Health services for prisoners vital to get to zero new HIV infections

In Cambodia, despite a higher rate of heroin use among prisoners than the general population, there is currently little in the way of treatment options for inmates.

In Cambodia, despite a higher rate of heroin use among prisoners than the general population, there is currently little in the way of treatment options for inmates.

Reaksmey Hong, is managing an EU-funded programme called Asia Action on Harm Reduction and he is a policy manager with KHANA, the largest national organisation providing HIV prevention, care and support services in Cambodia, said: “Injecting drug users in Cambodia do not have access to drug therapy while they are in police detention and prison. With our experience, more than 90 per cent of injecting drug users double their drug doses soon after they are released, and this is a very risky behaviour.”

But if prisoners who use drugs were engaged in drug treatment before being released this could be a very different story.

Links between drugs and HIV

One motivation to provide better drug treatment for prisoners relates to the global ambition to get to zero new HIV infections. Dependence on opioids, such as heroin, is linked to higher rates of HIV infection due to the risks of sharing injecting equipment which is contaminated.

Other risky behaviour associated with people who inject drugs includes lack of consistent use of condoms. HIV prevalence among people who inject drugs was estimated to be 24.4 per cent in 2007, compared to the much lower 1.1 per cent among people who use drugs without injecting.

The National Center for HIV/AIDS Dermatology and STD states: “In Cambodia, the population size of drug users is estimated to be approximately 13,000, with 2,000 people who inject drugs, although some NGOs consider the actual number to be far higher.”

Substitution therapy

Methadone maintenance treatment is a medical approach to treating individuals with dependence on opioids, by providing methadone as a substitute for drugs such as heroin.

This approach is important to improve the well-being and social functioning of people who inject drugs, as the World Health Organisation explains: “Substitution maintenance therapy is one of the most effective treatment options for opioid dependence. It can decrease the high cost of opioid dependence to individuals, their families and society at large by reducing heroin use, associated deaths, HIV risk behaviours and criminal activity.”

However, most facilities providing such treatment are based in the community and there are very few treatment programmes available to prison inmates, which is a violation of their basic human rights.

A World Health Organization policy brief states: “All prisoners have the right to receive health care, including preventive measures, equivalent to that available in the community without discrimination, in particular with respect to their legal status or nationality. The general principles adopted by national AIDS programmes should apply equally to prisoners and to the community. Drug-dependent prisoners should be encouraged to enrol in drug treatment programmes while in prison, with adequate protection of their confidentiality.”

Lack of Cambodian services

Cambodia currently has only one methadone clinic based in the Russia Referral Hospital. Patients must go there daily to take methadone in front of a doctor and cannot take it anywhere else without permission. This of course is impossible for prisoners, and anyone already on such a treatment programme before being sentenced is forced to drop out.

Chin Kimmneang is one such prisoner, a former injecting heroin user who managed to transition to methadone maintenance treatment with the support of KHANA. In prison, Kimmneang is now struggling as he no longer has access to treatment.

Many organisations are working together in Cambodia, including UNAIDS, AusAIDS and KHANA among others who believe substitution services and rehabilitation must be made available to people in prison.

Read Chin Kimmneang’s story

Image caption: A client takes his observed methadone treatment at Ar Rahman mosque in Kuala Lumpur, Malaysia
© International HIV/AIDS Alliance