Incidence of the human immunodeficiency virus (HIV) runs far higher among the 30 million people in the world's penitentiaries than in the general population, according to the UN Office on Drugs and Crime (UNODC).

Sex between inmates, injecting drug use and tattooing are the main triggers for the spread, helped by overcrowding, corruption and poor access to condoms and anti-HIV therapy, said specialists at the International AIDS Conference here.

Katherine Todrys, who carried out a study for Human Rights Watch in six Zambian prisons, said that country did not even have a programme to test newly-admitted inmates for HIV.

"Currently there is no health screening whatsoever (for them)," she said.

Only 14 healthcare workers were available for 15,300 prisoners in Zambia's 86 jails, and caring for this population was limited essentially to distributing paracetamol, a pain reliever and fever reducer, she said.

For those diagnosed with HIV, many fail to get treatment because of "security fears, lack of transport and the decision of non-medical officers and other inmates", according to the HRW report.

Twenty-seven percent of prisoners in Zambia have HIV, nearly double the rate outside jail, according to 2008 figures published by the US State Department.

In Nigeria, campaigners are barred even from distributing condoms in detention facilities, Emeka Chima, from the Society for Family Health, told AFP.

"It is prohibited because if you do that you're encouraging sodomy, that's the stance," he said. "In Nigeria, officially, same-sex practices don't exist." His association has now launched an information and education campaign for inmates and guards with the support of the Nigerian prison system.

The UNODC chose the AIDS forum to launch a "toolkit" spelling out ways for governments to introduce HIV prevention and treatment systems in prisons.

"Health care in prisons should be at least equivalent to that in the community," it insisted.

HIV prevention in detention facilities can be hugely effective, the Open Society Institute (OSI) said, citing the case of Moldova, which introduced needle and methadone programmes in the late 1990s that now reach 75 percent of inmates.

Researchers from Brown University in the United States said HIV prevention was most effective when initiated behind bars.

For instance, prisoners who were started on methadone, a safer substitute for heroin, before their release were far likelier to stick to this regimen compared with counterparts who, after emerging from prison, were simply pointed in the direction of a counsellor.

Relapse -- in which an injecting drug user turned once more to illegal drugs -- increased the later risk of HIV infection through shared syringes.

"Virtually every prisoner and every person who's arrested for a drug offence will return back to their community," said Samuel Dickman, who conducted the investigation.

"This isn't just about prisoners. This is about communities prisoners return to."

earlier related report
Lethal mixture drives AIDS pandemic in ex-Soviet bloc
Vienna (AFP) July 22, 2010 - Official indifference, stigma and a blinkered reflex to criminalise drug addicts have turned Eastern Europe and Central Asia into the region where HIV is spreading fastest, the world AIDS forum heard.

The six-day forum staged a series of workshops and seminars where policymakers and grassroots workers portrayed a regional pandemic growing at murderous pace.

Authoritarian policies, homophobia and a refusal to accept solutions tested elsewhere and proven successful are to blame, many said.

The main vector for spreading the AIDS virus is shared use of syringes among intravenous drug addicts, followed by sexual transmission by these individuals to their partners, Martin Donoghoe, programme manager for HIV/AIDS for the World Health Organisation (WHO) in Europe, told AFP.

Many infected drug users then turn to prostitution to feed their habit, which thus enables HIV to be catapulted into the mainstream, researchers have also found.

"The first intervention would be to give clean needles and syringes to drug injectors. This helps prevent transmission of the virus," said Donoghoe.

"The second is to get the drug injectors into drug dependence treatment," such as substitution therapy with methadone, he said.

Years of experience in Western Europe and other countries have shown that these so-called Harm reduction programmes, when combined, can reduce new infections of HIV by up to half.

But in most of Eastern Europe and Central Asia, the programmes are not implemented -- not for lack of funds, but because political resistance.

"It remains controversial in eastern Europe," explained Donoghoe. In particular, "there are some questions regarding whether you should be giving what is basically a drug to substitute for another drug."

Use of methadone for therapeutic purposes was especially banned in Russia, he said.

Some 1.5 million people in the region were infected with the human immunodeficiency (HIV) in 2008, compared to 900,000 in 2001, according to UNAIDS.

More than two-thirds of them lived in Russia, which combined with Ukraine accounts for more than 90 percent of the region's infections.

According to the UN child protection agency Unicef, more than 80 percent of those infected with HIV in eastern Europe and Central Asia were under 30 years old.

Other marginalised groups were street children, prison inmates, homosexuals and immigrants.

"There hasn't been any nationwide prevention campaign," said Olga Dudina, who works with a Ukrainian NGO.

"More than 60 percent of prisoners don't have any real access to testing or treatment," she noted.

Timur Abdulaev, an advisor on AIDS from Uzbekistan, agreed.

"In certain countries, there is a culture of silence: governments say 'we don't have any homosexuals, any prostitutes'. Denying the problem doesn't help solve it," he said.

The 18th International AIDS Conference, which ends in Vienna on Friday, placed the spotlight on the region's problems as the venue is the gateway to eastern Europe.

But no high-ranking official from the region responded to invitations from the International AIDS Society (IAS), which organised the forum.

IAS President Julio Montaner, a leading figure in AIDS research, singled out South Africa for praise, saying the attendance of its deputy president, Kgalema Motlanthe, showed the HIV-ravaged country no longer denied its own problems.

"On the contrary, the leadership of some Eastern European countries... has shown total indifference to our plea," Montaner said angrily.

"Not being here is actually being heard loud and clear as a sign of being irresponsible to the point of criminal negligence."

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