In The Name of God,In The Name of God,

The Compassionate, The MercifulThe Compassionate, The Merciful

Methadone Maintenance Program Methadone Maintenance Program in closed settings in closed settings

(Iran Prison Experience)(Iran Prison Experience)9 April 20079 April 2007

Farzad Kasraei,MDFarzad Kasraei,MDConsultant of Deputy for Consultant of Deputy for

health,correction & Rehabilitationhealth,correction & RehabilitationIran Prisons OrganizationIran Prisons Organization

“ “Iran has one of the bestIran has one of the bestAIDS programs, in particular itsAIDS programs, in particular its

needle-exchange efforts”needle-exchange efforts”

Dr. Peter Piot*Dr. Peter Piot*

Executive Director of UNAIDSExecutive Director of UNAIDS

**NEW YORK TIMES    3 JUNE 2005NEW YORK TIMES    3 JUNE 2005

Islamic Republic of IranIslamic Republic of Iran

Located in the Middle EastLocated in the Middle East

1.648.195 km1.648.195 km22

69.200.000 population69.200.000 population

Capital: TehranCapital: Tehran

30 Provinces30 Provinces

STATISTICS FROM IRAN STATISTICS FROM IRAN PRISONSPRISONS

In Iran there are 176 prisons, 23 juvenile In Iran there are 176 prisons, 23 juvenile correlation and rehabilitation centers, 20 correlation and rehabilitation centers, 20 camps,8 detention centers (totally 227) and 36 camps,8 detention centers (totally 227) and 36 centers of after release care.centers of after release care.

There are about 10,000 personnel in Iranian There are about 10,000 personnel in Iranian prisons organization and the ratio of prisoners to prisons organization and the ratio of prisoners to personnel is about 23. personnel is about 23.

There are 125 quarantine centers, 200 clinics, There are 125 quarantine centers, 200 clinics, 15 hospitals, 20 day clinics, 47 isolated rooms, 15 hospitals, 20 day clinics, 47 isolated rooms, 43 laboratories, 22 radiology centers and 5 43 laboratories, 22 radiology centers and 5 physiotherapy centers in health sector of Iranian physiotherapy centers in health sector of Iranian prisons organization.prisons organization.

Rate of prisoners per population is 214 per Rate of prisoners per population is 214 per 100,000 people100,000 people

Annual turnover is about 600,000 people and the Annual turnover is about 600,000 people and the mean residents are approximately 145,000 mean residents are approximately 145,000 prisonersprisoners

Incarcerated women include 3.5% of prisoners Incarcerated women include 3.5% of prisoners and their place of incarceration is separate from and their place of incarceration is separate from men like most of other countries that will be men like most of other countries that will be controlled just by women personnelcontrolled just by women personnel

The most common crime is crimes related to The most common crime is crimes related to illicit drugs (48%)illicit drugs (48%)

Approximately 3.3% of high risk prisoners are Approximately 3.3% of high risk prisoners are HIV positive.HIV positive.

Drug Abuse in IranDrug Abuse in Iran

Drug Use Problem in Iran since 400 years agoDrug Use Problem in Iran since 400 years ago Nowadays First Rank in Opiate Drug Use in the Nowadays First Rank in Opiate Drug Use in the

worldworld 3.7 million opiate user (opium, heroin, 3.7 million opiate user (opium, heroin,

buprenorphine)buprenorphine) 1.2 million opiate dependent (addiction)1.2 million opiate dependent (addiction) 137,000 Injecting drug users137,000 Injecting drug users

Trend of Drug Abuse in IRAN during 1978-1998: Trend of Drug Abuse in IRAN during 1978-1998: 8% annual increase in incidence of drug abuse 8% annual increase in incidence of drug abuse

Trend of IDU in IRAN during 1988-1998:Trend of IDU in IRAN during 1988-1998: 33% annual increase in incidence of drug abuse33% annual increase in incidence of drug abuse

