The global harm reduction response – an assessment of the current situation, interventions and evaluation of specific programs

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Date Commenced:
02/2017
Expected Date of Completion:
07/2018
Project Supporters:

United Nations Office on Drugs and Crime (UNODC)

Drug Type:
Project Members: 
Ms Rebecca Bosworth
Research Assistant
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Director
Ph EA Jemma Sale: 02 9385 0292 / j.sale@unsw.edu.au
Project Main Description: 

This project attempts to understand the global epidemiology of infectious disease among prisoners in all countries. It will also assess the level of availability and coverage of interventions from the United Nations Comprehensive Package of HIV prevention, treatment and care services in prisons and other closed settings, in every country.

Project Collaborators: External: 

Prof. Frederick Altice
Yale University School of Medicine 
& School of Public Health Section of Infectious Diseases, AIDS Program & Division of Epidemiology of Microbial Diseases

Prof. Stuart Kinner
Melbourne School of Population & Global Health, The University of Melbourne, Murdoch Children’s Research Institute & University of Melbourne

Rationale: 

The health of prison populations is extremely complex, with large proportions of prisoners living with multiple life-threatening diseases such as HIV, hepatitis, tuberculosis and sexually transmitted infections. HIV key populations (people who inject drugs (PWID), men who have sex with men (MSM), transgender people (TG) and sex workers (SW) bear a high burden of these diseases. Risk behaviours such as, sharing contaminated syringes, sex and unsafe tattooing practices within prison fuel the transmission of infectious diseases. The concentration of marginalized populations, combined with the risk behaviours pose a major public health threat, particularly as though prisoners often have limited access to essential health care, including preventative measures. The provision of health care is an ethical obligation, particularly as prisoners are solely dependent on prison authorities or health staff to provide care.

Aims: 

1.         To assess the prevalence, incidence, co-infection and mortality rates of HIV, hepatitis B, hepatitis C, and tuberculosis in prisons worldwide to understand the global epidemiology.

2.         To assess the current implementation and coverage of the 15 interventions   recommended in the comprehensive package for prison populations in every country.

Design and Method: 

1) A global survey of prison authorities in all countries

A key adviser from the prison authority in each country will complete the survey. Where required, a multi stakeholder approach may be taken involving Ministries of Health and Corrective Services to provide a collaborative response.

2) A comprehensive literature review (for the period 2013-2017)

Data will be extracted from databases, grey-literature and documents received from a call for data. A multiphase call for data will be facilitated by the UNODC Head Office on a global, country and regional level to UN country representatives, seeking data/information.

Progress/Update: 

The survey has been sent to 3 UNAIDS regions.

Findings: 

The number of interventions implemented in each country will be reported. The level of coverage, in terms of the percentage of prisoners who have access to interventions will be sought. The coverage of interventions within every country will be calculated for the first time from the survey results. Often a program is implemented but at very low levels. Additional data on the prevalence and incidence of HIV and other related infections in prison will be collected in the literature review.

Benefits: 

“Good prison health is good public health”, therefore when prisoners have adequate access to essential health care in prison, the risk of transmission both inside prison and beyond the prison walls is drastically decreased.

Project Status: 
Current