Knowing your Epidemic: Designing Better Interventions in Prisons

Deputy Commissioner Mary C. ChepkongaKenya Prisons Service

International AIDS Conference 2012, July 25 2012, Washington DC USA

About Kenya Prisons Service (KPS)

• Kenya Prisons Service established since 1911• Mandate of KPS:

– To contain and keep offenders in humane safe custody – To rehabilitate and reform offenders, – To facilitate administration of justice and – To promote prisoner social reintegration

• Headed by Commissioner of Prisons• 108 prisons countrywide• 23,000 uniformed and civilian staff• Directorate of Health Services manages prison health services• AIDS Control Unit set up in 2004 for HIV workplace policy

Profile of Inmates Population (KPS 2010)Total Prison Population 54,000

Annual cumulative 253,524 (2010)

Incarceration rate (per 100,000 pop) 667

Official Holding Capacity of Prisons 26,757

Female prisoner population Annual cumulative 23,644 (9.3%, 2010)

Child prisoner popn below 18 years (excludes children with mothers)

Annual cumulative 771 (0.3%, 2010)

Number of remand prisoners Annual cumulative 164,893 (2010)

% Pre-trial versus convicted prisoners 65% (KPS, 2010)

Prisons Study Design

• Objective: To determine prevalence of HIV and risk behavior in prison settings.• Study population: 783 inmates plus 247 prison staff • Target location: 25 prisons countrywide • Methods:

– Individual questionnaires: - 783 inmates and 247 prison staff– Focus group discussions - 6 for inmates– Key informant interviews – 25 prison staff – Health facility assessment – 25 facilities

• Ethical clearance: Kenyatta National Hospital Ethics & Research Committee

Age and Sex Distribution of Inmate Respondents

Female19%

Male

81%

< 19 years

19-24 years

25-29 years

30-34 years

35-39 years

40-44 years

45-49 years

>49 years

18.900%

23.100%21.200%

12.800%10.100%

6.800%

3.200% 4.000%

Age Distribution of Inmates by Age

A total of 783 inmates were interviewed and tested for HIV

Profile of inmate respondents

• 84% of inmates were first time offenders

6

< 1 month

1 to <3 months

3 to < 12 months

1 to < 3 years

> 3 years

7.700%

15.600%

37.500%

26.400%

12.800%

Length of Stay in Current Sentence Re-

mand/ await-

ing trial41%

sentenced/ convicted59%

Risky Behaviour in Prison

• 38% of inmates reported ever sharing razor-blades• 9% of inmates ever coerced into sex, particularly inmates <24 yrs • 13% of inmates had consensual sex with other inmates• Exchange of sex for money, goods or services is reportedly common• A third of prison staff could recall work related events that may

have exposed them to HIV infection, e.g. injury from needles for medical staff while warders cited injury from hidden needles when searching inmates.

HIV Testing History and Prevalence

• 77% inmates previously tested for HIV versus 23% for TB• High HIV prevalence among prison inmates 8.2% versus 6.4% for

adult population (KDHS 2008/09)• HIV prevalence for female inmates thrice that of male inmates:

19% versus 6%.• Inmates from Maximum Security prisons had highest HIV

prevalence (16%), followed by Women's prison (13%)

Drug Use in Prison

• 13% of inmates have used cannabis, • 3% amphetamines, • 2% alcohol, • 1% heroin and • 0.4% cocaine.• Illicit drugs trafficked into prison by inmates from court

hearings or corrupt security officers who supply drugs or facilitate their entry.

HIV-Related Services Availability in Prison

TB/HIV

HIV counseling and testing

Adherence support

HIV Care

Reproductive Health

PMTCT

PWP

Adult ART

PEP

Nutrition/HIV

VMMC

HBCT

HCBC

PrEP

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

91%

91%

86%

77%

73%

68%

64%

64%

50%

50%

46%

41%

36%

23%

Recommendations from Study

• Adapt the UNODC recommended comprehensive package for HIV interventions in prisons as per country context and national guidelines

• Promote a human rights approach and principle of equivalence for prison health as in the community

• Ensure enabling environment for smooth implementation of the comprehensive package of HIV prevention

• Develop a joint action plan with all concerned stakeholders for the pilot and roll out of the comprehensive package.

Progress to Date• Prisons study report disseminated widely: all provincial KPS

focal points, national HIV stakeholders and at ICASA 2011• Kenya Prisons Health Strategic Plan development is underway• Comprehensive Package for HIV Prevention in Prison Settings

launched in Nairobi and Mombasa• Drug use in prisons being addressed in national harm

reduction guidelines for IDUs

Acknowledgements

• MOHA• KNH• NHRL• NCHPR• UNODC• UNAIDS• NASCOP• NACC• Bon Sante

• KPS ACU & SUB-ACUs• Study participants:

– inmates, – prison staff, – health workers

THE ENDQ & A

14