Russia’s HIV epidemic is exploding. During 2000, 65% of all infections were registered. Prisoners are 15% of these registered infections. Over 1 million people are incarcerated in Russian prisons. These facilities are severely overcrowded; they lack adequate staffing and funding for essential operations. Scant evidence is available to describe the risk environment. Its nature is widely agreed upon: poor basic health and sanitation conditions; a concentration of drug-involved young people; in a strict regime driving many activities underground to greater risk.
Since 1999, Medecins Sans Frontieres has worked with the Russian Ministry of Justice on pilot HIV/AIDS prevention and health promotion mechanisms for Russian prisons. This three-year program includes: producing targeted health promotion publications; training prison officers, health workers and prisoners; bleach and condom distribution; peer education; pre- and post- HIV test counseling; and research.
Lessons Learned: - Public health rationale – targeting a high-risk population inside prison prevents the spread of HIV beyond prison walls – proved adequate justification. - “Approval and Strategy” workshops, combined with training seminars, involving counterparts from all levels, developed ownership early. - Including all players in materials preparation and production created consensus, acceptance and approval of (controversial) publications. - Health promotion publications must be tailored to Russian prison conditions, resources and risks. - Gender-specific publications were necessary and appreciated. - Research was integral to developing health promotion materials and training inmates and staff. - Active contribution of supporting regional agencies fosters future handover. - Program elements and references can be basis of federal-level directives and guidelines.
Learning Objectives: 1. Describe the process taken by MSF to establish a pilot HIV/AIDS prevention and health promotion program in the Russian prison system. 2. List the elements of MSF and the Russian Ministry of Justice’s pilot program. 3. Enumerate successful strategies used my MSF to gain access to the Russian prison system. 4. Articulate how these strategies can be applied to other prison prevention and public health programming in Russia and other countries with similar prison systems.
Keywords: Prevention, Prison
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