AFRO-NETS> HIV in Prisons

[AIDS2000 Key Correspondent <kcteam@aids2000.com>]

HIV in Prisons
--------------

Durban, 11 July 2000 - Session - D10 - Behind Walls - HIV in Prisons

All six presentations addressed the complicated relationship between 
two issues: injection drug use as a method for the transmission of HIV, 
and prison as a context for transmission to occur. Several papers moved 
beyond that relationship to other important concerns.

Europe: M. Rotily described a recent study of risk factors, especially 
IDU, among inmates of 22 prisons in seven European nations. Thirteen 
percent of Injection Drug Users IDU's (but 1.3% of non-IDU's) were 
HIV+. Time spent in prison and injecting in prison were major factors 
in HIV infection among IDU's.

Brazil: A. C. Saad presented information about (male and female) IDU's 
in the state prisons of Rio de Janeiro. Injection drug use is up in 
Brazil; 25% of Brazilians living with HIV were infected by sharing nee-
dles or works. Injection drug-using inmates had significantly more risk 
factors for HIV than their non-using counterparts: for example, previ-
ous history of STD's, and lack of condom use (inside or outside 
prison). Men were more likely to share needles inside prison, women 
more likely to share outside prison.

USA: A. Kim described HIV and STD prevalence among male inmates on in-
take into San Francisco (CA) jails. (The new STARHS HIV screening tech-
nology was used in this study.) Jails were found to be a major location 
for STD infection in general, and HIV infection in particular. For 
males, MSM, MSM & IDU, and IDU (in that order) were the primary routes 
of infection with HIV. HIV infection among Afro-American women was four 
times the rate for white women.

Uruguay: The work of M. Viana addressed extreme human rights abuses 
facing HIV+ inmates in Uruguayan prisons. She described the lack of 
harm reduction possibilities, the lack of medical and social supports, 
and the stigmatisation that face inmates living with HIV or AIDS, as 
well as an array of daily insults and oppressions. (Note: Her paper had 
to be presented by a colleague, because the Conference does not provide 
simultaneous translation from Spanish for all sessions. She spoke in 
Spanish briefly at the end to urge future Conference planners to 'break 
the silence' faced by Spanish-speaking presenters for all sessions.)

Spain: D. Zulaica described the operation of the first needle-exchange 
program in a Spanish prison -- in Bilbao Prison, in the Basque Region. 
After three years: there have been no negative incidents; needles were 
not used as weapons; 16,500 needles have been successfully exchanged; 
inmates report no problems with guards; drug use has not increased; 
risky behaviours have decreased; guards report no problems or conflicts 
with the program; and the associated NGO reported that the program was 
beneficial. Needle exchange has since expanded to five Spanish prisons.

USA: B. Stephenson reported on the effects of release (from a North 
Carolina prison) and re-incarceration on the viral loads and CD4 counts 
of HIV+ inmates. This was a control-group study. In most cases, on re-
incarceration, viral load was significantly greater than on release 
(and than controls'). CD4 counts of controls had increased during the 
interim, while counts of returnees had decreased. The implication is 
that aggressive follow-up supports are needed to assist released HIV+ 
inmates in health- and treatment-related matters.

Chair A. Berkman summarized the session with the comment, "Prisons 
around the world house the poor and marginalized and disempowered, and 
these are exactly the characteristics of people getting infected with 
HIV everywhere."

These were excellent, well-focused papers. It will be useful for future 
presentations to delve more deeply into the specific complexities and 
daily intricacies of the prison environment, so that we can better un-
derstand and articulate the value of harm reduction strategies and 
techniques.

Comments and Feedback

Q: There is an increase in viral load levels for those inmates who are 
re-incarcerated, hence would the option of insuring regulated therapy 
regime post release or (and I don't subscribe to this) that prisoners 
should remain incarcerated in order to ensure there is not an increase 
in their viral loads? ? George Clever (New York)

A: B. Stephenson's response was that she would favour the former rather 
then the latter as prisoners had no intentions of remaining incarcer-
ated.

Q: Are prisoners subjected to mandatory HIV test within prisons in the 
US? ? Yama Bella (South Africa)

A: Mandatory testing was subject to which state the prison was located. 
Some states within the US have mandatory testing rules. ? B Stephenson.

Q: What kinds of follow up procedures were in place post release for 
prisoners? ? Zeta Lazrani - (US)

A: The prisoners were given a 30-day supply of medication upon release 
and an appointment was made for them to see a doctor. ? B Stephenson.

Q: What is the percentage of needle users who had also been diagnosed 
with psychotic disorders, and if any, is this safe for these inmates to 
be involved in needle exchange programmes? - A. Shulks (US)

A: While there is are issues of safety involved, there is no specific 
data collected. It is a factor that does need to be borne in mind. - D. 
Zulaica.

--
AIDS2000 Key Correspondent
mailto:kcteam@aids2000.com
(Coordinated by H&D Networks: http://www.hdnet.org)

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