HIV and Drug Prevention in Estonian Prisons

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Kurt Jepsen
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1 HIV and Drug Prevention in Estonian Prisons Maret Miljan The Division of Social Rehabilitation The Estonian Ministry of Justice

2 Prisons in Estonia (3676 prisoners): Tallinn Prison ( 571 convicted male adults, 510 adults held in custody) Prison Hospital (38 prisoners) Viru Prison (735 convicted male adults and minors, 231 adults and male minors held in custody) Tartu Prison (719 convicted male adults, 202 adults held in custody) Murru Prison (550 convicted male adults) Harku Prison (120 convicted female adults and minors)

3 HIV Prevention and Treatment 15% of prisoners are HIV positive (575 persons, ) 90% male, 10% female 98% infected by injecting Mainly from Ida-Virumaa region According to the national strategy for HIV/AIDS in

4 HIV Prevention and Treatment Primary HIV diagnostics laboratories in all prisons Trained medical personnel Voluntary HIV testing (on arrival and after 1 year) Refusal rate under 1% Pre test and post test counselling HIV does not spread in Estonian prisons

5 HIV Prevention and Treatment ARV treatment 160 HIV positive under the treatment ( ) Various health care services 30% of the budget for medical expenses ( )

6 HIV Prevention and Treatment Support group services for HIV pos and prisoners with drug addiction 15 parallel groups in 4 prisons NGO Convictus Estonia In Estonian and Russian For male and female, for adults and minors, for convicted and persons held in custody

7 Hepatitis B and C Voluntary testing of risk groups (IDUs, HIV pos., etc) Pre and post test counselling Voluntary Hepatitis B vaccination Convicted prisoners in the risk group Prison officers Hepatitis C treatment (usually continuation)

8 HIV Prevention and Treatment Condoms are available in medical departments, long term meeting rooms and in the prison shops No needle and syringe exchange programs in prisons

9 Drug Treatment and Rehabilitation Estimated that 50% of prisoners have used drugs, around 20 % are drug addicts National drug prevention strategy till 2012 and the action plans Drug prevention strategy for prisons (2008) Drug prevention principles and guidelines for prisons

10 Specialisation of Prisons Tartu prison Special unit for drug addicts (174 places), including drug-free department (44 places) Psychiatric department Trained staff Viru prison Drug crimes Drug-free department for adults (20 places) and minors (20 places) Harku prison Drug-free department for women (8 places) Tallinn prison Remand prisons, high number of drug addicts among the persons held in custody

11 Drug Treatment in Prisons Drug treatment: Symptomatic treatment Substitution treatment (methadone) Short term detoxification Long term detoxification Maintenance treatment Prisoners on maintenance treatment prior to imprisonment should be able to continue the treatment in prisons Starting the substitution treatment takes place in Tartu prison, continuation is possible in medical departments of all the prisons (psychiatrists)

12 Substitution Treatment in Prisons: In 2008: 2 cases of detoxification with methadone No methadone maintenance treatment (MMT) Problems with continuation of MMT, because in many cases treatment stops in arrest houses Conservative attitude by psychiatrists Negative attitude by prisoners

13 Challenges in 2009 Maintain the level of HIV prevention and care in the prisons Further training of personnel (HIV, drugs), more attention to the guards Methadone treatment Pilot project in arrest houses (UNODC) Criteria for starting the treatment Study the attitude of prisoners and prison staff towards methadone Drug situation monitoring in prisons (quarterly reports)

14 Thank you!

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