Washington D.C., USA, 22-27 July 2012 Working together for the implementation of prevention, medical care and harm reduction in prisons:
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Working together for the implementation of prevention,
medical care and harm reduction in prisons: a practical experience!
Catherine Ritter
Heino Stöver
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Aknowledgements
• Nicolas Ritter• Sydney West, International AIDS Society (IAS) • Fondation Sidaide, Switzerland• Jörg Pont, Vienna/Austria
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Plan
• Introduction• Exercice• Discussion• Prevention, harm reduction and treatment in
prisons: Available tools and documents • Conclusions
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Introduction
• Aim of this workshop: explore prevention and harm reduction issues in prisons on an institutional level
• Participants - multiple professionals - will practice actively in an interdisciplinary way the steps of questioning around the implementation of prevention and harm reduction concerning HIV and hepatitis in prisons.
• Method: role play based on a concrete situation
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Drug use and Needle & syringe program (NSP) in prisons
• Drug use and dependence: 10-48% in male, 30-60% in female prisoners
• Prevalence and frequency of drug use decrease during imprisonment
• Sharing of equipment is a reality• Use of non sterile equipment in prison is the most
important independent determinant factor of HIV infection
• 50 NSP programs over the world• 12 countries: West and East Europe and central Asia
(Jürgens 2009)
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Exercice• Case study: working in groups to resolve a situation, by
playing - representing the various figures involved in prisons: health staff, prison staff and administrators, NGO’s, social staff
• Extracts of guidelines “Standards in prevention, testing and care of addictions and infections in prison” issued in the frame of a national project “Controlling infectious diseases in prisons (BIG) 2008–2011”, developed by the Federal Office of Public Health (FOPH) in partnership with the Federal Office of Justice (FOJ) and the Conference of Cantonal Justice and Police Directors (KKJPD) in Switzerland.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Steps - Running
• Read the case available• Make groups according to professional identity:
if possible, chose another profession than your own!
• Prepare the meeting (10 minutes)• Define 1-2 actors in each group and observers• Play the meeting (10-15 minutes)• Discussion
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Discussion
• What were the general feelings of the actors, for example if playing the part that is not your own profession?
• Should something be conducted differently in such interdisciplinary meetings?
• What decision was taken during the meeting?
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Discussion
• What were the main resistance factors towards change?
• What were the main factors helping/promoting the change that you could rely on?
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Overcome resistance…how• Show the evidence: it works!• Talk together! Regular interdisciplinary meetings
among all the actors: prison staff, administrators, health staff, harm reduction partners in the general community
• Staff training in harm reduction: health staff, prison staff and administrators
• Evaluation of harm reduction measures• Advocate harm reduction and be in line with national
policies• Communicate, inform, teach….all the time!
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Evidence of NSP’s: • No HIV/HCV
seroconversion• No increase in drug
use or iv drug use• Reduced needle
sharing• No reports of
agression with syringe used as weapon
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Prevention, harm reduction and medical care in closed settings: available tools and
documents
Heino Stöver, Germany
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Guiding Principles in Prison Health Care1
• Continuity of care as people pass through, in and out of the prison system is the critical issue.
• Access to drug treatment and health and social care provision equivalent to those provided in the community and appropriate to a prison environment.
• Drug users released from prison should be offered on-going rehabilitation and support on their return to the community and be encouraged to maintain their contact with community substance misuse services, as appropriate.
• Range of services provided should be appropriate, supported by best available evidence and ensure equivalence of national standards of care across the country.
• Needs of particular groups, must be considered.• Vital that the service users ‘voice’ is heard and their experiences are
taken into account.1THE PATEL REPORT (2010): PRISON DRUG
TREATMENT STRATEGY REVIEW GROUP)
Washington D.C., USA, 22-27 July 2012www.aids2012.org
http://www.euro.who.int/__data/assets/pdf_file/0009/99018/E90174.pdf
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Health in prison project WHO
http://www.euro.who.int/en/what-we-do/health-topics/health-determinants/prisons-and-health
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Training documents
Public Health Programme of the European Commission 2010
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Key documents
Lines & Jürgens Réseau juridique canadien VIH/Sida 2006, 2009
http://www.aidslaw.ca/FR/themes/prisons.htm
Washington D.C., USA, 22-27 July 2012www.aids2012.org
To get started…
Prison adaption: under
construction (2012)
WHO, 2007
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Systematic review of prison OST (Hedrich et al. 2012; Addiction)
• Review of 21 studies (incl. 6 RCTs) shows that OST is effective among the prison population:
++reduced heroin use, injecting and syringe-sharing in prison, if doses adequate;
++ increases in treatment entry and retention after release; ++post-release reductions in heroin use;+ pre-release OST reduces post-release deaths;+/-evidence regarding crime and re-incarceration equivocal; ? lack of studies addressing effects on incidence HIV/HCV;Disruption of continuity of treatment, especially due to brief
periods of imprisonment, associated with very sigificant increases in HCV incidence.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Time gaps in the official introduction of OST in prisons: ~7-8y (Source: EMCDDA; D. Hedrich et al. 2012,)
CYCZ, RO,
NO
SKLV, LT,
BG
FR, HU
BEPL,GR
DE, IE
SI, ES, HR
LU
SE
NL, UKDK
FI
IT
PTMT, AT
TR
LU, IE, NO
PT
ESFR, SI
NL AT
DKIT
DE
HU
UK Scot
FI, RO, BG, EE
BE
PL, UK E&W,CZ, SE
HR
TR
0
5
10
15
20
25
30
1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
no. c
ount
ries
prov
idin
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OST in the community OST in prison
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Websites
• UNODC/UNAIDS/WHO publications http://www.unodc.org/unodc/en/hiv-aids/publications.html
• WHO Harm reduction package
http://www.who.int/hiv/topics/idu/harm_reduction/en/# • Needles, syringes, and paraphernalia for harm
reduction http://www.exchangesupplies.org/
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Thank you for the active participation!
• Catherine Ritter: info@catherineritter.ch
• Heino Stöver: heino.stoever@fb4.fh-frankfurt.de
Washington D.C., USA, 22-27 July 2012www.aids2012.org
IAS/NIDA Research Fellowship ProgrammeEncouraging HIV and Drug Use Research
The IAS/NIDA Research Fellowship Programme is announcing a new round of research fellowships focusing on the linkages between HIV and drug use.
Stipend of US$ 75,000 in two categories: junior scientist for an 18-month post-doctoral training well-established HIV or drug use researcher for eight month
of professional development training
More information at www.iasociety.org/iasnida.aspx
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