HIV/AIDS prevention in the Russian prison system
6 June 2001
BACKGROUND In August 1, 2000, there were more than 7,500 HIV/AIDS cases officially registered among the Russian prison population. The vast majority of the cases are young, injecting drug users. To tackle the epidemic, Médecins Sans Frontières, in close collaboration with the Russian Ministry of Justice, began a pilot program on health promotion and HIV/AIDS prevention in the Russian prison system. The signing of a Memorandum of Understanding between MSF and the GUIN (Main Directorate of Corrections) in July 1999 marked the start of this pilot program. Other partners are: the Ministry of Health of the Russian Federation, the World Health Organization, UNAIDS, AIDS Infoshare (a Russian NGO, the Trimbos Institute (Netherlands Institute of Mental Health and Addiction), the University of Oldenburg, Germany, Mainline (a health promotion and prevention organization), and Penal Reform International. OBJECTIVES Four pre-trial detention centers ("SIZOs") and three prison colonies (one juvenile, one female, and one male colony) in the regions of Moscow, Krasnodar, Penza and Omsk were selected to participate in the pilot program. The selection was based on HIV prevalence in the regions and the prisons, geographical and demographic factors, and the interest and political commitment of key players in the regions towards prevention activities. The aim of the pilot program is to give Russian officials, penal and municipal medical staff, and inmates the practical tools to design and implement HIV/AIDS prevention programs appropriate for the particular Russian prison setting. A secondary goal is to create structural links between prison and municipal services addressing the problem of HIV/AIDS, so that follow-up and sustainability are ensured. The program directly serves 15,000 inmates and indirectly 80,000 inmates and 3,000 prison staff in the four pilot regions. The main program activities include:
the production of educational materials on HIV/AIDS prevention and health promotion
training (for health professionals and inmates) in pre and post test counseling, health promotion, and the implementation of practical HIV prevention activities
implementation of practical HIV prevention activities in the selected prisons
on-going epidemiological research
It is planned that the duplication of effective HIV/AIDS prevention programs in the prisons of the four selected regions will be possible by the end of the third program year. A controlled hand-over process will take place from MSF operations to federal and regional authorities.
The production of educational materials
This activity includes the translation of scientific articles, the development of training manuals, questionnaires, posters, etc. The booklet "Protect Yourself" - a guide for safer behaviour for inmates - was tested among 1200 inmates and 300,000 copies were printed and distributed.
All educational materials for the pilot program were reviewed by federal and regional justice authorities and Russian health professionals.
WHO, PRI, and MSF are working jointly on a guideline for medical professionals on the control of HIV/AIDS in prisons.
Training in Moscow for health professionals
Four workshops were held in Moscow during the first program year, focusing on strategies for developing and implementing HIV/AIDS prevention programs. The more than 70 participants in these workshops included Russian representatives from the federal and regional Ministries of Justice and Health, heads of AIDS centres and other medical institutions, prison directors, doctors, and psychologists, and prison security staff.
Training in the regions for inmates
With the support of Mainline and regional health services, 80 inmates in Krasnodar, Penza, and Omsk were trained in peer education work, and were informed about prevention methods for infectious diseases, first-aid in the case of overdoses, effective communication skills, etc. Case studies, role-playing games and specific exercises were prominent during the training. The juvenile, female, and male inmates devised concrete three-month action plans, and with the authorization of prison directors, MSF staff assisted the inmates in realizing their work plans.
Training in the regions for health staff
Sixty health professionals - doctors and psychologists working in the prison system in the regions of Krasnodar, Penza and Omsk - received training by MSF and Aids Infoshare in pre- and post HIV-test counselling. Topics also covered were the history of AIDS epidemic, testing methods, trends and routes of transmission, and principles and methods of treatment.
Follow-up training and visits
Every four months, MSF and Aids Infoshare teams - consisting of psychologists and peer support trainers - visit each region to follow-up with training inmates in peer education and health staff in pre- and post test counselling. They also check on progress and assist decision makers in the region in promoting and supporting further prevention activities. The teams play a vital role in stimulating co-operation between municipal and regional key players - notably between prison medical services and municipal health structures.
Epidemiological research is an on-going, integral part of the pilot program. MSF uses base-line KAP surveys among target groups prior to program implementation. Teams monitor the health situation of HIV-infected prisoners, and collected data is used for analyses and program recommendations. The regular sharing of data from participating regions and facilities allows for a common analysis of the incidence and prevalence of infectious diseases.
Considerable efforts have been made to develop unique quantitative and qualitative tools for the Russian prison context, to measure the impact of the programs. A questionnaire was pre-tested in Moscow's Matrosskaya Tishina Pre-Trial Detention Center, and was then used in August 2000 to survey 1,200 inmates in the four selected regions.
11 computers, e-mail access, and a list server were given to participating regions and prison sites to ensure regular communication between all participants.
Teams distributed 100,000 condoms and bleach to inmates.
Monthly meetings with representatives of the Ministry of Justice were established, and quarterly regional roundtables between penal and municipal health authorities and journalists.
One a year, key federal and regional decision makers come together for a steering / co-ordination meeting, to review the progress of the program, solve problems, and plan strategies for the continuation of prevention activities.