HIVComprehensivePackageofServicesinMoldovanPrisons

lieutenant-colonelDr.SvetlanaDoltu

AdvisoronMedicalIssuestotheHeadofPrisons(MinistryofJustice)intheRepublicofMoldova

UNAIDS37th PCBMeetingGeneva,27October2015

GeneralOverview

Moldovapopulation– 4mlnPrisonpopulation– 7643inmates,5%womenand2%juvenileTotalNumberofprisons– 17Incarcerationrate– 175per100,000populationOccupancyrate– 90%

Officialdata:HIVprevalence(1,6%)– 126,including81inARVHVCprevalence(4,6%)– 353 inmatesTBprevalence (1,3%)– 101,including78MDRTB

*dataasofJune2015datafromtherightbankonly

Prisonnr.15- CricovaPicturesbyInaTcaci

MoldovanPrisonAuthoritiescontinuouslydemonstratedhighlevelofcommitmentfor

buildingacomprehensivestrategyonHIV/AIDSprevention,treatmentandcare inprisonsby

ensuringaccessofinmatestoservicesequivalenttothoseavailableinthecommunity

Currently, theMoldovanprisonsystemis

implementing13outof15interventions

recommendedwithinthecomprehensivepackageof

servicesforPWIDsinprisons

TheMostImportantSteps1999- Startingneedleexchangeandcondomprovisionprograms;2001- Implementation ofDOTSintuberculosis treatment;2004- ImplementingantiretroviraltherapyanddevelopmentofthefirstDIPordinanceforHIV/AIDsprevention,treatmentandcare;2005- Implementation ofpharmacotherapywithMethadone,alsoin2005implementation ofDOTS(plus)fortuberculosis patients;2007- EndofthemandatoryHIVtestingofprisonersonenteringprison;2008– InitiationofHIVVoluntaryTestingandCounselling servicesandthe HIV–TBcollaborativeinprisons;2012- (GeneXpert)themethodforrapiddiagnosisoftuberculosis isimplemented;2013 – VCTservicesprovidedthroughNGOonsalivaavailableforinmates;2014- Overdosemanagement– allNSPsites inprisonshavebeenequippedwithNaloxoneforoverdosemanagement;2015– GuidingProcedureManualsforprisonmedicalservicesonOSTandNSPdevelopedandapproved.Inaddition:2015- Biologicalwastemanagement– withthesupportofUNODC,equipmentwasprocuredtoensuresafedisposalofneedleandsyringescollectedthroughNSP

CoveragewithInterventionsIntervention Since Availability

NSP 1999 Yes,in13

OST(treatmentandpsycho-socialpeer topeersupport)

2005 Yes,in13

HIVvoluntary testing(bloodandsaliva viaNGOs)

Yes Yes,inall

ARV 2004 Yes,inall(64,3%)

Peertopeerinformativesessionsand selfsupportgroups

1999 Yes,inall

Condomdistribution 1999 Yes, inall

Distributionofantiseptics 1999 Yes,in13

OverdoseManagement (Naloxone) 2014 Yes,in13

IECdistribution 1999 Yes, inall

NSP(picturesbyInaTcaci)

OST(picturesbyInaTcaci)

FinancingandPartners• Currently,HarmReductionprogramsinprisonsarefinancedbytheGFATM.In2013,theDPItookoverthemanagementforNSP.Since2014,2NSPsitesarefinancedfromtheDPI(MoJ)budget.

• Keypartners:UNODC,GFATM,SorosFoundation-Moldova,PompidouGroup/CouncilofEurope,UNAIDS,WHO,CSONewLifeandCSO“AFI”,Norlam.

• Since2014quarterlymeetingoftheTWGonDrugUseandHIV/TBPreventioninprisonstakeplace.Chair– theHeadofPrisons.

Impactofintervention

IBSSresultsamongstinmatesshowadecrease inblood-bornediseases suchasHIVandviralHepatitis.

Indicator 2007 2010 2012

% of people who inject drugs in the last year 4,7 3,0 2,7

% usage of sterile equipment in the last month100,0 100,0 100,0

% integrated indicator regarding the knowledge/information about HIV/AIDS

30,8 43,4 44,0

HIV Prevalence % 4,2 3,4 1,9

HVB Prevalence % 11,3 16,3 13,1

HVC prevalence % 21,0 15,5 8,6

Successes• ComprehensivepackageofservicestoHIVcanbeadaptedtotheprisonsystemconditions

• ThepartnershipwiththeCSOshasapositiveimpact

• NSPinprisonshavenotledtoanyincidentsrelatedtosyringesheldforpersonaluse

• NSPdeterminebehavioralchangesleadingtothereductionofdruguse-associatedharmsinprisons

Challenge• Advocacyandcapacitybuildingtargetingprisonstaffshouldbeongoing

• WhendevelopingandimplementingNSPinprisons,thenatureofprisonsshouldbeconsidered.

• Expandingthecomprehensivepackageofservices

• Needtorevisetheexistentlegalframework,CriminalCode

• NationalbudgetneedstograduallytakeoverthefinancingburdencoveredmostlybytheGFATM.

Commitment• Inacknowledgingtheimportanceoftheseinterventions,DPI‘sHealthManagementUnitintendstocontinuewiththeimplementationoftheseactivities,promotingthereforethefinancingfromthestatebudgetand/orseekingalternativesourcesoffunding.

• Strengtheningthecapacitybuildingandpsycho-socialcomponentofprisonservices;andenhancingthecooperationwithnon-governmentalorganizations.

• CreationoftherapeuticcommunitiesforPWIDsinprisons(startingin2016).2TCinP.7andP.9.

UndertheguidanceofUNODCMoldovainpartnershipwiththeDPI,2013-2014,2GuidingProcedureManualsforprisonmedicalservicesinimplementingNSPandOST

programs,approvedbyviaDPIOrdinance237/17.08.2014and237/19.08.2014

Prisonnr.15- CricovaPicturesbyInaTcaci

Thankyouforyouattention!

dip@penitenciar.gov.md

http://www.penitenciar.gov.md/http://www.justice.gov.md/