Washington D.C., USA, 22-27 July 2012 Working together for the implementation of prevention, medical care and harm reduction in prisons:

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


Aknowledgements

• Nicolas Ritter• Sydney West, International AIDS Society (IAS) • Fondation Sidaide, Switzerland• Jörg Pont, Vienna/Austria


Plan

• Introduction• Exercice• Discussion• Prevention, harm reduction and treatment in

prisons: Available tools and documents • Conclusions


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


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)


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.


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


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?


Discussion

• What were the main resistance factors towards change?

• What were the main factors helping/promoting the change that you could rely on?


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!


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


Prevention, harm reduction and medical care in closed settings: available tools and

documents

Heino Stöver, Germany


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)


UNODC/IL (2012)

www.UNODC.org/AIDS


http://www.euro.who.int/__data/assets/pdf_file/0009/99018/E90174.pdf


Health in prison project WHO

http://www.euro.who.int/en/what-we-do/health-topics/health-determinants/prisons-and-health


Training documents

Public Health Programme of the European Commission 2010


Key documents

Lines & Jürgens Réseau juridique canadien VIH/Sida 2006, 2009

http://www.aidslaw.ca/FR/themes/prisons.htm



To get started…

Prison adaption: under

construction (2012)

WHO, 2007


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.


Time gaps in the official introduction of OST in prisons: ~7-8y (Source: EMCDDA; D. Hedrich et al. 2012,)

CYCZ, RO,

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SKLV, LT,

BG

FR, HU

BEPL,GR

DE, IE

SI, ES, HR

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TR

LU, IE, NO

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NL AT

DKIT

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UK Scot

FI, RO, BG, EE

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PL, UK E&W,CZ, SE

HR

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1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

no. c

ount

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prov

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OST in the community OST in prison



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/


Thank you for the active participation!

• Catherine Ritter: [email protected]

• Heino Stöver: [email protected]


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

Washington D.C., USA, 22-27 July 2012 Working together for the implementation of prevention, medical care and harm reduction in prisons:

Documents

viennaaustria slide

minutes discussion slide

prisons drug use

concrete situation slide

prisons big

implementation of prevention

harm reduction issues

prison staff