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UNAIDS PCB – Statement
Agenda Item: 6
HIV in Prisons and Closed Settings

27 October 2015 – 37th UNAIDS PCB Meeting, Geneva, Switzerland

Before I begin I would like to recognize and thank our guest speakers for their contribution.

This statement is made on behalf of the Stop AIDS Alliance, the International HIV/AIDS Alliance, AIDS Fonds/STOP AIDS NOW, the Interagency Coalition on AIDS and Development (ICAD), the Global Network of People Living with HIV (GNP+), and the African Black Diaspora Global Network on HIV (ABDGN).

We thank UNAIDS for this report on HIV in prisons and closed settings and are encouraged by the emphasis on evidence showing good prison health as good community and public health, recognizing that almost all incarcerated peoples return to their communities.

With this statement we would like to highlight 4 key areas of concern recognizing the need for greater focus and clarity including: 1) a data revolution, or as Mr. Sidibe has termed ‘the democratization of data’ within prisons and closed settings; 2) efforts to reduce the devastating impact of harmful legal environments on public health programming within closed settings and in our communities, and; 3) a call for scale-up of multi-sectoral partnerships, including with civil society and community-based services. Only through partnerships, data transparency and enabling legal environments can we begin to minimize and heal the negative impact and downstream costs of incarceration both on the individual, communities, and the health system; and 4) a call to establish an integrated HIV/HCV/TB response, ensuring good HIV, HCV and TB services for the health of prisoners and their families.

The evidence shows us that:

  1. In places throughout the world, incarceration remains the prominent alternative to mental health treatment. The number of young people and adults in prison as a result of petty drug crimes is appalling. The severity of these experiences on human development impacts the health and social trajectory not only of the individual but also the health of families and communities. The assumption is that key populations don’t have families; but people who use drugs, gay men and other men who have sex with men, people living with HIV, sex workers, transgender people are mothers, are fathers, are brothers, and are sisters. So what happens to the children of key populations when their parent or caregiver is incarcerated or placed within a closed settings? Who then cares for these children and what is the downstream impact and how does this influence the child’s HIV risk, vulnerability and/or resilience?
  2. Fundamental structural inequalities, social prejudices and social exclusion explain why people of colour and Indigenous Peoples are disproportionately impacted by HIV and accompanying stigma and discrimination. Racism, not race, ethnicity, or culture has made people of colour and Indigenous Peoples increasingly vulnerable to HIV exposure and infection. Structured impoverishment, racial segregation, and mass incarceration are factors that impact on the risk of HIV infection, and other communicable diseases such as viral Hepatitis and Tuberculosis. We think this omission is an unfortunate oversight in todays background document by UNAIDS. And on that note I would like to draw your attention to the current issue of the publication the Atlantic “the Black Family in the Age of Mass Incarceration”
  3. People living with HIV and key populations living with HIV experience physical and psychological violence throughout the continuum of arrest, detainment, and imprisonment. The continuity of HIV care must be maintained to avoid treatment interruptions and delay. The timely transfer of medical records needs to be considered and provided throughout the journey from arrest, detainment, pre-release and after-release care in the community. We have similar concerns around the continuum of care for migrant, refugee and un-documented populations, particularly the transfer of medical records around the time of detainment, release or deportation.

Prisoners are vulnerable and at risk to contracting HIV, TB or other diseases. Regardless of the reason for imprisonment, the punishment of a prisoner should never result in the lack of healthcare. To end both HIV and TB epidemics, an integrated response is needed with clearly defined roles and responsibilities that hold actors accountable. An integrated approach will not only ensure continuity of care, it also encourages an equality of care that pays respect to human rights.

The issue of prisoners and closed settings has been on the agenda before but we have yet to hear a report back within this room on the impact of the efforts made through the Joint Programme. We reiterate our call for a data revolution on prison health and would like to hear how the UNAIDS Secretariat and co-sponsors have moved this agenda forward with in the UBRAF and with what progress.