Women Prisoners and Female Partners of Male Prisoners
"... Prisons have been largely neglected in the global response to the HIV pandemic" (Angora et al., 2011: 1244). Comprehensive HIV prevention, voluntary testing, care and treatment are often not provided in pretrial detention, even where these services exist in the community (Csete, 2011). "Many prison systems limit access to antiretroviral therapy, according to country reports to UNAIDS" (UNAIDS, 2010a: 99). As of 2008, more than 9.8 million people were incarcerated (Jurgens et al., 2011); of these, more than half a million were women and girls (UNODC, 2009; Van den Bergh et al., 2011). A recent review by UNODC (United Nations Office on Drugs and Crime) found that "although women represent a small percentage of the total prison population, their numbers are increasing and the rate of increase is much greater than that of men" (UNODC, 2009: v). One third of people in state custody at any given time are detained on a pretrial basis (Csete, 2011). A number of studies report high levels of injecting drug use among female prisoners (Jurgens and Lines, 2010). In many countries, women in prison, detention and rehabilitation centers lack access to basic health and HIV/AIDS information and services, including treatment and care for women living with HIV. As UNODC notes: "As prison systems have been primarily designed for men... prison policies and procedures often do not address women's health needs" (UNODC, 2009: 8; Van den Bergh et al., 2011). Health care for pregnant women in prisons is often far from equivalent to that available in the community (Van den Bergh et al., 2011). Interventions are clearly needed for this population.
"I do this because it is a good thing to do. It helps prevent infections and saves lives." Prisoner/ volunteer peer distributor of clean needles in Moldova (Hoover and Jurgens, 2009: 19)Female partners of male prisoners are also a key affected population due to the risky behaviors of their partners. A study found high rates of HIV among prison inmates in low- and middle-income countries. HIV prevalence was greater than 10% in prisons in 20 countries: Brazil, Burkina Faso, Cameroon, Cte DIvoire, Cuba, Estonia, Indonesia, Lithuania, Malawi, Malaysia, Romania, Rwanda, Slovakia, South Africa, Ukraine, Vietnam, Yemen and Zambia. Injecting drug use is common in prison populations and eight countries reported greater than 10% prevalence of PWID in prison. HIV prevalence among PWID prisoners was found reported in eight countries and was greater than 10% in seven countries: China, India, Indonesia, Iran, Libya, Russian, and Serbia and Montenegro (Dolan et al., 2007). Up to 27% of inmates in Turkmenistan are drug dependent (Kerimi and Pkhidenko, 2011), and need access to effective, evidenced-based interventions for PWID (see section on PWID). "Although the single most important strategy to controlling HIV in prison is to reduce the rate of incarceration, ample evidence suggests that the criminal justice system can be an effective place to identify and treat people with HIV..." (Altice et al., 2010: 74). However, poor continuity of care adversely affects successful HIV treatment in prisons (Altice et al., 2010).
Interventions that address drug use and provide prevention education and condom use are urgently needed to reduce HIV risk among women prisoners and female partners of male prisoners. South Africa is one of a few countries in Eastern and Southern Africa that provides condoms in prisons (Muntingh and Tapscott, 2009 cited in Csete, 2011). Each year, 30 million people enter and leave prisons (Jurgens et al., 2011). "The high prevalence of HIV infection among prisoners... contributes to the HIV epidemics in the communities to which prisoners return upon their release" (Jurgens et al., 2011: 1). Prisons should be included in national AIDS planning (Jurgens and Lines, 2010).