And the drug abuse statistics in prisons:And the drug abuse statistics in prisons: 45% of prisoners have drug related crimes 45% of prisoners have drug related crimes 64% have history of drug use 64% have history of drug use 30% intention to use drug in prisons 30% intention to use drug in prisons 17-23% IDU 17-23% IDU Tattoo in 65% of IDUs Tattoo in 65% of IDUs *Assesment of drug use in Iranian prisons 2001 (supported with UNODC –Iran)*Assesment of drug use in Iranian prisons 2001 (supported with UNODC –Iran)

Several assessments were done and Several assessments were done and according to their results harm according to their results harm

reduction measures were plannedreduction measures were planned

Assessment of Drug Use in Assessment of Drug Use in Iranian PrisonsIranian Prisons**

At first a big research was conducted for evaluation of At first a big research was conducted for evaluation of drug abuse and priority of educational needs in prisons. drug abuse and priority of educational needs in prisons. Base on the results, it was clarified that Base on the results, it was clarified that 48 present48 present of of prisoners had prisoners had entered prisons for drug related crimesentered prisons for drug related crimes and and 64 present of them have the history of drug abuse64 present of them have the history of drug abuse. . 30 present of them try to abuse drugs inside30 present of them try to abuse drugs inside prisons in prisons in any way. any way. 17 to 23% of them abuse drugs by injection17 to 23% of them abuse drugs by injection mostly with shared and contaminated syringes and mostly with shared and contaminated syringes and handmade tools. On the other hand it was determined handmade tools. On the other hand it was determined that that 65% of IDU prisoners tattooed65% of IDU prisoners tattooed the shin or had the the shin or had the history of tattooing.history of tattooing.

Assessment of HIV and BBD Assessment of HIV and BBD and psychological disorders and psychological disorders

in Iranian Prisonsin Iranian Prisons

Several studies for evaluation of psychologic Several studies for evaluation of psychologic disorder rate in prisons has been conducted , disorder rate in prisons has been conducted , using SCL90 , showing psychologic disorders using SCL90 , showing psychologic disorders are 3 to 3.5 times more than normal population. are 3 to 3.5 times more than normal population. As a result, psychologic health programs and As a result, psychologic health programs and involving of psychologists, psychiatrist and involving of psychologists, psychiatrist and expert physicians were initiated and it was set expert physicians were initiated and it was set that at least 80% of prisoners with psychologic that at least 80% of prisoners with psychologic disorders be treated by expert general disorders be treated by expert general physicians in 5 years. physicians in 5 years.

HIV increase in risky groups HIV increase in risky groups

2.1 % in 20022.1 % in 2002

2.3 % in 20032.3 % in 2003

3.3 % in 20043.3 % in 2004

3.5 % in 20053.5 % in 2005

2.5 % in 20062.5 % in 2006(sentinel sites ,common project of MOH&PO)(sentinel sites ,common project of MOH&PO)

HBV 5% HBV 5% HCV 40-60%HCV 40-60%(Prevalence of HBV and HCV in IDUs in Ghezel-Hesar prison ,Common project of (Prevalence of HBV and HCV in IDUs in Ghezel-Hesar prison ,Common project of

PO&TUMS center for gastrointestinal and liver diseases)PO&TUMS center for gastrointestinal and liver diseases)

Assessment of Training NeedsAssessment of Training Needs

According to educational need According to educational need assessment, it was determined that assessment, it was determined that knowledge of prisoners is favorite in parts knowledge of prisoners is favorite in parts but low in the others and there is a great but low in the others and there is a great gap between their knowledge, attitude and gap between their knowledge, attitude and practice. Moreover it was seen that peer practice. Moreover it was seen that peer group education was more effective. group education was more effective.

