The HIV epidemic is exploding in all prisons of the world.
In addition to increasing the profits and the dangerousness of the drug mafias, the war on drugs announced by President Bush seems to have also brought about the entry of an increasing number of drug users in the prisons of all the countries that joined such war, and along with the drug users, quantities of drugs which, consumed in poor hygienic conditions, has caused the spread of the HIV virus among the drug users of the entire world inside and outside of the prisons and, through sexual intercourse among them, to a huge number of new infections in young people who do not belong to the traditional "risk groups". Recent screenings carried out in the United States have shown that as much as 3% of high school students is HIV positive. The United States are therefore also experiencing the development of the epidemic among drug users and young people in general - a problem which, until very recently, seemed confined to Italy and Spain. The planetary explosion of the epidemic in the prisons lead the organizers of
the recent World Conference on AIDS in Amsterdam to include an entire session on the problem in the prisons in the program. In the next part, we will briefly refer on the findings of the reports and discussions in the context of such session.
Italian and Spanish representatives obviously participated in the interventions. As we said, Italy and Spain are the two states where the AIDS epidemic among drug users first emerged. In particular, Mercedes Diaz intervened for Spain on behalf of the Spanish government, and illustrated the various interventions carried out both in terms of education and prevention and of monitoring using voluntary and anonymous screening. In this way it is possible to dispose also of statistic data which enable, for example, to say that there is an HIV positivity rate in prison amounting to 20,6% at the entry in prison, and that the percentage is higher in women, because, in addition to the risk related to the promiscuous use of needles, there is a great number of women who prostitute "for drugs". As far as the prison population in general is concerned, a diminution in the percentage of HIV-positivity has been noticed in the 1989-1991 period following massive interventions: from 50% to 45%. It might be useful to remember tha
t among the interventions carried out, there is the massive distribution of condoms, that conjugal visits are allowed (with the appropriate intimacy), and that as far as sick inmates are concerned, reductions in penalty have been decided. Moreover, Spain was one of the first countries of Europe to accept needle-exchange schemes among drug users, second only to The Netherlands; as of 1985, Spanish supermarkets sell packets of condoms and syringes with information relative to the prevention of the HIV infection at extremely low prices (the first case of AIDS among drug users was diagnosed in Spain in the first semester of 1982).
As far as Italy is concerned, Enrica Mazzola referred about an informative and self-help initiative carried out on a voluntary basis in the women's prison of Turin, attended by Susanna Ronconi. There was no official intervention, on the contrary, on the part of government representatives.
Stephen Machon talked about the current situation in the State and in the city of New York; he said consistent funds were recently allotted for the enhancement of the repressive measures and of the U.S. prisons, following President Bush's "war on drugs", which lead a great number of drug users to be imprisoned (80% of the presences in the U.S. prisons is related to drug reasons, and 60-70% have a record of drug use). Even in the United States, therefore, it is mostly the drug users who end up in jail, and the latter are chiefly Afro-American (50%) or Latin American (32%). A
voluntary and anonymous test has highlighted a proportion of HIV-positives between 17% and 35% for men and between 19% and 25% for women; but more accurate data refer to a percentage of 50%. A peculiar characteristic of the United States seems to be the fact that even drug users who consume crack and do not inject, but smoke the substance, are mostly HIV-positive, given the great number of those who prostitute in exchange for a dose of drugs or the money to buy it. Another peculiarity is linked to the spread in the prisons of tuberculosis epidemics, which adds to the HIV epidemic which, through the contact with the drug users, is spreading also among the young people of the general population. In the city of New York alone, the AIDS mortality among young people has reached the rate of 20/100,000 per year. The interventions, especially in the prisons, seem to be of an educational type.
