HIV hit correctional facilities early and hit them hard. The rates of HIV infection among prisoners in many countries are significantly higher than those in the general population. Examples include countries in Western and Eastern Europe, Africa, Latin America, and Asia. Hepatitis C (HCV) seroprevalence rates in prisons are even higher than HIV rates. While most of the prisoners living with HIV or AIDS in prison contract their infection outside the institutions before imprisonment, the risk of being infected in prison, in particular through sharing of contaminated injecting equipment and through unprotected sex, is great. Coincident with the emergence of HIV, many countries were experiencing a significant increase in the incarcerated population. In 2003, experts estimated that 8.75 million people were incarcerated worldwide, with more than half of these in the United States, China, and Russia. The prison population in many countries increased significantly beginning in the 1990s. Each of these two “epidemics” – HIV and incarceration – has affected the other.

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This publication, together with other Evidence for Action technical papers, aims to make the evidence for the effectiveness of selected key interventions in preventing HIV transmission among injecting drug users accessible to a policy-making and programming audience. The interventions reviewed range from providing information and sterile injection equipment to the impact of drug dependence treatment on HIV prevention. Each publication summarizes the published literature and discusses implications for programming with a particular focus on resource-limited settings.
 

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Published in May 2008, this major report – The Global State of Harm Reduction 2008: Mapping the Response to Drug-Related HIV and Hepatitis C Epidemics – provides a region-by-region assessment of drug-related HIV and hepatitis C epidemics, as well as the extent of harm reduction policy and programmatic responses from multilateral agencies, government and civil society. It is designed to be an advocacy and reference tool for a wide range of audiences, including international donor organisations, multilateral and bilateral agencies, non-governmental and community-based organisations, including organisations and groups of people who use drugs, researchers and the media.

The report is the result of long-term collaboration between IHRA’s HR2 (harm reduction and human rights) team and harm reduction networks, researchers, and organisations of people who use drugs around the world to allow IHRA to gather the most reliable data to reflect the situation in over 200 countries and territories worldwide. The report will enable IHRA to engage with and work alongside a wide range of partners around the world – such as regional harm reduction networks, international human rights organisations and HIV and drug policy organisations – to advocate and lobby for harm reduction.

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O presente artigo procura sintetizar alguns dos principais resultados duma investigação, levada a cabo entre Julho de 2007 e Julho de 2008, acerca das terapias de substituição opiácea no sistema prisional português. Teve origem na solicitação que o GAT – Grupo de Activistas sobre Tratamentos VIH-Sida – fez ao Centro de Ciências do Comportamento Desviante (CCCD) da Faculdade de Psicologia e Ciências da Educação da Universidade do Porto para conduzir a parte portuguesa dum projecto de âmbito europeu denominado AGIS.

De acordo com um novo estudo, são muitos reclusos seropositivos para o VIH que, tendo recebido a terapêutica antiretrovírica no estabelecimento prisional, não cumprem o tratamento quando são libertados.

O estudo envolveu 2115 reclusos seropositivos para o VIH que estavam sob terapêutica antiretrovírica (ART) antes de serem libertados de uma prisão no estado do Texas entre Janeiro de 2004 e Dezembro de 2007. Entre os participantes no estudo, apenas 5.4 por cento foram levantar a medicação prescrita nos dez dias que se seguiram à saída, 17.7 por cento nos 30 dias seguintes e 30 por cento no período de 60 dias. Os reclusos de origem hispânica e os afro-americanos apresentavam uma probabilidade 60 por cento inferior de virem a levantar a medicação em 10 dias e, após 30 dias a probabilidade era 30 por cento inferior.

No geral, foram mais de 90 por cento os ex-reclusos que não levantaram a medicação prescrita num intervalo de tempo que evitasse a interrupção do tratamento.

“Do ponto de vista da saúde pública, estas elevadas taxas de interrupção prolongada de tratamento são problemáticas “, afirma Jacques Baillargeon, PhD, da Medical Branch-Galveston da Universidade do Texase principal autor do estudo. “São vários os estudos que sugerem que os prisioneiros libertados que descontinuam a terapêutica antiretrovírica também retomam comportamentos de alto risco como consumo de drogas injectáveis ou práticas sexuais desprotegidas e esta combinação pode resultar não só em resultados clínicos insatisfatórios como também no aparecimento de reservatórios de VIH resistente na comunidade.”

Como referem os autores, “Resolver uma crise de saúde pública com esta escala e complexidade irá requerer a coordenação cuidada de esforços entre as instituições académicas, sistema criminal e autoridades de saúde pública.”

O estudo, “Accessing Antiretroviral Therapy Following Release from Prison,” foi publicado no Journal of the American Medical Association (2009;301(8):848-857).