There is a large gap between knowledge There is a large gap between knowledge and practice of prisonersand practice of prisoners

Peer education is more effective than Peer education is more effective than other methodsother methods

14 title of education has been identified14 title of education has been identified (Health promotion project in Iranian Prisons-2002 supported by prisons organization)(Health promotion project in Iranian Prisons-2002 supported by prisons organization)

PREVENTIONPREVENTION

In order to prevent this widespread In order to prevent this widespread of HIV and hepatitis B and of HIV and hepatitis B and C,planning a comprehensive C,planning a comprehensive program, which covers program, which covers approximately all target groups and approximately all target groups and all ways of transmission is the only all ways of transmission is the only remained solution.remained solution.

And MMT is one of the most important And MMT is one of the most important activities in this program.activities in this program.

Drug treatment measures in Iran Drug treatment measures in Iran PrisonsPrisons

Detoxification with clonidin and sedativesDetoxification with clonidin and sedatives Maintenance Therapy withMaintenance Therapy with

Antagonists: NaltroxaneAntagonists: Naltroxane Agonists: Methadone (MMT)Agonists: Methadone (MMT)

Non medical therapies:Non medical therapies: PsychotherapyPsychotherapy Long term residential PsychotherapyLong term residential Psychotherapy

Among above mentioned measures Among above mentioned measures MMT is the most popular and most MMT is the most popular and most regular measure.regular measure.

There is a standard MMT protocol for prison There is a standard MMT protocol for prison setting that has approval of MOH, the inclusion setting that has approval of MOH, the inclusion criteria are:criteria are:

-several histories of unsuccessful abstinence -several histories of unsuccessful abstinence -IDUs who have not the trend of abstinence-IDUs who have not the trend of abstinence -Drug abusers who use drugs heavily or have -Drug abusers who use drugs heavily or have

used drugs for many yearsused drugs for many years -Youth drug abusers who have started abusing -Youth drug abusers who have started abusing

drugs with heroin and at least have used it one drugs with heroin and at least have used it one yearyear

And there are slight changes from MOH protocol And there are slight changes from MOH protocol due to the nature of prison.for example in MOH due to the nature of prison.for example in MOH centers the client should fulfil four criteria but centers the client should fulfil four criteria but actually due to limited numbers of MMT centers actually due to limited numbers of MMT centers they only cover HIV+ IDUs.they only cover HIV+ IDUs.

Methadone Maintenance TreatmentMethadone Maintenance Treatment

First First MMT Clinic of IranMMT Clinic of Iran in 2002 in 2002 Nowadays more than 40 MMT clinics in medical Nowadays more than 40 MMT clinics in medical

universities, 20 in Drop-in Centers and 60 in Prisons universities, 20 in Drop-in Centers and 60 in Prisons across Iranacross Iran

4500 Patients on MMT by MOHME and 8048 others in 4500 Patients on MMT by MOHME and 8048 others in Prisons (totally 12548)Prisons (totally 12548)

Nowadays the MMT program in Iran is the biggest Nowadays the MMT program in Iran is the biggest MMT program in Prisons of the worldMMT program in Prisons of the world

Effectiveness on Iranian patients:Effectiveness on Iranian patients: 68% retention in treatment68% retention in treatment 20% increase in Employment20% increase in Employment 70% decrease in criminal activity70% decrease in criminal activity Saving 130 Euro per month per patientSaving 130 Euro per month per patient

Nowadays managers of prisons feel and sense Nowadays managers of prisons feel and sense the positive impacts of MMT on prisoners and the positive impacts of MMT on prisoners and even on their smoother management for the even on their smoother management for the prison.prison.

There are less There are less violenceviolence self injuryself injury TheftTheft SuicideSuicide Drug abuse detection in inspectionsDrug abuse detection in inspections Drug traffickingDrug trafficking Abscesses Abscesses

Reported inside prisons that implement MMT.Reported inside prisons that implement MMT.

The 15 year Strategic Plan of Iran The 15 year Strategic Plan of Iran Prisons OrganizationPrisons Organization

According a 15 year strategic plan, Iran According a 15 year strategic plan, Iran Prisons is suppose to cover all IDU Prisons is suppose to cover all IDU prisoners with MMT and other needed prisoners with MMT and other needed harm reduction measures. Which has harm reduction measures. Which has started from 2003.started from 2003.

