CURBING HIV, TB AND Hep. C IN PRISONS HAVING LIMITED

RESOURCESCONFRONTING OBSTACLES OF ACCESS TO HIV, TB

PREVENTION AND TREATMENTBy

Abdus Samad DullooI.Goomany Treatment Centre, Mauritius

DETAINEES …Pre-trial detaineesLife sentence

prisonersElderlyInfants,Juveniles,

Young Prisoners under

death sentenceWomen ( with

different problems )High-risk prisoners

INTRODUCTION/SOME FACTS 10 % of the worlds prison population , roughly 918,000 are in

African prisons. Prisoners are perceived as deviants and social outcasts who have

wronged society. “Same sex” behavior in prisons, though not denied, is society’s

homophobia. Consensual or coercive sex without condoms, rape, put prisoners

at higher risk of HIV infection. Detainees who inject drugs and share contaminated injecting

materials are on the increase. Tattooing with non-sterile objects is common Blood flashing ?? Overcrowding and poor hygiene increase the risk of TB and other

infections. Undernourishment prevails.

THE HEALTH OF PRISONERS MEANS ALSO THE HEALTH OF THE COMMUNITY

Priority areas of Intervention

Providing same health services to detainees as for people outside prisons

Identify alternatives to Custody

Bridging the gap between prisons and the wider community

GOALS

Provide additional safeguards to detainees as a result of their status.

Prisoners should not leave the prisons in a worse condition than when they entered.

Combat over-crowding of our prisons which is the source of all the hurdles in the prevention and care of HIV, TB and Hep C.

Goals for the 3 priority areasProvide additional safeguards to detainees as

a result of their status.

Prisoners should not leave the prisons in a worse condition than when they entered.

Combat over-crowding of our prisons which is the source of all the hurdles in the prevention and care of HIV, TB and Hep C.

Providing same health services…Medical screening at entry to evaluate1. General Health of detainee.2. Mental predisposition to suicide3. Two-way risk of TB, Hep C, STI, and HIV

This assessment will be determinant to help prevent suicide andfurther health problems and infections

ALTERNATIVES TO CUSTODYPreamble :The world is

witnessing a massive expansion in the use of imprisonment. As a consequence, allocation of resources, financial and human remains a challenge particularly for poorer countries.

Alternative measures to custodyReduce length of stayEarly or compassionate release for the sickGood conduct early release (remission )Non-prison sanctions: 1. Prescribed treatment in rehabilitation

centres for PWUDs. 2. Community Service Order.Half-way house, furlough( permission).Deferred sentenceParole, Pardon

Bridging the gap between prisoners and the wider communityOBJECTIVESRehabilitate and reformChange the prospects of

life of ex-detainees and marginalized.

Help protect the wider community from infections

Prisoners should not leave the prisons in a worse condition than when they started their detention

MeasuresRecognising the prisoner as a unique Individual with respect and

inherent dignity Provide for work/skills training sanctioned by a certificateEducational authorities provide education/values /culture

training programsPre-release schemes by NGO and CBO ( second chance Relatives’ visits ( incl foreign prisoners ), telephone calls,

newspapers, mails, contacts with legal advisersClear Morality Certificate/or ‘character’ after detention periodReferral/Follow-up of medical problems in community health

services

A question ! What are individuals forced to do in order to survive… if their access to society Is denied?

Conclusion and discussion

What do you think about the following :Should criminal justice and health work hand

in hand, or merge in prisons.Support Don’t Punish advocacy CCM should imperatively have firm members

and alternates from prisons depts and are accountable to the latter.