HIV, Drugs

1
HIV, Drugs Prisons

• Gino Vumbaca

Photo by Mr. Alessandro Scotti, UNODC Good Will
Ambassador
2
A Beautiful Set of Numbers?

• Over 11,000 become infected with HIV everyday
  in the world
• Over 2,600 become infected with HIV everyday in
  our Region
• Over 1,300 people die everyday from HIV in our
  Region
• In Asia, there are over 3 million people
  officially listed as being in prison

3
HIV prevalence in injecting drug users
Myanmar
Manipur Yunnan
Edinburgh
Ho Chi Minh City
Lithuania
Bangkok
Odessa
Jakarta
4
Injecting Drugs in Prison

• Internationally, research shows
• 50-75 of prisoners have injected drugs before
  prison
• 25-50 continue to inject in prison
• Frequency of injecting less
• Frequency of sharing much greater

5
Prisons and HIV

• Prisons are very important in development of HIV
  epidemic among IDU
• many prisoners are IDU
• many IDU have been to prison
• many continue to inject in prison
• drugs are available in all prison systems
• few needles/syringes, so sharing occurs

6
Prisons and HIV Figures

• 9 of prisoners in Estonia are HIV positive
  (2003)
• In Ukraine the number of new HIV cases in prisons
  has risen by 26 compared to 5 in the general
  population (2002)
• In Russian Prisons there are 34,000 HIV positive
  prisoners with 95 being injecting drug users
  (2002)
• In US Prisons it is estimated that 2 of the
  prison population is HIV positive (1999)
• 43 of South African prisoners are estimated to
  be HIV positive (2002)
• (Source Prison Healthcare News)

7
HIV in Prisons in Asia

• Iran
• 1996 2 prisons in Teheran
• 29 of IDU are HIV-infected
• 2001 10 prisons in Iran all found HIV among IDUs
• one prison 63 HIV-infected(Ref. MAP
  (Monitoring the AIDS Pandemic). 2001. The Status
  and Trends of HIV/AIDS/STI Epidemics in Asia and
  the Pacific. MAP. Provisional Report October 4,
  Melbourne, Australia)
• Indonesia
• Salemba penitentiary, Central Jakarta
• 1998 first HIV cases - 4 of 509
• 2001 200 prisoners tested - 22 positive
• (Ref. During R 2002. Indonesian prisons begin
  to accept HIV threat. Asian Times April 20
  (on-line http//www.atimes.com/se-asia/DD20Ae05.ht
  ml)

8
HIV in Prisons in Asia (cont)

• Malaysia
• August 2001
• - number of HIV infections in Malaysian prisons
  is 1,834
• - 6 of total prison population
• - main mode of transmission is sharing
  contaminated needle and syringe (94)Ref
  Prisons Department of Malaysia. 2001. Programmes
  related to AIDS prevention and management in
  Malaysian Prisons Department 2001. Rehabilitation
  and Treatment Division. Selangor. Malaysia.

9
Vietnam

• There are approximately 185,000 drug users in
  Vietnam typically aged between 18-25 years.  HIV
  prevalence in 2004 was estimated at 28.6 though
  rates are as high as 70 in some provinces
• Since the 1990s authorities have dramatically
  increased the number of compulsory
  rehabilitation camps for drug users to over 80
  with approx. 40,000 people now being detained for
  between 1-5 years each
• People can be literally removed from the streets
  and detained by authorities for being in
  possession of an illicit substance the camps to
  not provide any recognised form of drug treatment
  or HIV education
• It is estimated that HIV rates in the camps are
  50

10
HIV Transmission Risks in Prisons

• Between prisoners, from prisoners to staff
• Blood contact
• Violence
• Blood exposures
• Injecting drug use
• Tattooing
• Sexual contact
• - Heterosexual and homosexual

11
Needle Syringes
12
Needle After One Use
13
Needle Used Five Times
14
Needle Used Five Times
15
IDU Mixing in Prisons
A IDU Network HIV -ve
C IDU Network HIV -ve
B IDU Network HIV ve
D IDU Network HIV -ve
PRISON
A IDU Network HIV ve
B IDU Network HIV ve
C IDU Network HIV ve
D IDU Network HIV ve
16
At Risk HIV Exposures Model of IDU in Prisons
Based on a Model Developed by Dr Wiwat
Rojanapithayakorn, UNAIDS SEAPICT
A 10 HIVve people X 5 episodes X 1
sharer 50 (HIV risk exposures per
week) X 5 sharers
250 X 10 sharers
500
B 100 HIVve people X 5 episodes X 1
sharer 500 (HIV risk exposures per
week)
X 5 sharers 2,500

X 10 sharers 5,000
C 400 HIVve people X 5 episodes X 1
sharer 2,000 (HIV risk exposures per
week)
X 5 sharers 10,000

X 10 sharers 20,000
To Reduce Number of at Risk Exposures
Prevalence Unsafe Injecting Episodes
No. of People Using/Sharing
17
Lithuanian Case Study
New HIV Cases 1988 - 2002

• Prison population of over 11,000, with over
  1,000 IDU
• Very few, if any HIV prevention drug treatment
  programs in prison system

18
Photo by Mr Alessandro Scotti, UNODC Good Will
Ambassador
19
Photo by Mr Alessandro Scotti, UNODC Good Will
Ambassador
20
Photo by Mr Alessandro Scotti, UNODC Good Will
Ambassador
21
Photo by Mr Alessandro Scotti, UNODC Good Will
Ambassador
22
Photo by Mr Alessandro Scotti, UNODC Good Will
Ambassador
23
Photo by Mr Alessandro Scotti, UNODC Good Will
Ambassador