1

Harm Reduction Related to Injection Drug Use

in Penal Enforcement System in the Kyrgyz Republic

T. BeishenalievDeputy Chief

Division for Reforming Penal Enforcement Systemunder the Ministry of Justice of the Kyrgyz Republic

2

The Kyrgyz RepublicThe Kyrgyz Republic

The Kyrgyz RepublicThe Kyrgyz Republic

3

The Structure of Criminal Executive System under the Ministry of Justice of the Kyrgyz Republic

4

• Total: 36 penitentiary facilitiesAmong them:• 22 or 62,8 % of total number of facilities are based in the Chui

oblast • The remaining Correctional Facilities (CF) are located in:• Osh oblast – 3• Jalalabat oblast – 3• Batken oblast – 2• Talas oblast – 2• Naryn oblast – 2 • Issyk-Kul oblast – 2

Location of Penitentiary Facilities in the Kyrgyz Republic

5

The Size of Prison Population

• The total size of prison population as of 1 May 2007 makes 14914 persons

• In prisons– 8714 persons (58,5%)

• In remand prisons – 2453 persons (16,4%)

• In colonies [prison settlements] – 3747 persons (25,1%)

6

The HIV/AIDS related Policy and Legislation in the Kyrgyz Republic

The Law on HIV/AIDS (as of 2005) The State Program for 2006-2010 on

prevention of HIV/AIDS epidemics and its socio-economic implications in the Kyrgyz Republic

«Ymyt» [Hope] - the National Penitentiary System Reforms Program in the Kyrgyz Republic until 2010

7

• The information on those with HIV positive is strictly confidential and protected by the law (the Law on HIV/AIDS, the Law «On health protection of population of the KR»)

• Unlawful disclosure of information on HIV status of a person is pursued by criminal legislation (Criminal Code)

• It is prohibited to abuse rights and stigmatize persons living with HIV (PLWH) (The Law on HIV/AIDS)

• The rights of prisoners are safeguarded by the Code of Criminal Procedure of KR (CCP) and the Law on HIV/AIDS, including the rights:– to access health care– to voluntary medical examination for HIV – to get information on examination findings, on their rights, nature of the

disease, used methods of treatment

Safeguards to Persons with HIV/AIDS Enforced by Legislation

8

Testing for HIV in the Penitentiary System in the Kyrgyz Republic

• Testing for HIV is voluntary in accordance with the Law «On HIV/AIDS», except for the cases specified in the national legislation

• It is obligatory that the prisoners prior to testing must go through the procedure of pre-test counseling

• In case of positive test results the epidemiologist or AIDS specialist from the medical unit of GUIN or the National AIDS Centre conducts the post-test counseling

• The share of those tested for HIV during different years has varied from 2% to 8% from the total number of prisoners

• In the Penal Enforcement System (PES) since 2005 it is prohibited to isolate and separate HIV positive persons

9

Involuntary Testing• Involuntary examination for HIV is done based on

decision of investigator, procurator prescribing such examination.

• The fact and results of such examination are also confidential and protected by the law (Article7 of the Law on HIV/AIDS in the Kyrgyz Republic)

• The person under examination has a right to refuse from going trough medical examination at any stage except for involuntary medical examination (Article7 of the Law on HIV/AIDS in the Kyrgyz Republic)

10

Annual HIV/AIDS Incidence Rate among Total Population and in Penal Enforcement System

Identified PLWH

Years Nationwide In PES of KR out of them

2004 164 (100%) 54 (32,9%)

2005 171 (100%) 24 (14%)

2006 244 (100%) 41 (16,8%)

2007 (1 quarter) 65 (100%) 2 (3,1%)

11

Ratio of Cumulative HIV Detection Cases in Penal Enforcement System and Nationwide

Registered PLWH Nationwide In PES of KR out of them

2004 559 (100%) 124 (22,2%)

2005 733 (100%) 148 (17,9%)

2006 1071 (100%) 189 (17,6%)

2007 (as of 01.04.07.) 1135 (100%) 191 (16,8%)

12

The Rate of Prevalence of HIV, Hepatitis C, Syphilis among Injection Drug Users (IDUs) in the Penitentiary

System of the Kyrgyz Republic according to Epidemiological Surveillance Data (2004-2006)

2004 2005 2006

HIV % (n / N)

3,8%(17/450)

0,4%(2/450)

3,5%(16/451)

Hepatitis C (n / N)

- 40,3%(181/450)

46,6%(210/451)

Syphilis % (n / N)

- 21,2%(91/450)

15,9%(72/451)

%- equivalent share in percentagen- number of positive casesN- number of examined cases

13

Tuberculosis in Penitentiary System

• As of April 2007, there are 2584 TB patients in PES, which makes 16% of prisoners

• 114 persons out of them are those detected for the first time or 4 % of all TB cases in the penitentiary system

• Under DOTS - 67 persons

14

Education on HIV/AIDS

• There is a training centre under the PES system on training and qualification upgrade of PES officers (funded by the state and donor agencies), which implements 12-hour program to cover the following issues (3 hours on each field): – STIs, – HIV/AIDS, – Tuberculosis, – Viral Hepatitis

• Frequency of classes – once in half a year• The certificates are issued after completion of the course