VER AQUI NOTÍCIAS CRIAS

Introdução
Saúde em meio prisional
Doenças infecciosas em meio prisional
A infecção VIH/sida em meio prisional

Objectivos

Métodos e Participantes
Desenho do estudo
Características dos inquiridos
Características relacionadas com a reclusão
Características socio-demográficas
Consumo de substâncias psicoactivas

Resultados
Atitudes e conhecimentos em relação à infecção VIH/sida
Comportamento sexual
Resultados analíticos

Discussão
Amostra estudada
Consumo de substâncias psicoactivas
Atitudes em relação à infecção VIH/sida
Comportamento sexual
Resultados analíticos

Referências

Introduction
At any given day, more than 600.000 people are held in prisons in 27 EU Member States. Taken into account the estimated annual turnover rate, between 860.000 and one million pris-oners pass through the system every year. Between 10% and 30% of sentenced prisoners are incarcerated for violation of drug laws. Based on these data at least 86,000 to a quarter million drug users or drug experienced people are incarcerated every year in the 27 EU-Member States.
Thus the management of opioid dependent inmates poses a major problem to health care and security services in prisons. Drug trafficking, drug use and drug use related offences inside prisons as well as violence concerning trading and purchasing of drugs are challenges for prison governors and the daily work of security staff. Opioid substitution treatment (OST) is an established treatment measure in the community and is effective in reducing opiate use, reduc-ing HIV risk behaviour and criminal activity. The term “opioid substitution treatment” (OST) re-fers to the medically supervised treatment of individuals with opioid dependence, based on the prescription of opioid agonists (Thomas 2001). These can include methadone, buprenorphine, codeine, morphine, and diamorphine. The treatment options include the management of with-drawal on admission as a gradual detoxification (preceding abstinence-oriented treatment) or the long-term substitution maintenance.
The implementation of OST in prison settings is still not meeting the same standards as in the community and is far from being adequate. Recent studies indicate that opioid substitution treatment initiated in the community is most likely to be discontinued in prisons. This often leads to relapses both inside prisons and immediately after release, often with severe consequences as high mortality rates after release from prisons indicate. Other studies show the benefits of OST for the health and social stabilisation of the patients/inmates. This report gives an overview of the project ‘Reduction of Drug-related Crime in Prison’ funded by DG JLS (JLS/2005/AGIS/130) that was conducted by WIAD and BISDRO. The main aim of the study was to investigate the effects of opioid substitution treatment on the management of opioid drug using inmates in 7 European countries (Austria, England, Germany, Italy, Portugal, Slovenia and Spain). The present project is a follow-up study of the STEP-study (Substitution Treatment in European Prisons) (Stöver et al. 2004) which had the objective to examine practices and policies in place for the provision of OST in prisons in 18 European countries. While Stöver et al. were interested in how substitution treatment was applied, the aim of this study is to investi-gate the effects of OST on the prison and the manageability of the opioid dependent prisoners. Therefore, its focus does not primarily lie on a health related topic but on crime prevention.
The project was conducted over 24 months by research institutions in Austria, England, Ger-many, Italy, Portugal, Slovenia and Spain. The study investigates prison staff’s and inmates’ experiences with the effects of the introduction of opioid substitution treatment in the prison setting. Data collection was done with two standardised questionnaires in the respective native language: one for inmates under OST and one for prison staff. Additionally, an extensive litera-ture review was carried out and data from qualitative interviews with key experts were part of the analyses.
Chapter two gives a brief overview of the methods and objectives of the study. In chapter three the results of the literature review on substitution treatment in European prisons are outlined whereas in chapter four the results of expert interviews conducted in the seven above men-tioned countries inform about country-specific particularities in opioid substitution treatment.
In chapter five, the results of the quantitative study on the evaluation of the impact of opioid substitution treatment on the management of opioid dependent inmates in seven European countries are summarised. This includes a short overview of the used methods, i.e. the sam-pling, the process of the field work, the instruments used for data collection and the results of the analysis of the data on the institutional background of the prison, prison staff and prisoners.
Examples of good practice of the implementation of opioid substitution treatment in prison are outlined in chapter 6 and the main results are summarized and recommendations are presented for an improved practice in European prisons regarding opioid substitution treatment. Finally, models of good practice are described, which are based on the research carried out and the evaluation of an expert rating.

The aim of the policy is to establish good practices in minimising drug related problems in prisons by appropriate preventive and therapeutic measures. The basis for this is research evidence from epidemiological studies, from needs assessment, from evaluation of interventions and policy documents from WHO and UNODC. The policy strikes a balance between Public Health interests, security aspects of prisons and the human rights of inmates