In 2007 Iran prisons will cover 10000 IDU In 2007 Iran prisons will cover 10000 IDU prisoners with MMTprisoners with MMT

Studies showed that at least Studies showed that at least 10000 10000 prisoners and at most prisoners and at most 1200012000 prisoners in prisoners in all Iran prisons should be covered with all Iran prisons should be covered with MMT. Till now approximately MMT. Till now approximately 8000 8000 prisonersprisoners in in 60 clinics at 26 provinces60 clinics at 26 provinces have been covered with MMT which is have been covered with MMT which is about about 66-80%66-80% of availability. MMT of availability. MMT coverage is rapidly increasing. coverage is rapidly increasing.

IMPORTANT NOTE:IMPORTANT NOTE: In prisons, due to insufficient amount of drugs, In prisons, due to insufficient amount of drugs,

extremely high cost of it and lack of security extremely high cost of it and lack of security because of smell of abusing drug, the most because of smell of abusing drug, the most common method of drug abuse is injection. The common method of drug abuse is injection. The method of abuse mostly shifts to injection inside method of abuse mostly shifts to injection inside prison instead of other methods. In many cases prison instead of other methods. In many cases the first experience of injecting drug have been the first experience of injecting drug have been reported inside prisons.reported inside prisons.

Moreover unavailability of sterile injection Moreover unavailability of sterile injection equipments has lead prisoners to use common, equipments has lead prisoners to use common, old and even handmade tools for injection .old and even handmade tools for injection .

Therefore heavy drug abusers who are Therefore heavy drug abusers who are not still injectors may become eligible not still injectors may become eligible for MMT.for MMT.

Ghezel-hesar prisonGhezel-hesar prisonthe biggest numberthe biggest number

Ghezel-hesar is the biggest prison in Iran with Ghezel-hesar is the biggest prison in Iran with more than 12000 inmates located in Karaj city more than 12000 inmates located in Karaj city near Tehran (the capital of Iran) and annual near Tehran (the capital of Iran) and annual turnover of 120000 prisoners.turnover of 120000 prisoners.

The prisoners crimes are usually drug related The prisoners crimes are usually drug related and stealing which can be due to drug abuse.and stealing which can be due to drug abuse.

Last year only 450 IDU prisoners were under Last year only 450 IDU prisoners were under MMT and they had lots of problem for scaling up MMT and they had lots of problem for scaling up MMT due to budget and human resource MMT due to budget and human resource limitations.limitations.

With help of Global Fund project which With help of Global Fund project which added 3 physicians and the support of added 3 physicians and the support of prisons organization and UNODC they are prisons organization and UNODC they are now covering 1048 prisoners under MMT. now covering 1048 prisoners under MMT. But there are still 400-500 prisoners in the But there are still 400-500 prisoners in the waiting list.waiting list.

It’s now the biggest MMT project in closed It’s now the biggest MMT project in closed settings.settings.

Besides the previous mentioned positive Besides the previous mentioned positive outputs of MMT the point here is that there outputs of MMT the point here is that there is not any MMT severe complication is not any MMT severe complication reported! just some constipation and slight reported! just some constipation and slight side effects.side effects.

Especially no death was reported during Especially no death was reported during the last yearthe last year

The clue is peer education among The clue is peer education among prisoners, they will learn from each prisoners, they will learn from each other about the complications and other about the complications and

overdose of drug injection after overdose of drug injection after MMTMMT..

There is a study being conducted for best There is a study being conducted for best practice of MMT in Ghezel-hesar with practice of MMT in Ghezel-hesar with technical support of Kyoto University and technical support of Kyoto University and financial support of UNODC. The report of financial support of UNODC. The report of qualitative part will be released soon.qualitative part will be released soon.

