South Asia: Delegates from Bangladesh, India, Maldives and Nepal visit Tihar Prisons, India to learn about Oral Substitution Treatment

Prison inmates are an important vulnerable group for risk behaviours including drug abuse, HIV and AIDS. Drug use is a well-recognised problem in the prisons. Worldwide, the levels of HIV infection among prison populations tend to be much higher than in the populations outside prisons. The contributing factors to the spread of HIV and AIDS in prisons are overcrowding, unsafe sexual activities, injecting drug use, violence and poor prison health services. These factors create an environment that increases the vulnerability to HIV infection and other diseases such as tuberculosis, hepatitis and other sexually transmitted infections.

Preventing HIV in prisons is integral part to broader prevention, as any medical conditions during confinement become public health issues for the society at large when people are released. There is now a growing awareness and concern about how to tackle drugs and HIV and AIDS in prisons. The public in general has generally accepted that prisoners retain all rights which cannot be taken away as a fact of incarceration. Loss of liberty alone is the punishment, not the deprivation of fundamental human rights. States therefore have an obligation to implement legislation, policies and programmes consistent with international human rights norms to ensure that prisoners are provided a standard of health care equivalent to that available in the outside community.

A considerable progress has been made through pilot interventions undertaken by the UNODC Regional Office for South Asia under the project "Prevention of spread of HIV amongst vulnerable groups in South Asia" in collaboration with Governments and NGOs in South Asia. The biggest breakthrough under this project was the launch of the oral substitution treatment (OST) programme in Tihar prisons, India, which is also the largest prison complex in South Asia. This was the first OST programme being implemented for drug dependents in any prison of South Asia. The overall objective is to ensure that every prisoner has access to essential drugs, HIV and AIDS prevention and care programmes that are linked with the services available to the wider community. The OST center in Tihar has definitely become a 'model' and reference for other countries in South Asia.

UNODC organized recently a visit for delegates from Bangladesh, India, Maldives and Nepal to Tihar prison with the aim to observe the OST programme in Tihar prisons, help understand the modality for implementing it in their respective countries and appreciate the role of each stakeholder involved. Of special interest to delegates was the follow-up care of prisoners after release to Drop in Centers (DICs) which also have OST in place.

Visits such as this, help to respond collaboratively and comprehensively to the problem of drug use, HIV and AIDS. They help to understand that to effectively address drug use and HIV and AIDS in prisons a comprehensive rights based strategy must be developed. An essential first step to such a strategy is to create awareness among policymakers about the HIV and AIDS situation in prisons. The strategy also needs to address issues such as the development of alternatives to imprisonment and the equity of health care; structural issues such as overcrowding; raise awareness among prison staff; provide prisoners with information, means of prevention, counseling and drug dependence treatment such as OST and rehabilitation opportunities. They also help to initiate a policy dialogue among stakeholders and scaling up of national efforts to address these issues, leading to a global commitment to provide universal access to HIV prevention, treatment, care and support.

The implementation of the Oral Substitution Treatment (OST) in Tihar prisons is part of the UNODC project "Prevention of spread of HIV amongst vulnerable groups in South Asia" which is possible thanks to the contributions by the Government of Sweden