School of Public Health and Community Medicine

  HIV prevalence, incidence and mortality in prison: A global

overview

Professor Kate Dolan and Babak MoazenProgram of International Research and TrainingNational Drug and Alcohol Research Centre UNSW, Sydney, Australia

Background

Prison settings have characteristics that increase HIV transmission

Elevated levels of HIV, HBV, HCV, TB & mental illness

Widespread risky behaviour, few prevention/treatment measures

Unless HIV is controlled in prison it may be uncontrolled in the community

Yet prison settings are a practical point of HIV prevention and treatment

Background

Drug dependence key factor in prison growth

US popn up 13%prison popn up 33%PWIDs prisoners up 43%

1/3 of 200,000 heroin users in US imprisoned annually60% of PWIDs in a 12-city study been in prison

Re-incarceration rates very high for PWIDs- In Australia, 84% of PWIDs inmates were re-incarcerated in 2 yrs of release versus 44% of all prisoners. They had a mean of 5 imprisonments.

 

Aim

Global systematic review of the HIV situation in prisons on

A. Imprisonment rates

B HIV prevalence

C HIV incidence

D AIDS related mortality

E Services provided in prison

The time period under observation January 2008 to April 2013.

Methods

• A multilingual (English, German, Spanish, Croatian, French,

Arabic, Portuguese and Russian) desk review of the

literature

• A survey of UN staff and experts

• List of Countries from

http://www.unaids.org/en/regionscountries/countries/

 Imprisonment rates from the International centre for prison

studies

http://www.prisonstudies.org/info/worldbrief/

Results

Identified 4,640 peer reviewed papers and 8,292 documents Total number of documents used was 261

10 million prisoners - 3 million on pre trial remand in the world

BUT 30 million individuals enter and leave prison - 90% male

The world average rate of incarceration was 144 per 100,000

Imprisonment rates for each Region per 100,000 adult popn

Imprisonment rate No. of countries Region

182 20 East/ Southern Africa

68 25 West/Central Africa

129 35 Asia and Pacific

332 16 Caribbean

220 30 Eastern Europe and Central Asia

210 17 Latin American

128 21 Middle East and North African

127 22 Other Countries

144 196 Total

Data located on HIV prevalence for each region and key populations

HIV prevalence among inmates No. of countries Region

MSM PWIDs Female Male All

1 1 6 6 10 20 East/ Southern Africa

1 2 2 12 25 West/Central Africa

1 5 4 8 35 Asia and Pacific

1 16Caribbean

3 6 6 12 30Eastern Europe and Central Asia

3 4 3 17Latin American*

2 3 4 7 21Middle East and North African

2 1 1 2 6 22Other Countries

3 9 26 28 58 196Total

Range of HIV prevalence for each Region by sex and all prison popn

% All Male % female% Region

6 – 34 0 - 50 2 – 75 East/ Southern Africa

1 – 19 3 - 5 0 – 17 West/Central Africa

0 – 29 0 - 2 0 – 30 Asia and Pacific

4 -- -- Caribbean

0 – 15 1 - 33 1 - 38 Eastern Europe and Central Asia

0 – 12 0 - 18 1 – 4 Latin American

0 - 4 0 - 1 0 – 4 Middle East and North African

0 - 8 1 - 4 1 - 2 Other Countries

Range of HIV prevalence in prison populations

East and Southern Africa

%

Ethiopia 8

Kenya 6 – 27

Malawi 41 - 42

Mauritius 23

Mozambique 17

Rwanda 2 - 8

South Africa 16

Swaziland 0 - 75

Uganda 11 - 13

Tanzania 5 - 15

Zambia 26 - 42

Range of HIV prevalence in prison populations

West and Central African Region

%

Burkina Faso 5

Cameroon 5-8

Cape Verdi 2

Cote d’Ivoire 3 – 17

DR Congo 8

Ghana 10-20

Mali 0 - 3

Mauritania 4

Niger 3

Nigeria 2

Senegal 3

Togo 7

Range of HIV prevalence in prison populations

Asia and Pacific %

Australia 0

Cambodia 3

China 0 – 30

India 6 – 10

Indonesia 1 – 30

Malaysia 6

Pakistan 2

Sri Lanka 0

Thailand 3

Range of HIV prevalence in prison populations

Caribbean %

Saint Vincent and the Grenadines 4

Range of HIV prevalence in prison populations

Eastern Europe and Central Asia

%

Azerbaijan 3

Estonia 1 - 38

Georgia 0 - 5

Hungary 1

Kazakhstan 2 - 12

Latvia 6

Lithuania 4

Moldova 1 - 3

Romania 1 – 10

Tajikistan 6 - 18

Ukraine 12 - 33

Range of HIV prevalence in prison populations

Latin America %

Argentina 3

Brazil 10

Chile 2

Mexico 1 - 12

Range of HIV prevalence in prison populations

Middle East and North African Region

%

Afghanistan 1 – 4

Egypt 0

Iran 0 – 2

Lebanon <1

Morocco < 1

Oman < 1

Saudi Arabia < 1

Range of HIV prevalence in prison populations

Other Countries Region %

Italy 4

Luxembourg 1

Netherlands 0

Portugal 6

Spain 6 – 11

USA 1

Outbreaks of HIV transmission in prison populations and in IDU prisoners

Country incidence

Thailand 35/per 100

Lithuania300 inmates infected in 6 months

Doubled number of HIV cases

Russia 400 inmates infected in a few months

Iran Two outbreaks with hundreds infected

Australia At least 4 up to 12

Scotland 12

Afghanistan 17

HIV incidence in prison

Country Year % among males

% among females

% of total prisoners

Number of cases

Mozambique 2008-12 0.23 0.26 0.24      Kazakhstan

2008       772009       752010       43                  

 Latvia

2008     0.2  2009     0.16  2010     0.17  

 Lithuania 

2008       12009       102010       282011     0.4  

   Romania

2008 0.18      2009 0.15      2010 0.11      2011 0.11      2012 0.16      

HIV incidence in prisonCountry Year % among

males% among females

% of total prisoners

Number of cases

  Spain

2008 0.09      2009 0.0      2010 0.0      2011 0.04      2012 0.02      

Moldova 2012       12

Russia 2008       229

Tajikistan 2009       258 (m)2010       279 (m) 21 (f)2011       475 (m) 28 (f)2012       514 (m) 29(f)

Ukraine 2008     0.9 9612009     0.8 23182010     11.2 36902011     10.4 28192012     10.6  

  Afghanistan

2008       1 (M) 0 (F)2009       21 (M) 0 (F)2010       6 (m) 1(F)2011       0 (M) 1(F)2012       7 (M) 0 (F)

AIDS related mortality in prison populationsCountry Year % among

malesNumber of cases among males

Republic of Moldova

200820092011

 12.7%10.5%22.9%

  

Romania 20082009201020112012

  31033

Russian Federation

 2008

   128

Ukraine 20082009201020112012

  85169180388313

Summary of the number of countries per Region with HIV programs

Conclusions and Recommendations

Good prisoner health is good public health: High turnover of

inmates mean diseases contracted inside leave prison.

High imprisonment rates in regions- non custodial sentences

Few data on prevalence, incidence and mortality

Low prevalence in Latin & MENA time to intervene

increase ARV, OST, condomsReduce prison populations: OST in community, divert PWIDsLegal obligation to medical treatment same level as in the

community. Compassionate release from prison for inmates in final stages

of AIDS. 

Acknowledgment

Co-authors

Atefeh Noori, Shadi Rahimzadeh, Farshad Farzadfar and

Fabienne Hariga