Kate Dolan reported on the situation in England and Wales. The problem of the spread of HIV linked to drug dependency does not seem to be particularly serious (personal physicians can freely prescribe substitute drugs, and there are various programs for the controlled distribution of heroin). The presence of drug users in the prisons is not particularly relevant; in any case, as in Italy and in every other "prohibitionist" country of the world, more injectable drugs than needles are introduced in the prisons and, as a consequence, the imprisoned drug users share the needles to inject the drugs, and in this way contribute to the spread of the HIV virus. It is useful to mention that estimates point to a number of habitual drug users corresponding to approximately 100,000, and of these, 3,000 are believed to share needles in prison each year. Of those who have been in prison, the proportion of HIV-positives nears 10%, whereas it is much lower among those who have had no experience in prison. There are no partic
ular programs under way in the prisons, but the situation could improve greatly by introducing measures such as needle-exchange schemes or diminutions of penalty for the infected inmates and the drug users, or by introducing measures apt to keep drug users out of prison. The impact of each of these measures has been accurately measured thanks to scenario studies carried out in cooperation by teams of experts from various organizations.
Dr. Simooya from Zambia reported instead on the situation in Africa. In Africa the epidemic is spreading especially through unprotected heterosexual intercourse. Homosexuality in the prisons does not seem to be a particular problem, whereas the presence of drug users both in the prisons and in the country is irrelevant. Despite this general situation, it has not been considered appropriate to authorize marital visits in prison or distribute condoms in prison or to the population at large. The permanence in prison, on the other hand, is a moment in which to receive information on the problems of the infection.
Lastly, Theodore Hammet spoke about the inefficiencies of the various countries as regards the recommendations of the World Health Organization on HIV-positive individuals and on AIDS patients in prison. In particular, the following are recommended: information programs for inmates, no anti-HIV tests except on a voluntary basis, no segregation measures against the HIV-positives and the AIDS patients. Surveys carried out in 42 countries has highlighted a situation which is very distant from these recommendations. The following diagrams contain a summary of some of the survey's results.
AFRICA
number of prisons considered 9
information programs 2
compulsory test 0
voluntary test 2
segregation of HIV-positives 0
non-systematic segregation 3
U.S.
number of prisons considered 51
information programs 50
compulsory test 17
voluntary test 33
segregation of HIV-positives 4
non-systematic segregation 46
CANADA
number of prisons considered 12
information programs 11
compulsory test 0
voluntary test 9
segregation of HIV-positives 0
non-systematic segregation 12
OTHER AMERICAN COUNTRIES
number of prisons considered 8
information programs 3
compulsory test 1
voluntary test 3
segregation of HIV-positives 3
non-systematic segregation 4
GERMANY
number of prisons considered 8
information programs 8
compulsory test 1
voluntary test 5
segregation of HIV-positives 0
non-systematic segregation 4
OTHER EUROPEAN COUNTRIES
number of prisons considered 19
information programs 16
compulsory test 3
voluntary test 7
segregation of HIV-positives 3
non-systematic segregation 15
AUSTRALIA
number of prisons considered 7
information programs 7
compulsory test 5
voluntary test 2
segregation of HIV-positives 5
non-systematic segregation 2
Moreover, generally speaking, there is no distribution of condoms in the prisons because sexual intercourse is almost completely forbidden. Moreover, there are no syringe-exchange schemes or distribution of sterile needles for the same formal reason.
At the end of the speeches, the discussant, Dr. Jurgens from the Mc Gill University (Canada), spoke briefly, giving a very severe judgement on the drug policies currently enacted in the world. In particular, Dr. Jurgens said there is a growth in HIV-positivity in the prisons, linked to the problem of drug dependency, and "this is the result of laws that criminalize the use or the possession of "drugs", bringing most drug users to prison. These spend most of their lives in a out of the institutes. In prison the risk of a contagion grows out of the need to share needles and syringes. The politicians and the prison officials oppose the idea of supplying sterile equipment to the prisons, saying that this would seem like an encouragement, in an environment which is designed to apply the laws and discourage the use of drugs. But because the HIV infection has devastating consequences, it is necessary to accept the contradictions and, since drug users are in prison because of the punishment and not with the purpose
of being punished, the Governments have the duty to face the risks of the impact of the spread of HIV in prison. A further problem is related to the fact that the public health and therapeutical measures are particularly insufficient in the prisons. In any case, the prisoners should not be exposed to greater risks of contagion simply because they are in prison. The State has specific responsibilities as far as their health conditions are concerned. "The war against drugs in the U.S. has become a war against the drug consumers with which the prison system instead of the health system is forced to come to terms with".
