Prevention of spread of HIV amongst most at risk prisoner in Bangladesh
United Nations Office on Drug and Crime (UNODC)
The judiciary is currently overburdened with 3.4 million cases. The overcrowding of prisons, which are on average at 200% of capacity, is further exacerbated by this. In January 2018, 79% of all detainees were not convicted. Prison inmates are important vulnerable group for risk behaviors including drug abuse and HIV/AIDS. According to Justice Audit data, in 2016, 32% of inmates were detained for drug-related offences. In addition, drug issues in Bangladesh are not yet adequately treated as a health problem, but only as a criminal offence. In 2019 about 43% prisoners are drug-related cases which approximately 37,000 people and this number alone exceeds jail capacity in Bangladesh where actual capacity of prisoners 36,614. HIV prevalence in prison is higher than in the community within all countries. Effective policies to prevent HIV inside prisons are often hampered by denial of the problem. At the same time existence of the factors that contribute to spread of HIV: overcrowding, unsafe sexual activities and injecting drug use, female, weakest inmates and poor prison health services. In 2019 report of national HIV/AIDS data reflects that in Bangladesh 14000 people living with HIV (PLHIV)/AIDS.HIV programmes have been introduced in prisons in many countries, but most are small in scale and rarely comprehensive in nature. Women prisoners are more venerable then male prisoners in respective of HIV and other communicable diseases. The National Strategic Plan for HIV/AIDS Response 2018-2022 has focused several ‘fast track’ approaches for achieve the global on ‘Ending AIDS by 2030’ and treatment target of ’90- 90-90’ by 2020.The objectives of the strategic plan has emphasized to increased HIV case detection, encompasses strategies to reduce mortality and morbidity among PLHIV through ensuring access to treatment, case and support services, to guide smooth management, ensure effective coordination, advocacy, health system strengthening and capacity development plans.
The National Strategic Plan for HIV/AIDS Response 2018-2022 has focused several ‘fast track’ approaches for achieve the global on ‘Ending AIDS by 2030’ and treatment target of ’90- 90-90’ by 2020.The objectives of the strategic plan has emphasized to increased HIV case detection, encompasses strategies to reduce mortality and morbidity among PLHIV through ensuring access to treatment, case and support services, to guide smooth management, ensure effective coordination, advocacy, health system strengthening and capacity development plans.
The specific objectives of this project is to strengthen capacity of prison authorities, prisoners and community based organization-to address HIV-prevention, treatment, care and support in prison. Considering the country scenario of prison the proposed project will not only cover project objectives but also achieve all objectives of National Strategy Plan of HIV/AIDS and reduce transmission in Prison. In addition, there are three other factors: 1) transitioning between injecting and non-injecting drug use; 2) high levels of the population mixing between vulnerable groups and mainstream society; and 3) suppressed immunity of drug users due to use of drugs has made this population vulnerable to infectious diseases such as STIs, HIV, Hepatitis B and C, and Tuberculosis.
The purpose of this project is to prevent the spread of HIV among most at risk prisoners by providing comprehensive HIV, TB and Reproductive Health Care in Kashimpur Central Jail I, II, & III (Female) through evidence based and gender sensitive approaches. Specifically, the project objectives are as follows:
- Build technical and programmatic capacity of prison department to create enabling environment for implement HIV prevention activities inside the prison Improve the basis for evidence-based, gender-sensitive and needs-based activities. This includes strengthening capacity of prison department. DAM will build capacity to implement the project and paying special attention to gender issues with respect of developing project materials and training. DAM will organize three capacities building online training during project period. DAM has experience to provide online training to prison staffs in COVID-19 situation.
- To increase awareness among prisoners and prison officials on harms of HIV, TB, other communicable disease and reproductive health care services (for women prisoner) the project will organize awareness program through peer to peer approach. 06 (4-male and 2- women) peer educator (long convicted prisoner) training will be organized during this project period. Trained Peer educator will organize awareness session for other prisoners. For increase awareness, BCC materials will be developed on harms of HIV, TB, Reproductive health and other communicable disease. Observe relevant international days.
- Strengthen continuum of care by enhancing referral mechanisms and linkages with other agencies Referral mechanisms will be set-up with service agencies, including public and privateorganization, as well as vocational training. DAM is providing vocational training through Improvement of the Real Situation of Overcrowding in Prisons (IRSOP) project since 2014. Clients suspected to have active TB during health check-up or noticed any symptoms will be referred to inside prison health centre/TB DOTS treatment provider.
One Year (January 2021 to December 2021)
Project will be implemented in Kashmipur Central Jail- I, II & III and training will be provided to medical staffs in 68 prisons in Bangladesh.
DAM will organize inception meeting with the involvement of IG prison and sensitize him to achieve the project objectives and also discuss about activities. IEC & BCC materials development: In order to complement the Behavior Change Communication (BCC) efforts, adequate IEC/BCC materials will be developed and stocked in the centre for distribution and display. During the materials development stage DAM will ensure gender based issues.
- Capacity development: To build the capacity of prison department to reduce HIV transmission among substance user prisoners in Bangladesh, DAM will ensure both knowledge based and hands on training and capacity building. Total 3 online training (03 trainings-120 prison authorities) will be organized with 13 Central Jails authorities (non technical persons) of Bangladesh during the project period. Along with 6 peer educator trainings (06 trainings-120 peer educators per batch 20 participants) will be provide in Kashimpur central jail-I, II and III. 05 online trainings will be provided to the prison medical staffs in 68 prisons on HIV, TB and reproductive health. During the development of training course DAM will review previous UNODC/WHO recommended issues and consider gender issues.
- Tuberculosis (TB) Screening and Referral: Project staffs will maintain close links with local TB control programs and receive counseling and health education on the risks of TB. Capacity building online training will be provided to the prison medical staffs.
- Reproductive Health Services: The women prisoners will get orientation on reproductive health related information by peer educator. Project staff and female peer educator will provide basic family planning information, the risks of mother-to-child transmission and the benefits of family planning.
- Peer Training: Trained peer educators will conduct education sessions for their peer person’s safe injection, overdose, safe sex, importance of regular access to NSEP, safe disposal, abscess prevention, HIV, hepatitis B & C, prevention of other blood-borne infections, detoxification and treatment etc by follow the flipchart and handbook.
- Linking Services and addressing the Multiple Needs: DAM will address complex and multiple adverse social and health consequences of prisoners. The substance users need HIV counseling, employment opportunities, Hepatitis B & C and antiretroviral treatment, and recreational opportunities. So, links will be established with the organizations whose are following WHO framework for HCT for improving overall quality of HCT services through advocacy.
- Day Observance: DAM will assist respective prisons to Observe World AIDS Day, World TB Day and International Day against Drug Abuse and Illicit Trafficking.