Also another positive impact were Also another positive impact were reminded:reminded: The satisfaction of their families for lowering The satisfaction of their families for lowering

their expenditures and problemstheir expenditures and problems Therefore strong support of families is Therefore strong support of families is

backbone of covered prisoners and there is backbone of covered prisoners and there is the force of families for being involved in MMT the force of families for being involved in MMT for those who are not covered yet.for those who are not covered yet.

The complementary stepThe complementary step There are about 36 There are about 36 aftercare centersaftercare centers affliated to affliated to

PO that PO that provide ex-prisoners with MMTprovide ex-prisoners with MMT (mostly (mostly in centers of provinces) and also there are some in centers of provinces) and also there are some agreements with local medical universities and agreements with local medical universities and MOH for covering prisoners after release by and MOH for covering prisoners after release by and introduction letter. Furthermore Drug Control introduction letter. Furthermore Drug Control head Quarter and national Harm reduction head Quarter and national Harm reduction Committee has approved that prisoners MMT Committee has approved that prisoners MMT should be continued after release by MOH, but should be continued after release by MOH, but due to limited number of MMT centers affiliated due to limited number of MMT centers affiliated to MOH they don't receive wide range of to MOH they don't receive wide range of services nationally.services nationally.

We should have in mind that several other We should have in mind that several other activities besides MMT were done.In this activities besides MMT were done.In this way a comprehensive Harm reduction way a comprehensive Harm reduction package is working in Iran Prisons package is working in Iran Prisons including :including :

Establishment of Voluntary Establishment of Voluntary Counseling and Testing Units Counseling and Testing Units

(Triangular Clinics)(Triangular Clinics) 1-To reduce the harm related to injection drug 1-To reduce the harm related to injection drug

use, use, 2-To deal with sexually transmitted infections2-To deal with sexually transmitted infections 3-To provide support and care for people living 3-To provide support and care for people living

with HIV/AIDSwith HIV/AIDS First Triangular Clinic in Kermanshah in 2000First Triangular Clinic in Kermanshah in 2000 Nowadays approximately 70 VCT Units across Nowadays approximately 70 VCT Units across

Iran by MOH and 95 by Prison OrganizationIran by MOH and 95 by Prison Organization

Triangular clinics for behavioral counseling, as Triangular clinics for behavioral counseling, as an innovative and comprehensive measure, for an innovative and comprehensive measure, for prevention, treatment, surveillance and reducing prevention, treatment, surveillance and reducing harm of HIV/STI/IDU has been established and harm of HIV/STI/IDU has been established and the number of them has reached to the number of them has reached to 60 clinics 60 clinics inside prisons and 34 in after release care inside prisons and 34 in after release care centerscenters. It is designed to have . It is designed to have 90-100 clinics90-100 clinics by by the end of the program. These centers provide the end of the program. These centers provide all services of prevention, treatment, surveillance all services of prevention, treatment, surveillance and harm reduction for all high risk groups. and harm reduction for all high risk groups.

Educational activitiesEducational activities:: According to educational need assessment, it was According to educational need assessment, it was

determined that knowledge of prisoners is favorite in determined that knowledge of prisoners is favorite in parts but low in the others and there is a great gap parts but low in the others and there is a great gap between their knowledge, attitude and practice. between their knowledge, attitude and practice. Moreover it was seen that peer group education was Moreover it was seen that peer group education was more effective. more effective.

Consequently Consequently educational packageseducational packages, according to the , according to the fourteen needs of prisoners, were prepared in format of fourteen needs of prisoners, were prepared in format of filmfilm, , VCDVCD, , DVDDVD, , computerized messagescomputerized messages, , postersposters, , pamphletspamphlets, , brochures and etcbrochures and etc.. About two million .. About two million pamphlets and posters were produced and distributed. pamphlets and posters were produced and distributed. By finishing the educational programs another evaluation By finishing the educational programs another evaluation was conducted which showed the effectiveness of was conducted which showed the effectiveness of education and confirmed that education should change education and confirmed that education should change from HBM to Benefit Based model.from HBM to Benefit Based model.

