UN to tackle HIV related deaths in prison

During the XVIII International AIDS conference in Vienna the United Nations Office on Drugs and Crime (UNODC) launched a publication entitled "Toolkit for HIV Situation and Needs Assessment in Prisons" intended to reduce the deaths of prison inmates due to HIV related diseases.  The rate of infectious diseases such as HIV, hepatitis C (HCV) and tuberculosis  (TB) in the world’s prisons is much higher than the wider population. This is despite the fact that a contained environment such as a prison does provide authorities the ideal opportunity to enact HIV preventative measures. Many inmates are coinfected with HCV and HIV, which leads to a more rapid progression of chronic HCV to cirrhosis and liver failure. People who are infected with HIV are also more susceptible to TB and many of the HIV related deaths in prison are because of HIV.

According to the UNODC the high rates of HIV amongst the world’s 30 million penitentiary inmates are caused by non-consensual and consensual sex, tattooing and injection drug use. Inadequate screening processes, overcrowding corruption and limited access to HIV prevention, exacerbate the problem. Prisoners with infectious disease can also spread them to the wider community on release. Commenting at the Vienna conference the UN chief torture expert has said that prisons act as “HIV incubators.” Manfred Nowak stated “We have 30 million persons that enter and leave prisons every year in the world," he said. "So it means it's not just a prison health problem, it's a public health problem."

Even in some of the most developed countries drug use exists in prison. In many cases efforts to reduce the supply of drugs into prison have been ineffective in reducing the HIV rate, as they mainly seem to affect the supply of softer drugs such as cannabis while opioids are unaffected. In some cases measures such as mandatory drug testing can actually increase the HIV rate as prisoners move from cannabis to less detectable drugs such as heroin, which is often injected with needles smuggled into the prison and shared amongst multiple inmates.

Even though many countries are employing evidence-based harm reduction measures to tackle HIV epidemics outside of prison such measures are often not used within the prison system. Needle and Syringe Programs (NSPs) and Opioid Substitution Therapy (OST) are considered by experts to be effective forms of halting the spread of HIV amongst intravenous drug users. However to date globally only ten countries in the world have at least one prison operating with NSPs and there are only 40 countries in the world that have OST in at least one prison.

Unsurprisingly some of the countries with the worst records on drug policy and human rights outside of prison have some of the highest rates of infectious diseases inside of prison. In Russia almost half of prison inmates are ill and 55,000 are infected with HIV, many die before their trial has taken place. In Zambia a study conducted by Human Rights Watch showed that 27% of the Country’s 15,300 prisoners were HIV positive and in Indonesian prisons, the HIV rate is 21 per cent, compared to the 0.2 per cent national average.

The UNODC report recommends that governments take effective action to improve prison conditions as overcrowding, corruption, inadequate natural lighting and ventilation, violence and malnutrition undermine the implementation of effective responses to HIV and AIDS.  The report also encourages the use of HIV prevention and harm reduction measures inside prison facilities and making sure they are accessible by all inmates and staff.

One of the main initiatives pushed forward at this years AIDS conference was the Vienna Declaration, which seeks the incorporation of science-based evidence in illicit drug policies. Many experts support the declaration pointing out that greater employment of harm reduction measures that have proven to be effective will considerably reduce the global spread of HIV.