing governments

26

THANK YOU!

Access Equity in Prisons in Africa? Epidemiology, Programmes and Practice in Africa

Nthabeleng Motsomi-MoshoeshoeUNODC -Southern Afria

28

In 2009, the HIV in Prisons Situationand Needs Assessment Toolkit wasdeveloped.

Using this toolkit, HIV sero-prevalence and behavioural studieswere conducted for the first time inprisons in Sub-Saharan Africa

29

HIV Sero-prevalence and Behavioural Studies in Prisons

0

5

10

15

20

25

30

35

ETHIOPIA LESOTHO MALAWI MOZAMBIQUE NAMIBIA* SWAZILAND TANZANIA ZAMBIA ZIMBABWE

1.3

23.6

11 11.313.8

25.9

5.3

13.5 13.7

4.2

31.4

27.5

24.5

13.2

34.9

9.96

27.4 28

Pre

vala

nce

rate

-%

Countries

HIV Prevalence in Community vs Prisons in Selected Sub-Saharan African Countries

(2009 – 2014)

HIV Prevalence in % Community HIV Prevalence in % Prisons

Access to and provision of health care services in prisons is uniquely

characterised by`:

• the security and risk environments,

• prison culture,

• often limited resources and restricted range of options for health

service provision.

• General guiding documents exist for HIV service provision, however;

these are not responsive to the prison environment

• The provision of services therefore has to be tailored to the unique

characteristics of this environment, provide solutions for prison specific

barriers and challenges to ensure access to health service that is

equivalent to that available in the community.

Improving Provision of HIV & TB Services in Prison Settings in Sub-Saharan Africa

United National Office on Drugs and Crime (UNODC)

therefore commissioned a set of toolkits as part of its

Regional Programme on HIV and AIDS Prevention,

Treatment, Care and Support in Prison Settings in Sub-

Saharan Africa.

The toolkits were developed in cooperative, consultative and

inclusive process with experts, professionals and

practitioners from relevant government institutions, prison

and correctional services, international organisations and

civil society organisations from the region.

During a high-level meeting on Improving HIV Service Provision in Prison Settings in

November 2014, Commissioner Generals of Correctional Services and experts agreed

on the need for these documents and in three consecutive thematic expert group

meetings the expertise, experience and inputs of these regional experts was sought to

ensure that the final documents are responsive to the local situation, while in line with

international standards.

The guidelines address the needs among people working in prison settings for

guidance and standard operating procedures, consistent with the legal framework of

the correctional services in each country, based on internationally agreed, effective and

efficient interventions and standards

Improving Service Delivery

This set of toolkits covers seven important areas

related to HIV & TB care in prison settings:

General Counselling for key populations in prison

settings

Psycho-social Counselling & Support for people

living with HIV in prison

Voluntary HIV Testing and Counselling (HTC) in

Prison settings

TB/HIV collaborative activities, management and

care in prison settings

Prevention of mother to child transmission

(PMTCT) in prison settings

Antiretroviral Treatment (ART) services provision

and care in prison settings

Provision of HIV Preventative Commodities in

Prison settings

34

THANK YOU!

Access Equity in Prisons in Africa

A CALL FOR ACTION

Commissioner General Dr. Johnson Byabashaija, Uganda Prison ServiceChairperson – African Correctional Services Association

Access Equity in Prisons: Towards a Joint Response in Africa

Towards A Joint Response

CALL FOR ACTION |

• Southern and Eastern African Consultation forum for the launch of the

African HIV in Prisons Partnership Network, held in Johannesburg, South

Africa, on 17-18 November 2009

• West and Central Africa Regional Consultation on HIV in Prisons and Among

Injecting Drug Users held in Grand Bassam Cote d’Ivoire on December 15-

18, 2009

African Declaration of Commitment for HIV and AIDS Prevention Care, Treatment and Support in Prisons


A Call for Action

18 July 2016: Nelson Mandela International Day:

Pan-Africa Consultation on Health and HIV in

Prisons in Africa:

Recognize progress and efforts made

Concerned about gaps, challenges and

barriers to achieving access equity in prisons

CALL FOR ACTION |


A Call for Action

We, the African Correctional Services Association

and the African HIV in Prison Partnership

Network, call upon all stakeholders, including

governments, parliamentarians, prison and

correctional services, international, regional and

national development partners, civil society,

including non-governmental and community-

based organisations, to:

CALL FOR ACTION |


We call for action to:

1) Prioritise prison populations as part of national HIV & health strategies and responses, and ensure that people in prison settings have access to the same standards of human rights-based, evidence-informed and gender-responsive health care services and support that are available in the community;

2) Ensure that each prison has in place quality health-care services providing a comprehensive package of interventions for HIV and TB prevention, treatment, care and support, which are integrated within public health systems to ensure continuity of care on admission, during transfer between penal institutions and upon release;

Call for Action |


We call for action to:

3) Develop, revise, reform, adopt and implement national legislation and regulatory frameworks that ensure the equitable access of prison populations to health and HIV services in line with international standards and principles, such as the Nelson Mandela Rules.

4) Ensure that sufficient financial, technical and human resources are made available to enable the effective implementation of the comprehensive package of HIV services for prison populations.

5) Improve prison infrastructure in line with international standards to protect the human dignity of prisoners and to allow for effective quality provision of HIV & health services.

Call for Action |


We call for action to:6) Improve cooperation and coordination among and between national

criminal justice and health institutions, including implementation of national measures such as alternatives to imprisonment and reducing overcrowding in prison.

7) Develop and improve HIV and health monitoring and evaluation mechanisms to address the disparities related to the collection, availability and dissemination of data and strategic information on health and HIV in Prisons in African countries

8) Call on the United Nations Office on Drugs and Crime to develop in coordination with AHPPN and ACSA a strategic Pan-African Programmeon HIV and AIDS in Prison Settings to provide technical support to Member States to improve their national responses to HIV their prison settings in line with the Nelson Mandela Rules.

Call for Action |


THANK YOU

AFRICAN DECLARATION |

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