HIV and Hepatitis in Prisons: UNAIDS Urges Global Action for Prevention and Treatment

2023-06-10 22:00:00

Emergency. Many prison systems struggle to cope with overcrowding, insufficient resources (financial, human), limited access to care and other support services, violence, and the use of drugs and , alerted, in May, UNAIDS. It calls, once once more, for access to prevention, treatment and care for HIV and viral hepatitis in prisons. According to the UN agency, people in prison are 7.2 times more likely to be living with HIV than adults in the general population. UNAIDS reports that HIV prevalence among prisoners has increased by 13% since 2017, reaching 4.3% in 2021. Although data is limited, it is estimated that around a quarter of the total prison population is infected. of chronic hepatitis C. “Prisons are too often overlooked in countries’ efforts to respond to HIV. A multi-sector and multifaceted approach is urgently needed to save lives, which includes access to clean needles and syringes, effective treatment for opioid addiction, and reduction of stigma and discrimination,” said Eamonn Murphy, UNAIDS Regional Director for Asia-Pacific and Eastern Europe and Central Asia. Of the countries reporting prison information to the UN agency in 2019, only six out of 104 countries had needle and syringe exchange programs in at least one prison. Only twenty out of 102 countries had opioid substitution treatment programs in at least one prison. In addition, 37 out of 99 countries had condoms and lubricants in some prisons. UNAIDS, the United Nations Office on Drugs and Crime and the World Health Organization (WHO) have long supported the expansion of harm reduction services to all prisons. However, according to the NGO Harm Reduction International, only 59 countries worldwide offer opioid agonist treatment in prisons. Opioid agonists such as methadone or buprenorphine are therapeutic drugs used for the management of opioid addiction. This alert comes as the estimated number of people incarcerated has increased in 2021 by 24% to around 10.8 million people, increasing the pressure on prison systems already overburdened and under-doubted in human and financial resources. Another finding: drug use is widespread in prisons. UNODC estimates that in some countries up to 50% of people in prison use or inject drugs. Injection practices are a major risk factor for HIV and hepatitis C transmission due to limited access to harm reduction services, including condoms, clean needles and syringes, and lack of comprehensive treatment programs for drug use, in particular the use of opioid agonists (or opioid substitution therapy). The UNAIDS press release underlined that certain advances exist, citing in particular the example of Moldova. Despite the difficulties encountered by the influx of refugees and the repercussions of the war in Ukraine, Moldova (which has an HIV prevalence of 3.2% in its prisons, compared to 0.4% in the general population) has committed many more resources to its systems, says UNAIDS. If in the early 2000s, few of its prisons offered harm reduction services, all 17 penitentiaries in the country now offer DRR services. These include methadone (OST), access to psychiatrists, doctors and treatment programmes, needle and syringe exchange and HIV prevention, testing, treatment and care. UNAIDS wants 95% of people in prisons and other closed settings to know their HIV status. Its objective is that 90% of detainees use condoms the last time they had sex with a non-regular partner. It also aims to achieve that 90% of prisoners who inject drugs use sterile needles and syringes at the last injection; and that 100% of detainees have regular access to appropriate health care or community services.

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