Psychotherapy and treatment of psychologic Psychotherapy and treatment of psychologic disorders:disorders:

Several studies for evaluation of psychologic disorder Several studies for evaluation of psychologic disorder rate in prisons has been conducted , using SCL90 , rate in prisons has been conducted , using SCL90 , showing psychologic disorders are 3 to 3.5 times more showing psychologic disorders are 3 to 3.5 times more than normal population. As a result, psychologic health than normal population. As a result, psychologic health programs and involving of psychologists, psychiatrist and programs and involving of psychologists, psychiatrist and expert physicians were initiated and it was set that at expert physicians were initiated and it was set that at least 80% of prisoners with psychologic disorders be least 80% of prisoners with psychologic disorders be treated by expert general physicians in 5 years. treated by expert general physicians in 5 years.

(prevalence of mental disorder in Prisoners of Tehran province-Dr. Esmaeeli,Iraj ,2001- (prevalence of mental disorder in Prisoners of Tehran province-Dr. Esmaeeli,Iraj ,2001- Prevalence of psychologic disorder in prisoners of Ardebil province ,Agha-Prevalence of psychologic disorder in prisoners of Ardebil province ,Agha-sadeghi,2000- psychopathology of addiction ,Dr. Shahmohamadi et al. , 2001 – sadeghi,2000- psychopathology of addiction ,Dr. Shahmohamadi et al. , 2001 – Assessment of drug abuse in Iranian prisons ,supported by UNODC,2001)Assessment of drug abuse in Iranian prisons ,supported by UNODC,2001)

In addition, yards of In addition, yards of long-term psychotherapy cover long-term psychotherapy cover prisoners in a one year periodprisoners in a one year period : 3 month of observation; : 3 month of observation; 3 month of education; 6 month of deep intervention. In 3 month of education; 6 month of deep intervention. In recent years at least 10/000 prisoners had deep recent years at least 10/000 prisoners had deep intervention and re-incarceration for these prisoners has intervention and re-incarceration for these prisoners has been decreased from been decreased from 29% to only 3%. 29% to only 3%.

(Effectiveness of longterm psychotherapy ,Shams,Ali,2003)(Effectiveness of longterm psychotherapy ,Shams,Ali,2003)

Syringe and Needle program:Syringe and Needle program: Which was really the result of success and Which was really the result of success and

improvement of harm reduction measures improvement of harm reduction measures especially MMT on convincing policy makers especially MMT on convincing policy makers and governors in such a way that an Executive and governors in such a way that an Executive Order to All Judicial Authorities Nationwide was Order to All Judicial Authorities Nationwide was released by the Head of the Judiciary power for released by the Head of the Judiciary power for permission of provision of needles and syringes: permission of provision of needles and syringes:

Executive Order to All Judicial Authorities Nationwide… One of interventions has been done by the Ministry of Health and Medical Education includes provision of needles, syringes and other material used individually by drug addicts and AIDS patients as well as methadone maintenance treatment programs as means of combating HIV and Hepatitis infections among drug addicts… Therefore all judicial authorities must consider the lack of malicious intent in the interventions of the Ministry of Health and Medical Education as well as those of other centers and organizations which are active in this field and not accuse the service providers…Seyed Mahmood Hashemi SharoudiHead of the JudiciaryJan 24th 2005

Distribution of bleach and disposable razors:Distribution of bleach and disposable razors: In order to disinfect tattooing tools, In order to disinfect tattooing tools, bleachbleach

distribution program has been approved, distribution program has been approved, implementing by the AIDS program of Global implementing by the AIDS program of Global Fund. Fund.

Furthermore, for prevention of Furthermore, for prevention of sharing shaving sharing shaving bladesblades, after piloting distribution of shavers with , after piloting distribution of shavers with plastic guard in two prisons and finally approval plastic guard in two prisons and finally approval of generalization, shavers are being sold with of generalization, shavers are being sold with little price in prisons store. This causes little price in prisons store. This causes shortening of shaver sharing. In near future it will shortening of shaver sharing. In near future it will be distributed to prisoners in their health be distributed to prisoners in their health package for free instead of hair remover package for free instead of hair remover powders. powders.