15

Education on HIV/AIDS• The training program «Peer to Peer» (AFEW) is implemented for

prisoners• There are information and awareness increase stands at the syringe

exchange points, which are aimed at educating on safe behavior• There are group classes under rehabilitation programs «Atlantis»,

which are conducted primarily by NGOs staff who are ex drug users and aimed at developing drug related safe behavior

• There are 12 trainers- health workers in the penitentiary system itself who also conduct classes under «Atlantis» and in needle exchange points (trust point)

• There are psychologists in all CF (correctional facilities) who provide individual counseling for prisoners including counseling on issues related to STIs and infections transmitted through blood

16

Sexual Behavior• There are substantial supplies of condoms in all

prisons of the penitentiary system and in remand prisons, which are available at syringe exchange points and in meeting rooms

• The GFATM supplies condoms to the penitentiary system

• Currently there is no officially approved strategy with regard to aggressive sexual behavior among prisoners in the country

17

The Programs under Implementation in the Penitentiary System of the KR

• Harm reduction programs- 13 programs

• «Atlantis» Programs - 8 programs

• Social Support Programs - 1 program

• Health Care Program in Prisons - 1 program

18

Programs Related to Prevention of Injection Transmission of HIV in Correctional Facilities of the

Kyrgyz Republic

• Harm Reduction Program includes the following :

• 13 points for syringes and needles exchange (under the support of GFATM)

• Procurement of disinfecting supplies (GFATM)

• Pre-testing counseling and testing (National AIDS Centre, GFATM)

• The program covers 6240 persons

19

The Program on Drug Demand Reduction

• The rehabilitation programs for addicted on psychoactive substances «Atlantis» (8 programs) (Stefan Batori Fund (Poland), Soros Foundation –Kyrgyzstan, EU BOMCA-CADAP)

• The program covers 200 persons

20

Social Management Programs

The social management programs offer services related to preparation of prisoners for release from prisons

• Social Bureau under the Prison № 47 (AFEW) • The program covers 364 persons• It is intended to open social bureaus in 9 prisons

and 1 in the Remand Prison ( CARHAP, Soros Foundation-Kyrgyzstan, DFID,NGO, )

• Expected coverage of the program - 3300 persons

21

Health in Prisons Program

• Demonstration program «Health in Prisons » in the prison № 16 (WHO)

• The program covers 1200 persons

22

The Services Provided by Needle Exchange Programs

• There are 13 trust points in the system of PES in 11 correctional facilities, which provide the following services on harm reduction:– Exchange of syringes and needles

– Distribution of condoms

– Voluntary pre-testing counseling

– Voluntary testing for HIV

– Training volunteers among drug addicted prisoners

– Provision of information on safe behavior

– Consultations of a psychologist

23

The Substitution and Methadone Support Therapy Program

• There are active measures undertaken since 2007 on implementing the substitution and support therapy - sociological survey, introductory visits (GFATM, WHO,UNODC)

• It is intended to cover 1000 prisoners and 160 staff members by a sociological survey (10% of total number)

24

Anti-Retro-Viral Therapy• Since 2005 ARV is available in the KR for free (the drugs are

purchased due to GFATM funds)• The anti-retro-virus therapy in introduced in the penitentiary

system in 2005• In 2005 – 13 prisoners had ARV-therapy• In 2006 – 6 prisoners had ARV -therapy• As of 01.04.07 – 6 prisoners are still on ARV – therapy • ARV is prescribed strictly according to indications, and

accordingly, all prisoners who have indications for such treatment get ARV therapy

• The state program on HIV/AIDS has developed the individual program for pregnant women, which envisages chemoprevention of vertical transmission of HIV/AIDS using ARV drugs, according to clinical protocols, according to WHO recommendations»

25

The Trend of Drug Users in Prisons in the KR

2005 2006

The number of «officially» registered drug users in prisons (the court verdict prescribes involuntary treatment for drug addiction)

635 1231

The number of IDUs registered in the syringe exchange programs in prisons

3335 6500

The number of individuals voluntarily involved in «Atlantis» programs on rehabilitation of addicts on psychoactive substances

174 141

26

Comment to the Number of Drug Users in Prisons

The numbers of both registered drug users and participants of needle exchange programs increased by 2 times, which means that statistical registration improved as well as awareness of the prison population on safe behavior.

27

• Main problems of Penal Enforcement System:– High accessibility of drugs and high rate of joint drug use culture– Discrimination of MSM and lack of access to HR programs for them – Poor logistical and technical base of correctional facilities– Insufficient funding of correctional facilities

• Ways to solve problems:– To Increase the number of syringe exchange points– To implement social support programs– To conduct educating «advocacy» series of training on substitution

therapy– To conduct surveys to find out the attitude of the staff of

correctional facilities and prisoners to substitution therapy programs– To introduce substitution and support therapy – To Implement programs focused on increasing the accessibility of

HR programs for MSM in the penitentiary system

Problems and Ways to Solve Problems

28

• It is intended until 2013 to implement as many types of services as possible in each correctional facility (syringe exchange, social bureau, rehabilitation centers, services of psychologists, lawyers, health workers, volunteers), as well as improve the social and living conditions, as well logistical and technical base.

Future Plans

29

THANK YOU FOR ATTENTION!