Conjugal meetings and condom distribution:Conjugal meetings and condom distribution: To control sexual transmission of HIV, To control sexual transmission of HIV, private private

meeting roomsmeeting rooms, with , with provision of condom and provision of condom and educationeducation, were established. Initially it was an , were established. Initially it was an award but with suggestion of health office and award but with suggestion of health office and approval of programming council of prisons approval of programming council of prisons organization, it has become a general right for all organization, it has become a general right for all married prisoners. In addition, condom is easily married prisoners. In addition, condom is easily available in VCTs to cover other prisoners and available in VCTs to cover other prisoners and they can easily have condoms they can easily have condoms

Other Drug treatment facilities :Other Drug treatment facilities : In order not to shift oral drug abusers to In order not to shift oral drug abusers to

injection use, injection use, detoxificationdetoxification facilitations facilitations and and counselingcounseling is available in prisons. For is available in prisons. For instance, 50000 prisoners used these instance, 50000 prisoners used these services in the last year services in the last year

Establishment of hotline counseling:Establishment of hotline counseling: - Hot line services is being implemented - Hot line services is being implemented

and generalized in some provinces. and generalized in some provinces.

Decreasing the number of inmates and alternative to Decreasing the number of inmates and alternative to incarceration policies:incarceration policies:

To To decrease total populationdecrease total population of prisons as a major harm reduction of prisons as a major harm reduction objective the following measures have taken into action: objective the following measures have taken into action:

-The law of replacement punishments-The law of replacement punishments- Social punishments - Social punishments - Reducing criminal titles - Reducing criminal titles - Elimination of prison punishment for check crimes. - Elimination of prison punishment for check crimes. - Using the advantage of chronic non-curable diseases and very old - Using the advantage of chronic non-curable diseases and very old

age for not being incarcerated . age for not being incarcerated . - Court-based treatment Court-based treatment

As a result of mentioned measures, total number of prisoners has As a result of mentioned measures, total number of prisoners has been decreased from 175000 prisoners in 2002 to been decreased from 175000 prisoners in 2002 to 135000 in 2005135000 in 2005. . Certainly it will be decreased more. Consequently in all low density Certainly it will be decreased more. Consequently in all low density settings settings implementation of measures will be easier and more implementation of measures will be easier and more effectiveeffective. .

Having sentinel sites:Having sentinel sites: Sentinel sitesSentinel sites are active for epidemiologic are active for epidemiologic

study and surveillance of AIDS. These study and surveillance of AIDS. These sites are dependent to MOH and each sites are dependent to MOH and each year at a predefined time take year at a predefined time take 250 to 400 250 to 400 samplessamples for evaluation. Nowadays there for evaluation. Nowadays there are are 65 sentinel sites65 sentinel sites which are observing which are observing HIV/ AIDS situation in prisons. HIV/ AIDS situation in prisons.

Well Well collaboration with MOHcollaboration with MOH has been has been initiated for initiated for sustainability of servicessustainability of services and and their their continuation after freedomcontinuation after freedom. All . All prisoners who use services will be referred prisoners who use services will be referred to public health centers after freedom with to public health centers after freedom with a referral form. It is valuable to mention a referral form. It is valuable to mention that for re-socializing prisoners in that for re-socializing prisoners in After After Release care centersRelease care centers, dependent to , dependent to prisons organization, there are triangular prisons organization, there are triangular clinics providing MMT for prisoners in a clinics providing MMT for prisoners in a period of at most three month till they can period of at most three month till they can be covered by public health centers. be covered by public health centers.

Thank You For Your Attention.Thank You For Your Attention.

And And

You are all welcome to visit You are all welcome to visit our activities in Iranour activities in Iran

Thank You For Your Attention.Thank You For Your Attention.

And And

You are all welcome to visit You are all welcome to visit our activities in Iranour activities in Iran